Endometriosis: Diagnosis, Treatment and preventons.

Endometriosis: Diagnosis, Treatment and  prevention

?What is Endometriosis

Endometriosis may be a common condition that affects women during the reproductive years. It occurs when normal tissue from the uterine lining, the endometrium, attaches to organs within the pelvis and begins to grow. This displaced endometrial tissue causes irritation within the pelvis which will cause pain and infertility

During each menstrual period, most of the uterine lining and blood is shed through the cervix and into the vagina. However, a number of this tissue enters the pelvis through the fallopian tubes. Women who develop endometriosis simply could also be unable to clear the pelvis of those cells. It mainly affects women during their reproductive years. It can affect women from every group and ethnicity. Endometriosis isn't an infection and it's not contagious. Endometriosis isn't cancer

Types of endometriosis

There are several sorts of endometriosis

Peritoneal endometriosis: Peritoneal implants that contains glandular and stromal tissue and answer hormonal changes related to the cycle showing cyclic changes similar but not just like the traditional endometrium. These implants heal by fibrosis.4

Ovarian endometriomas: Benign, estrogen-dependent cyst also referred to as “chocolate cyst” that contains thick, old blood that appears as a brown fluid. This results from recurrent chronic bleeding from the endometriotic implants. In long-standing endometriomas, the endometriotic 

tissue is gradually replaced by fibrotic tissue

Deep endometriosis (DE): this type of endometriosis is characterized by proliferative fibromuscular tissue with sparse endometrial grandular and stromal tissue (akin to adenomyosis), with no surface epithelium. DE doesn't show significant changes during the cycle . Growth of endometriotic nodules are usually found within the uterosacral ligaments, the rectovaginal space, the upper third of the posterior vaginal wall, the bowel, and therefore the tract .4,6

Adenomyosis: Uterine endometriosis presents as asymmetrical uterine enlargement

Disseminated endometriosis: Growth of endometriotic tissue in various organs within the bodyincluding at the scar site

Causes of endometriosis

Although the precise explanation for endometriosis isn't certain, possible explanations include

Retrograde menstruation. In retrograde menstruation, menorrhea containing endometrial cells flows back through the fallopian tubes and into the cavity rather than out of the body. These displaced endometrial cells stick with the pelvic walls and surfaces of pelvic organs, where they grow and still thicken and bleed over the course of every cycle 

Transformation of peritoneal cells. In what’s referred to as the “induction theory,” experts propose that hormones or immune factors promote transformation of peritoneal cells cells that line the inner side of your abdomen into endometrial cells

Embryonic cell transformation. Hormones like estrogen may transform embryonic cells within the earliest stages of development into endometrial cell implants during puberty

Surgical scar implantation. After a surgery, like a hysterectomy or C-section, endometrial cells may attach to a incision 

Endometrial cells transport. The blood vessels or tissue fluid (lymphatic) system may transport endometrial cells to other parts of the body

Immune system disorder. It’s possible that a drag with the system may make the body unable to acknowledge and destroy endometrial tissue that’s growing outside the uterus

Risk Factors for Endometriosis

Early menarche

First-degree relative with endometriosis

Late menopause

Low body mass index

Müllerian anomalies

Nulliparity

Prolonged menstruation (> five days)

Shorter lactation intervals

Shorter menstrual cycles (< 28 days)

White race (compared with black race)

Women who do experience symptoms may have one or more conditions

Painful periods (dysmenorrhoea) which don't answer over-the-counter pain relief. Some women have heavy periods

Pain during or after sexual activity (dyspareunia)

Painful defecation (dyschezia) which will be cyclic or semi-cyclic

Painful micturition (dysuria)

Lower abdominal pain

chronic pelvic pain

Difficulty in getting pregnant or infertility

Pain associated with the bowels and bladder (with or without abnormal bleeding)

Chronic fatigue

Ovulation pain

Irritable bowel syndrome

Cyclical or perimenstrual symptoms (e.g. bowel or bladder associated) with or without abnormal bleeding

Infertility

Complications

Complications include

Infertility, which may affect 50 percent of these with the condition

Increased risk of developing ovarian cancer or endometriosis-associated adenocarcinoma

Ovarian cysts

Inflammation

Scar tissue and adhesion development

Intestinal and bladder complications

Diagnosis

If you've got any symptoms of endometriosis or are having difficulty becoming pregnant, contact your gynecologist. There are several things she will do to work out if you've got endometriosis, including

Pelvic exam

Ultrasound exam

MRI

Laparoscopy

Biopsy

Treatment and medications

Understandably, you would like quick relief from pain and other symptoms of endometriosis. This condition can disrupt your life if it’s left untreated. Endometriosis has no cure, but its symptoms are often managed

Medical and surgical options are available to assist reduce your symptoms and manage any potential complications. Your doctor may first try conservative treatments. they'll then recommend surgery if your condition doesn’t improve

It may be frustrating to urge diagnosis and treatment options early within the disease. due to the fertility issues, pain, and fear that there's no relief, this disease are often difficult to handle mentally. Consider finding a support group or educating yourself more on the condition

MEDICATION

Pain medications

You can try over-the-counter pain medications like ibuprofen (Advil), but these aren’t effective altogether cases

Hormonal therapy

Taking supplemental hormones can sometimes relieve pain and stop its progression. This therapy helps your body to manage the monthly changes in hormones that promote the tissue growth that happens once you have endometriosis

Hormonal contraceptives

Hormonal contraceptives decrease fertility by preventing the monthly growth and buildup of endometrial tissue. contraception pills, patches, and vaginal rings can reduce or maybe eliminate the pain in less-severe endometriosis

The medroxyprogesterone (Depo-Provera) injection is additionally effective in stopping menstruation. It stops the expansion of endometrial implants. It relieves pain and other symptoms. this might not be your first choice, however, due to the danger of decreased bone production, weight gain, and increase within the incidence of depression in some cases

Gonadotropin-releasing hormone (GRNH) agonists and antagonists

Women take what are called gonadotropin-releasing hormone (GnRH) agonists and antagonists to dam the assembly of estrogens that stimulate the ovary. Estrogen is that the hormone that’s mainly liable for the event of female sexual characteristics. This prevents menstruation and creates a man-made menopause. The therapy has side effects like vaginal dryness and hot flashes. Taking small doses of estrogen and progesterone at an equivalent time can help to limit or prevent these symptoms

Danazol

Danazol is another medication wont to stop menstruation and reduce symptoms. While taking danazol, the disease may still progress. Danazol can have side effects including acne and hirsutism, which is abnormal hair growth on your face and body. Other drugs are being studied which will improve symptoms and slow disease progress

Conservative surgery

Conservative surgery is for ladies who want to urge pregnant or experience severe pain and for whom hormonal treatments aren’t working. The goal of conservative surgery is to get rid of or destroy endometrial growths without damaging your reproductive organs

Laparoscopy, a minimally invasive surgery, is employed to both visualize, diagnose, and take away the endometrial tissue. Your surgeon will make small incisions in your abdomen to get rid of the growths surgically or to burn or vaporize them. Lasers are commonly used lately as how destroy this “out of place” tissue

Last-resort surgery (hysterectomy)

Rarely, your doctor may recommend a complete hysterectomy as a final resort if your condition doesn’t improve with other treatments. During a complete hysterectomy, your surgeon will remove your uterus and cervix. Your doctor also will remove your ovaries because they create estrogen, and estrogen causes the expansion of endometrial tissue. they're going to also remove visible implant lesions

This radical approach to treatment is employed only other treatment approaches have failed, and therefore the pain and inflammation are interfering with quality of life. This procedure will stop the cycle of menstruation, and symptoms of endometriosis should reduce. there's no guarantee that each one pain will get away , however

You’ll be unable to urge pregnant after a hysterectomy. Get a second opinion before agreeing to surgery if you’re brooding about starting a family

Prevention of Endometriosis

Endometriosis can't be prevented. this is often partially because the cause is poorly understood. But long-term use of contraception hormones (patch, pills, or ring) may prevent endometriosis from becoming worse

Eczema: Risk factors, Diagnosis and Management

Eczema: Risk factors, Diagnosis and Management

Definition

Eczema refers to a chronic inflammatory skin condition, characterized by dry skin, with patches that are red and intensely itchy. These patches of eczema may ooze, become scaly, crusted or hardened. The patients may have times when their skin is obvious and other times once they have rash. it's also called atopic dermatitis

Atopy refers to a hereditary tendency toward eczema, asthma and rhinitis (hay fever). People with eczema may suffer with one among the opposite atopic diseases. Both dermatitis and eczema mean inflammation of the skin

Types of eczema

Atopic dermatitis

Atopic dermatitis is that the commonest sort of eczema. it always starts in childhood, and sometimes gets milder or goes away by adulthood. atopic eczema is a component of what doctors call the atopic triad. “Triad” means three. the opposite two diseases within the triad are asthma and pollinosis . many of us with atopic eczema have all three conditions

Contact dermatitis

If you've got red, irritated skin that’s caused by a reaction to substances you touch, you'll have dermatitis . It comes in two types: Allergic dermatitis is an system reaction to an irritant like latex or metal. Irritant dermatitis starts when a chemical or other substance irritates your skin

Dyshidrotic eczema

Dyshidrotic eczema causes small blisters to make on your hands and feet. It’s more common in women than men

Hand eczema

Eczema that only affects your hands is named hand eczema. you'll get this sort if you're employed during a job like hairdressing or cleaning, where you often use chemicals that irritate the skin

Neuro dermatitis

Neuro dermatitis is analogous to atopic eczema . It causes thick, scaly patches to crop up on your skin

Nummular eczema

This type of eczema causes round, coin-shaped spots to make on your skin. The word “nummular” means coin in Latin. Nummular eczema looks very different from other sorts of eczema, and it can itch tons

Stasis dermatitis

Stasis dermatitis happens when fluid leaks out of weakened veins into your skin. This fluid causes swelling, redness, itching, and pain

What can trigger eczema

Having eczema means when the skin barrier is broken , moisture evaporates and this makes the skin more vulnerable to allergens and irritants. This irritation can trigger the skin to release certain chemicals that make the skin itchy. If you scratch, more chemicals are released and therefore the skin feels even itchier. This “scratch and itch” cycle are often most distressing

Known triggers (or aggravating factors) for eczema in some people include

Dry skin

Scratching (night gloves and clipped fingernails could also be needed in young children)

Viral or bacterial infections

Swimming in chlorinated swimming pools

Playing in sand and particularly sandpits

Sitting directly on carpets or grass

Inhalant allergens – worsening of eczema in spring and summer can also flow from to pollen sensitivity

Food intolerances to artificial colour and preservative in some people

Irritants like perfumes, soap, chemicals, woollen or synthetic fabrics

Temperature changes (such as heat) or overly heated rooms

Stress (this can make it worse but eczema isn't a psychological condition)

Contact with allergens can worsen eczema, and allergen avoidance or minimization often brings about improvement. For example

Close contact with animals can cause itching or hives, as can sitting and playing on the grass

Contact with house dust mite allergen on the skin can increase inflammation

Constant exposure to water, soap, grease, food or chemicals can damage the protective barrier function of the skin. Once the protective barrier of the skin is lost, eczema frequently develops

Risk factors behind Eczema

Many factors during a person’s environment can make eczema worse; these include heat, dust, wool, pets and irritants like soap and detergents

Being unwell, for instance having a standard cold can make eczema flare

Infections with bacteria or viruses can make eczema worse. Bacterial infection (usually with a bug called Staphylococcus) makes the affected skin yellow, crusty and inflamed, and should need specific treatment. An infection with the oral herpes virus (herpes simplex) can cause a sudden painful widespread (and occasionally dangerous) flare of eczema, with weeping small sores and should need treatment with oral antiviral treatment. Topical steroids shouldn't be used if this is often an opportunity

Dryness of the skin

Teething in babies

In some people food allergens may cause flares in eczema

?What are the symptoms of atopic eczema

The skin usually feels dry

Some areas of the skin become red and inflamed. the foremost common areas affected are next to skin creases, like the front of the elbows and wrists, backs of knees and round the neck. However, any areas of skin could also be affected. The face is usually affected in babies with atopic dermatitis 

Inflamed skin is itchy. If you scratch tons it's going to cause patches of skin to become thickened

Sometimes the inflamed areas of skin become blistered and weepy

Sometimes inflamed areas of skin become infected

Diagnosis and Test used for Eczema

While the medical history is of paramount importance, additional tests can help support the diagnosis of atopic dermatitis or identify other conditions which can be causing symptoms  

a number of these tests are

Blood tests: These require alittle blood sample, typically drawn through a needle within the arm. One such test looks for top levels of eosinophils, cells within the blood that are a part of an immune response . Another looks for top levels of a molecule called IgE antibody. Blood levels of those are elevated in people with atopic diseases, including eczema. Even more useful are allergen-specific IgE tests, which measure levels of the antibody, each of which is related to a special allergen

Skin biopsy: during this procedure a doctor first numbs the skin then removes one or more small pieces of skin, which is used to rule out other skin diseases from atopic dermatitis , sort of a low-grade carcinoma or psoriasis

Allergy skin testing: Prick skin tests are often done to common foods or inhalant allergens to means sensitization or lack of sensitization to specific allergens because of eczema

Patch testing: during this test, small patches covered with allergenic chemicals are placed on the skin for 48 hours, then removed and thus the skin reaction is evaluated at 72-96 hours for atopic dermatitis . It can identify contact allergy to chemical sensitizers like fragrances, metals, lanolin, rubber, etc

Buccal swabs: the within of the cheek are often swabbed with a cotton applicator to urge cells as a source of DNA material to look for mutations within the Filaggrin gene, one of the causes of eczema

Treatment and medicines therapy

Daily “Soak and Seal”

Soak within the bath or shower a day for 15-20 minutes so as that the skin absorbs plenty of water. Use warm water

A gentle skin cleanser should be used without scrubbing

Excess water should be gently pat away and thus the recommended medicine or moisturizer should be immediately applied to moist skin

Try to do this within three minutes. This seals within the water. (If you're applying skin medicine, don't apply moisturizer over it)

A skin cleanser could also be a bar or liquid used to clean the skin. Use products that are authorized to be used on “sensitive skin

Emollients (moisturizers)

Emollients (moisturizers) are a significant a neighborhood of eczema treatment. A moisturizer could also be a skin care product that adds moisture to the skin. Ointments and creams are recommended instead of lotion for people with very dry skin. they're used to replace lost skin moisture, help restore the normal barrier function of the skin, help the skin feel easier and reduce

.Emollients are very safe to use. you'll apply them as often as you'd like or wish

Depression: Causes, symptoms, and coverings 

Introduction

Everyone feels sad or low sometimes, but these feelings usually pass with a touch time. Depression also called “clinical depression” or a “depressive disorder” may be a mood disorder that causes distressing symptoms that affect how you are feeling , think, and handle daily activities, like sleeping, eating or working

Depression are often a neighborhood of several psychological state problems

Bipolar disorder

Borderline mental disorder (BPD) and other personality disorders

Schizo affective  disorder

?What are the various sorts of depression

:Two of the fore most common sorts of depression are

Major depression having symptoms of depression most of the day, nearly a day for a minimum of 2 weeks that interfere together with your ability to figure , sleep, study, eat, and luxuriate in life. An episode can occur just one occasion during a person’s lifetime, but more often,  

individual has several episodes

Persistent clinical depression (dysthymia) having symptoms of depression that last for a minimum of 2 years. an individual diagnosed with this type of depression may have episodes of major depression along side periods of less severe symptoms

Some sorts of depression are slightly different, or they'll develop under unique circumstances, such as

Perinatal Depression: Women with perinatal depression experience full-blown major depression during pregnancy or after delivery (postpartum depression)

Postpartum depression (PPD) may be a condition that describes a variety of physical and emotional changes that a lot of mothers can have after having a baby. PPD are often treated with medication and counseling

Seasonal major affective disorder (SAD): SAD may be a sort of depression that comes and goes with the seasons, typically starting within the late fall and early winter and departure during the spring and summer

Psychotic Depression: this sort of depression occurs when an individual has severe depression plus some sort of psychosis, like having disturbing false fixed beliefs (delusions) or hearing or seeing upsetting things that others cannot hear or see (hallucinations)

Bipolar disorder is different from depression. the rationale it's included during this list is because someone with manic depression experiences episodes of utmost low moods (depression). But an individual with manic depression also experiences extreme high moods (called “mania”)

.Depression level supported gender and age

Women have depression more often than men. Biological, lifecycle, and hormonal factors that are unique to women could also be linked to their higher depression rate. Women with depression typically have symptoms of sadness, worthlessness, and guilt

Men with depression are more likely to be very tired, irritable, and sometimes angry. they'll lose interest in work or activities they once enjoyed, have sleep problems, and behave recklessly, including the misuse of medicine or alcohol. Many men don't recognize their depression and fail to hunt help

Older adults with depression may have less obvious symptoms, or they'll be less likely to admit to feelings of sadness or grief. they're also more likely to possess medical conditions, like heart condition , which can cause or contribute to depression

Younger children with depression may pretend to vomit , refuse to travel to high school , hold close a parent, or worry that a parent may die

Older children and teenagers with depression may get into trouble at college , sulk, and be irritable. Teens with depression may have symptoms of other disorders, like anxiety, eating disorders, or drug abuse 

Epidemiology

Depression is prevalent among all age groups, in most walks of life. . Indians are among the worlds most depressed. consistent with a World Health Organization-sponsored study, while around 9% of individuals in India reported having an extended period of depression within their lifetime, nearly 36% suffered from what's called Major Depressive Episode (MDE)

Approximately 11% of Canadians meet criteria for MDD at some point in their lives and approximately 4% of Canadians suffer from MDD within any given year.1 About 2% of individuals with depression kill , and 50% of those individuals will are in touch with their GP within the month preceding the suicide

Lowest prevalence of MDE was in China (12%). the typical age of depression in India is 31.9 years compared to 18.8 years in China, and 22.7 years within the US. The female: male ratio was about 2:1.”WHO ranks depression because the fourth leading explanation for disability worldwide and projects that by 2020, it'll be the second leading cause

Risk Factors for depression include

Prior episode(s)

Family history of clinical depression 

Female gender

Postpartum period

Peri/postmenopausal period

Medical co-morbidity

Lack of social support

Major life stressor (loss of beloved or other members of social network)

Substance abuse

History of adverse childhood events

Negative cognitive style

Causes of depression

The exact explanation for depression isn't known. Many researchers believe it's caused by chemical changes within the brain. this might flow from to a drag together with your genes, or triggered by certain stressful events. More likely, it’s a mixture of both

Some sorts of depression run in families. But depression also can occur if you've got no case history of the illness. Anyone can develop depression, even kids. the subsequent may play a task in depression

Alcohol or substance abuse 

Certain medical conditions, including underactive thyroid, cancer, or future pain

Certain medications like steroids

Sleeping problems

Stressful life events, such as

Breaking up with a boyfriend or girlfriend

Failing a category 

Death or illness of somebody on the brink of you

Divorce

Childhood abuse or neglect

Job loss

Social isolation (common within the elderly)

?What are the signs and symptoms of depression

Sadness is merely one small a part of depression and a few people with depression might not feel sadness in the least . Different people have different symptoms. Some symptoms of depression include

Persistent sad, anxious, or “empty” mood

Feelings of hopelessness or pessimism

Feelings of guilt, worthlessness, or helplessness

Loss of interest or pleasure in hobbies or activities

Decreased energy, fatigue, or being “slowed down”

Difficulty concentrating, remembering, or making decisions

Difficulty sleeping, early-morning awakening, or oversleeping

Appetite and/or weight changes

Thoughts of death or suicide or suicide attempts

Restlessness or irritability

Aches or pains, headaches, cramps, or digestive problems without a transparent physical cause and/or that don't ease even with treatment

Suicide Risk Assessment

Once patient has met MDD criteria, conduct a suicide risk assessment

Ask the patient if they need thoughts of death or suicide, feel life isn't worth living, have made a previous suicide attempt and if there's a case history of suicide

If the solution is yes to any of the above, ask about their plans for suicide (e.g., have they considered a way , do they need access to material required for suicide and if they need written a note)

Consider emergency psychiatric consultation and in-patient treatment if the patient has: persistent suicidal thoughts; a previous suicide attempt; or a current plan

If the patient is taken into account low risk, discuss and/or create a security plan with the patient, detailing steps the patient will take if their situation deteriorates

Treatment and medications for depressed person

The first step in getting the proper treatment is to go to a health care provider or psychological state professional, like a psychiatrist or psychologist. Your health care provider can do an exam, interview, and lab tests to rule out other health conditions which will have an equivalent symptoms as depression

Once diagnosed, depression are often treated with medications, psychotherapy, or a mixture of the 2 . If these treatments don't reduce symptoms, brain stimulation therapy could also be another treatment choice to explore

Medications

Medications called antidepressants can work well to treat depression

Selective serotonin reuptake inhibitors (SSRIs) are medications that increase the quantity of the neurochemical serotonin within the brain. SSRIs are often the first-line treatment for depression. samples of SSRIs include fluoxetine (Prozac), paroxetine (Paxil), ser traline (Zoloft), citalopram (Celexa), fluvoxamine (Luvox), and escitalopram (Lexapro

Serotonin and norepinephrine reuptake inhibitors (SNRIs)

Tricyclics and tricyclic-related drugs

Monoamine oxidase inhibitors (MAOIs)

They can take 2 to 4 weeks to figure . Antidepressants can have side effects, but many side effects may lessen over time. ask your health care provider about any side effects that you simply have. don't stop taking your antidepressant without first lecture your health care provider

Psychotherapy

Psychotherapy helps by teaching new ways of thinking and behaving, and changing habits which will be contributing to depression. Therapy can assist you understand and run through difficult relationships or situations which will be causing your depression or making it worse

Brain stimulation therapies

Electroconvulsive therapy (ECT) and other brain stimulation therapies could also be an option for people with severe depression who don't answer antidepressant medications. ECT is that the best studied brain stimulation therapy and has the longest history of use.

Transcranial magnetic stimulation (TMS) uses pulses of energy to stimulate nerve cells within the brain that are believe to affect mood. there's some research to suggest that it can help relieve depression

Light therapy may relieve depression symptoms within the winter time. However, it's usually not considered a first-line treatment

How to control and stop yourself from depression

As you continue treatment, you'll start to feel better gradually. Remember that if you're taking an antidepressant, it's going to take 2 to 4 weeks to start out working. attempt to do things that you simply wont to enjoy. Go easy on yourself. Other things which will help include

Trying to move and exercise

Breaking up large tasks into small ones, set priorities, and do what you'll as you'll 

Spending time with people and open up to a trusted friend or relative

Postponing important life decisions until you are feeling better. Discuss decisions with others who know you well

Avoiding self-medication with alcohol or with drugs not prescribed for you

How to support an individual who is depressed

If you recognize someone who has depression, first help him or her see a health care provider or psychological state professional. you'll also

Offer support, understanding, patience, and encouragement

Never ignore comments about suicide, and report them to your loved one’s health care provider or therapist

Invite him or her out for walks, outings, and other activities

Help him or her adhere to the treatment plan, like setting reminders to require prescribed 

medications

Help him or her by ensuring that he or she has transportation to therapy appointments

.Remind him or her that, with time and treatment, Depression will lift

Health Assessment 

 is that the gather information about as patient's physiological, psychological, sociological, and spiritual status inorderto identify actual and potential health problems

The purposes of the health assessment

 Obtain baseline data and expand the info base from which

subsequent phases of the nursing process can evolve

 to spot and managea sort of patient problems (actual and

potential)

 Evaluate the effectiveness of medical care 

 Enhance the nurse-patient relationship

 Make clinical judgments

Therapeutic relationship 

Therapeutic communication defined as apurposeful sort of conversation, serving as some extent of human

contact between nurse and client allowing them to succeed in common health-related goal

Phases of communication

 Introductory

 Working

 Termination–closing

Preparation for Health assessment includes the 

A-Preparation for the nurse

Wearproper comfortable uniform

 Should be knowledgably: know disease process, physiological mental and psychological changes which can effects client's condition and has scientific background to gather complete

accurate data

 Skillful: skills to perform physical examination and use

tools

 Receiving requesttoper form physical examination

 Working associated with professional nursing issues as (confidentiality, respect and following infection control measures–handwashing)

B-Preparation of physical environment

a- Clean wells furnished place

b- Quiet

c- Proper temperature

d- Proper ventilation

e- Proper humidity

f- Proper light–natural and artificial light may used

C-Preparation of Client

 The nurse identify herself\his tot he client

Explain thepurpose for examination and therefore the procedures which can 

perform

 Explain the necessity for changing position during examination asking the client ifhe\she has the power to try to to so

Maintain the client privacy

 Provide the client with clean gown

D-Preparation of the equipments

 Besure that’s the equipments is in fitness working well

 Clean well arrange daccording to use

 All infection control measures should bevtaken into account 

—Gathering Data

—Subjective data-Said by the client(S) by using interview to gather the subsequent data

—Biographical

—Past history

—Present history

—Family history

—Information associated with lifestyle& activities of daily living

Objective data -Observed by the nurse(O)

—Physical Examination: collection of objective data by using

many techniques such as: The order of techniques is as

follows (Inspection-Palpation-Percussion-

Auscultation)

—A. Inspection : critical observation* always first *

. Take time to“observe”with eyes, nose

. Use good lighting

. Look at color , shape , symmetry, position

. Observe for odors from skin, breath, wound

—B. Palpation : light and deep touch

. Back of hand(dorsal aspect) to assess skin

temperature

. Fingers (light) within1-2cm to assess texture,moisture, areas often derness, pain and assess size,shape, and consist encyoflesions

. Deep palpation= 4-5cm to assess mass and organs

. Bimanual using two hand 5-8 cm to assess organs

—C. Percussion : sound sproduced by striking or tapping body surface

. Produces different sounds counting on underlying structures (dull, resonant, flat, and tympanic)

. wont to determine under lying structures

. Action is perform edin the wrist.

—D. Auscultation : taking note of sound sproduced by the

body

. Flat diaphragm picksup high-pitched respiratory

sounds best

. Bell picks uplow pitched sounds like heart murmurs

.

Bladder Cancer: Causes, Symptoms, Risk factors and Medications

introduction

Bladder cancer begins when healthy cells within the bladder lining, most ordinarily urothelial cells, change and grow out of control, forming a mass called a tumor. A tumor are often cancerous or benign. A cancerous tumor is malignant, meaning it can grow and spread to other parts of the body. A benign tumour means the tumor can grow but won't spread

The bladder may be a hollow organ within the pelvis with flexible, muscular walls. Its main function is to store urine before it leaves the body. Urine is formed by the kidneys and is then carried to the bladder through tubes called ureters. once you urinate, the muscles within the bladder contract, and urine is forced out of the bladder through a tube called the urethra

Structure of bladder

Start and spread of bladder cancer

The wall of the bladder has several layers, which are made from differing types of cells (see How is bladder cancer staged? for descriptions of the various layers)

Most bladder cancers start within the innermost lining of the bladder, which is named the urothelium or transitional epithelium. because the cancer grows into or through the opposite layers within the bladder wall, it becomes more advanced and may be harder to treat

Over time, the cancer might grow outside the bladder and into nearby structures. it'd spread to nearby lymph nodes, or to other parts of the body. (If bladder cancer spreads, it often goes first to distant lymph nodes, the bones, the lungs, or the liver

Stages of bladder cancer

Stage 0: The cancer cells are found only on the surface of the inner lining of the bladder. The 

doctor may call this carcinoma in place 

Stage I: The tumor has grown deeper into the inner lining of the bladder. But it hasn’t invaded the muscle layer of the bladder

Stage II: The tumor has invaded the muscle layer of the bladder

Stage III: The tumor has grown through the muscle layer to succeed in tissues near the bladder, like the prostate, uterus, or vagina

Stage IV: The tumor has invaded the wall of the pelvis or abdomen, but cancer isn't found in any lymph nodes. Or, the cancer cells have spread to a minimum of one lymph gland or to parts of the body distant from the bladder, like the liver, lungs, or bones

Types of bladder cancer

The type of bladder cancer depends on how it's under the microscope. the three main sorts of bladder cancer are

Urothelial carcinoma. Urothelial carcinoma accounts for about 90% of all bladder cancers. It begins within the urothelial cells found within the lining the bladder. Urothelial carcinoma is that the common term for this sort of bladder cancer. Previously, it had been called transitional cell carcinoma or TCC

Squamous cell carcinoma. Squamous cells develop within the bladder lining in response to irritation and inflammation. Over time these cells may become cancerous. epithelial cell carcinoma accounts for about 4% of all bladder cancers

This type accounts for about 2% of all bladder cancers and develops from glandular cells

In addition to its cell type, bladder cancer could also be described as noninvasive, non-muscle-invasive, or muscle-invasive

Non-muscle-invasive. Non-muscle-invasive bladder cancer typically has only grown into the lamina propria. Non-muscle invasive cancer can also be called superficial cancer, although this term is getting used less actually because it's going to incorrectly suggest that this sort of cancer isn't serious

Muscle-invasive. Muscle-invasive bladder cancer has grown into the bladder’s wall muscle and sometimes into the fatty layers or surrounding tissue outside the bladder

Background

Timeline Developmental stages

19th century The cytoscope develops. the primary cystectomy for bladder cancer is performed.

1940s–1960s Urine cytology emerges as a tool to detect recurrent bladder and tract cancers

1970s Cigarette smoking is linked to bladder cancer risk. First chemotherapy drug is released for bladder cancer.

1980s Mitomycin chemotherapy is consolidated. Surgical advances improve bladder cancer survival. First successful combination chemotherapy for advanced bladder cancer is achieved.

1990s Surgical techniques consolidate. New chemotherapies emerge to treat bladder cancer.

2000s New chemotherapies convince extend survival against bladder cancer. CT scan improves bladder cancer detection.

Recent years As of 2010, bladder cancer resulted in 170,000 deaths up from 114,000 in 1990 worldwide. Current treatment options for people with bladder cancer can include surgery, intravesical therapy, chemotherapy, radiotherapy and immunotherapy.

Prevalence of Bladder cancer at world wide

Globally, in 2010, bladder cancer resulted in 170,000 deaths up from 114,000 in 1990.[53] this is often a rise of 19.4%, adjusted for increase in total world population.

In the us , bladder cancer is that the fourth commonest sort of cancer in men and therefore the ninth commonest cancer in women. quite 50,000 men and 16,000 women are diagnosed with bladder cancer annually . Smoking can only partially explain this higher incidence in men. One other reason is that the androgen receptor, which is far more active in men than in women, plays a serious part within the development of the cancer. Bladder cancer is that the seventh commonest cancer within the UK (around 10,400 people were diagnosed with the disease in 2011), and it's the seventh commonest explanation for cancer death (around 5,200 people died in 2012

Causes and risk factors that results in bladder cancer

Bladder defects from birth

Chemotherapy and radiotherapy

Chronic bladder infections and irritations

Exposure to certain chemicals including aromatic amines

Low fluid consumption

Personal or case history of bladder cancer

Being male and/or white (women have lower rates of bladder cancer, as do African-Americans, Hispanics, Asian-Americans, and Native Americans

Some medications and dietary supplements – pioglitazone (Actos) and aristolochic acid (mainly from plants within the Aristolochia family)

Exposure to arsenic in beverage

People who add the subsequent industries or who have the subsequent professions even have an increased risk of bladder cancer, likely thanks to exposure to certain chemicals

Manufacturing of rubber, leather, textiles and paint products

Printing

Painters

Machinists

Hairdressers

Truck drivers

Complications during Bladder cancer

Emotional impact

Continent urinary diversion

Urostomy

Erectile dysfunction

Narrowing of the vagina

Symptoms and signs of Bladder cancer

Bladder cancer may cause these common symptoms

Finding blood in your urine (which may make the urine look rusty or darker red)

Feeling an urgent got to empty your bladder

Having to empty your bladder more often than you wont to

Feeling the necessity to empty your bladder without results

Needing to strain (bear down) once you empty your bladder

Feeling pain once you empty your bladder

These symptoms could also be caused by bladder cancer or by other health problems, like an infection

Diagnosis and testing of bladder

Urine tests: The lab checks your urine for blood, cancer cells, and other signs of disease

Cystoscopy: Your doctor uses a skinny , lighted tube (a cystoscope) to seem directly into your bladder. it's going to be done at your doctor’s office. This test are often uncomfortable because the doctor will insert the cystoscope into the bladder through your urethra. you'll need local anaesthesia for this test

Biopsy: Your doctor can remove samples of tissue with the cystoscope. A pathologist then examines the tissue under a microscope. The removal of tissue to seem for cancer cells is named a biopsy. In most cases, a biopsy is that the only sure thanks to tell whether cancer is present

If bladder cancer is diagnosed, your doctor must learn the extent (stage) of the disease to assist you select the simplest treatment. Your doctor may order these tests

Blood tests: Blood tests can show how well the liver and kidneys are working

Chest x-ray: An x-ray of the chest can show a tumor within the lung

IVP: A dye that shows abreast of x-rays is injected into your vessel . The dye collects in your urine, which makes the bladder and therefore the remainder of the tract show abreast of x-rays

CT scan: you'll receive an injection of contrast medium so your tract and lymph nodes show up clearly within the pictures. The CT scan can show cancer within the bladder, lymph nodes, or elsewhere within the abdomen

MRI: you'll receive an injection of contrast medium . MRI can show cancer within the bladder, lymph nodes, or other tissues within the abdomen

Ultrasound: the image of an ultrasound can show a tumor or blockage within the tract 

Treatment and Medications

Several newer sorts of treatment are now being studied to be used against bladder cancer

Surgery

Some surgeons are employing a newer approach to cystectomy during which they sit at an impact panel within the OR and maneuver robotic arms to try to to the surgery. This approach, referred to as a robotic cystectomy, lets the surgeon operate through several small incisions rather than one large one. this might help patients recover more quickly from surgery

Intravesical therapy

Researchers are watching variety of latest medicines to ascertain if putting them into the bladder after surgery can help lower the danger of the cancer returning . The hope is to seek out some that are better and/or safer than currently used drugs like Bacillus Calmette-Guérin (BCG) and mitomycin

Photodynamic therapy

Photodynamic therapy (PDT) is now being studied to ascertain if it’s useful in treating early stage bladder cancers. A light-sensitive drug is injected into the blood and allowed to gather within the cancer cells for a couple of days. Then a special sort of laser light is concentrated on the inner lining of the bladder through a cystoscope. the sunshine changes the drug within the cancer cells into a replacement chemical which will kill them

An advantage of PDT is that it can kill cancer cells with little or no harm to nearby normal cells. One drawback is that the chemical must be activated by light, so only cancers near the surface of the bladder lining are often treated during this way. the sunshine can’t reach cancers that have grown deeper into the bladder wall or have spread to other organs

 Immunotherapy

Immunotherapy is treatment that uses the body’s own system to fight the cancer

Intravesical immunotherapy: One sort of immunotherapy already wont to treat some early bladder cancers is BCG, which may be a sort of intravesical therapy. When this germ is put into the bladder (in liquid form), it attracts immune cells to the bladder lining, which then attack cancer cells

Immune checkpoint inhibitors: a crucial a part of the system is its ability to stay itself from attacking the body’s normal cells. It does this by using “checkpoints” – molecules on immune cells that require to be turned on (or off) to start out an immune reaction . Cancer cells sometimes use these checkpoints to avoid being attacked by the system 

Gene therapy

Adding or changing the particular genes inside cancer cells or other cells within the body – is another new treatment method being tested for bladder cancer. One approach to gene therapy uses special viruses that are modified within the lab. The modified virus is put into the bladder and infects the bladder cancer cells. When this infection occurs, the virus injects a gene into the cells for GM-CSF, an system hormone which will help system cells to attack the cancer

Preventing Bladder cancer

Although there's not a guaranteed method to stop bladder cancer, people can surely reduce the danger of getting it. for instance , smokers are far more likely to develop bladder cancer than nonsmokers

Also, those exposed to industrial or environmental carcinogens like azo dyes and arylamines are at a better risk. People working with dyes, rubbers, textiles, paints, pesticides, insecticides, leathers, and chemicals are more vulnerable

Avoiding any potential carcinogens by inhalation, ingestion, or direct contact would definitely reduce risk not only of bladder cancer but also of other cancers

Nutritional factors are widely investigated in cancer prevention

Autism: Causes, Epidemiology, Treatment and Prevention

Definition

Autism, or autism spectrum disorder, refers to a variety of conditions characterized by challenges with social skills, repetitive behaviors, speech and nonverbal communication, also as by unique strengths and differences. We now know that there's not one autism but many sorts , caused by different combinations of genetic and environmental influences. The term “spectrum” reflects the wide variation in challenges and strengths possessed by everyone with autism

Types of autism

There are four main sub-types of autism recognized within the Diagnostic and Statistical Manual of Mental Disorders

Autistic Disorder, also referred to as autism, childhood autism, early autism , Kanner’s syndrome or infantile psychosis. People with autistic disorder usually have significant language delays, social and communication challenges, and weird behaviors and interests. many of us with autistic disorder even have intellectual disability

Asperger Syndrome, also referred to as Asperger’s disorder or just Asperger’s. People with Asperger syndrome usually have some milder symptoms of autistic disorder. they could have social challenges and weird behaviors and interests. However, they typically don't have problems with language or intellectual disability

Childhood Disintegrative Disorder, also referred to as CDD, dementia infantalis, disintegrative psychosis or Heller’s syndrome. These children develop normally for a minimum of two years then lose some or most of their communication and social skills. this is often a particularly rare disorder and its existence as a separate condition may be a matter of debate among many psychological state professionals

Pervasive Developmental Disorder-Not otherwise Specified, also referred to as PDD (NOS) or atypical autism

  ?How common is Autism

Autism statistics from the U.S. Centers for Disease Control and Prevention (CDC) released in March 2014 identify around 1 in 68 American children as on the autism spectrum – a ten-fold increase in prevalence in 40 years. Careful research shows that this increase is merely partly explained by improved diagnosis and awareness. Studies also show that autism is four to 5 times more common among boys than girls. An estimated 1 out of 42 boys and 1 in 189 girls are diagnosed with autism within the us 

ASD affects over 2 million individuals within the U.S. and tens of millions worldwide. Moreover, government autism statistics suggest that prevalence rates have increased 10% to 17% annually in recent years. there's no established explanation for this continuing increase, although improved diagnosis and environmental influences are two reasons often considered

Historical background about ASDs

The term Autism comes from the Greek word “autos,” meaning “self”. Eugen Bleuler coined the word “autism” in 1908 among severely withdrawn schizophrenic patients

In 1943 American child psychiatrist Leo Kanner studied 11 children. the youngsters had features of difficulties in social interactions, difficulty in adapting to changes in routines, good memory, sensitivity to stimuli (especially sound), resistance and allergies to food, good intellectual potential, echolalia or propensity to repeat words of the speaker and difficulties in spontaneous activity

In 1944 Hans Asperger, working separately, studied a gaggle of youngsters . His children also resembled Kanner’s descriptions. the youngsters he studied, however, didn't have echolalia as a linguistic problem but spoke like grownups. He also mentioned that a lot of of the youngsters were clumsy and different from normal children in terms of fine motor skills

Next Bruno Bettelheim studied the effect of three therapy sessions with children who he called autistic. He claimed that the matter within the children was thanks to coldness of their mothers. He separated the youngsters from their parents. Kanner and Bettelheim both worked towards making hypothesis that showed autistic children had frigid mothers

Bernard Rimland was a psychologist and parent of a toddler with autism. He disagreed with Bettelheim. He didn't agree that the explanation for his son’s autism was thanks to either his or his wife’s parenting skills. In 1964, Bernard Rimland published, Infantile Autism: The Syndrome and its Implications for a Neural Theory of Behavior

Autism came to be better known within the 1970’s. The Erica Foundation started education and therapy for psychotic children within the beginning of the 80s. Many parents still confused autism with retardation and psychosis

It was in 1980’s that Asperger’s work was translated to English and published and came into knowledge

It was within the 1980’s that research on autism gained momentum. it had been increasingly believed that parenting had no role in causation of autism and there have been neurological disturbances and other genetic ailments like tuberous sclerosis, metabolic disturbances like PKU or chromosomal abnormalities like fragile X syndrome

Lorna Wing, along side Christopher Gillberg at BNK (Children’s Neuro-Psychiatric Clinic) in Sweden within the 1980’s found the Wing’s triad of disturbed mutual contact, disturbed mutual communication and limited imagination. within the 1990’s they added another factor making it a square. The factor was limited planning ability

Ole Ivar Lovaas studied and furthered behavioural analysis and treatment of youngsters with autism. Lovaas achieved limited success initially together with his experimental behaviour analysis. He developed it to focus on younger children (less than 5 years of age) and implemented treatment reception and increased the intensity (a measurement of the quantity of “therapy time”) to about 40 hours weekly. Lovaas wrote Teaching Developmentally Disabled Children: The Me Book in 1981. In 2002, Lovaas wrote, Teaching Individuals with Developmental Delays: Basic Intervention Techniques

Signs and symptoms of ASDs

People with ASDs may have problems with social, emotional, and communication skills. they could repeat certain behaviors and won't want change in their daily activities. many of us with ASDs even have alternative ways of learning, listening , or reacting to things. ASDs begin during  infancy and last throughout a person’s life

A child or adult with an ASD might have

Not play “pretend” games (pretend to “feed” a doll)

Not point at objects to point out interest (point at an airplane flying over)

Not check out objects when another person points at them

Have trouble concerning others or not have an interest in people in the least

Avoid eye contact and need to be alone

Have trouble understanding other people’s feelings or talking about their own feelings

Prefer to not be held or cuddled or might cuddle only they need to

Appear to be unaware when people ask them but answer other sounds

Be very curious about people, but not skills to speak , play, or relate to them

Repeat or echo words or phrases said to them, or repeat words or phrases in situ of normal language (echolalia)

Have trouble expressing their needs using typical words or motions

Repeat actions over and once again

Have trouble adapting when a routine changes

Have unusual reactions to the way things smell, taste, look, feel, or sound

Lose skills they once had (for instance, stop saying words they were using)

Causes of Autism

There’s nobody explanation for autism. Research suggests that autism develops from a mixture of genetic and non-genetic, or environmental, influences. These influences appear to extend the danger that a toddler will develop autism

Autism’s genetic risk factors: Changes in certain genes increase the danger that a toddler will develop autism. If a parent carries one or more of those gene changes, they'll get passed to a toddler (even if the parent doesn't have autism)

Autism’s environmental risk factors: certain environmental influences may further increase – or reduce – autism risk in people that are genetically predisposed to the disorder. Importantly, the rise or decrease in risk appears to be small for anybody of those risk factors

Advanced parent age (either parent)

Pregnancy and birth complications (e.g. extreme prematurity [before 26 weeks], low birth weight, multiple pregnancies [twin, triplet, etc.])

Use of alcohol

Maternal metabolic conditions like diabetes and obesity

Use of anti-seizure drugs during pregnancy

Untreated phenylketonuria (called PKU, an inborn disorder caused by the absence of an enzyme)

Rubella (German measles)

Diagnosis of ASDs

Diagnosing autism spectrum disorder (ASD) are often difficult, since there's no medical test, sort of a biopsy , to diagnose the disorders. Doctors check out the child’s behavior and development to form a diagnosis

ASD can sometimes be detected at 18 months or younger. By age 2, a diagnosis by an experienced professional are often considered very reliable. Diagnosing an ASD takes two steps

Developmental Screening

Comprehensive Diagnostic Evaluation

Developmental Screening

Developmental screening may be a short test to inform if children are learning basic skills once they should, or if they could have delays. During developmental screening the doctor might ask the parent some questions or talk and play with the kid during an exam to ascertain how she learns, speaks, behaves, and moves. A delay in any of those areas might be a symbol of a drag 

All children should be screened for developmental delays and disabilities during regular well-child doctor visits at

9 months

18 months

24 or 30 months

Additional screening could be needed if a toddler is at high risk for developmental problems thanks to preterm birth, low birth weight or other reasons. additionally , all children should be screened specifically for ASD during regular well-child doctor visits at

18 months

24 months

Other lab tests could also be done under specific circumstances. These tests include

Chromosomal analysis, which can be done if intellectual disability is present or there's a case history of intellectual disability. for instance , fragile X syndrome, which causes a variety of below-normal intelligence problems also as autistic-like behaviors, are often identified with a chromosomal analysis

An electroencephalograph (EEG), which is completed if there are symptoms of seizures

MRI, which can be done if there are signs of differences within the structure of the brain

Treatment of ASDs

Applied behavioral analysis (ABA

This intervention works by breaking down skills like communication and cognitive skills into smaller and simpler tasks. The tasks are then taught during a highly structured way. the straightforward tasks over time coalesce into more complex skills that help in development

Early start Denver model

This is yet one more behavioral intervention that mixes applied behavioral analysis with developmental and relationship based approaches. the kid is brought into interactive social relationships, using positive emotional exchanges and joint play activities. It improves cognitive, language and adaptive behavioral skills

Discrete Trial Training (DTT

This is a method of teaching that uses a series of trials and efforts to show each step of a desired behavior or response

Pivotal Response Training (PRT

This is intended to extend the child’s motivation to find out and monitor his or her own behaviour and start communication

Verbal Behavior Intervention (VBI

VBI may be a sort of ABA that focuses on teaching verbal skills

Speech and language Therapy (SLT

This therapy aims at improving communication and language skills. this will improve their ability to interact with others socially. This intervention may use visual aids, stories and toys and other aids to develop language skills

Occupational therapy

This focuses on development and maintenance of fine motor and adaptive skills

Stem cell therapy

Medicines

Medicines are most ordinarily wont to treat related conditions and problem behaviors, including depression, anxiety, hyperactivity, and obsessive-compulsive behaviors.

Prevention

Although the precise explanation for autism isn't known in most instances, some cases are linked to chemical exposure during pregnancy. Therefore, it's essential to avoid taking any drugs during pregnancy unless the doctor specifically prescribes them

It is also essential to avoid drinking alcoholic beverages of any kind during pregnancy. Being immunized against rubella (German measles) before becoming pregnant can prevent rubella-associated autism

Following delivery, there are certain measures which will be helpful in preventing autism. One is early diagnosis and treatment of phenylketonuria (PKU). this is often a genetic disease that's caused by the shortage of a liver enzyme required to digest the enzyme phenylalanine

Similarly, early diagnosis and treatment of disorder may reduce the danger of a toddler having autism