Nursing Care Plan for Osteomyelitis : Nursing Diagnosis for Osteomyelitis and Nursing Interventions for Osteomyelitis

Osteomyelitis is an infection of the bone. It can be caused by a variety of microbial agents (most common in staphylococcus aureus) and situations,
including:

 An open injury to the bone, such as an open fracture with the bone ends piercing the skin.
 An infection from elsewhere in the body, such as pneumonia or a urinary tract infection that has spread to the bone through the blood (bacteremia,
sepsis).
 A minor trauma, which can lead to a blood clot around the bone and then a secondary infection from seeding of bacteria.
 Bacteria in the bloodstream bacteremia (poor dentition), which is deposited in a focal (localized) area of the bone. This bacterial site in the bone
then grows, resulting in destruction of the bone. However, new bone often forms around the site.
 A chronic open wound or soft tissue infection can eventually extend down to the bone surface, leading to a secondary bone infection.

Symptoms of osteomyelitis

The symptoms of osteomyelitis can include:

 Pain and/or tenderness in the infected area

 Swelling and warmth in the infected area
 Fever
 Nausea, secondarily from being ill with infection
 General discomfort, uneasiness, or ill feeling
 Drainage of pus through the skin

Additional symptoms that may be associated with this disease include:

 Excessive sweating
 Chills
 Lower back pain (if the spine is involved)
 Swelling of the ankles, feet, and legs
 Changes in gait (walking pattern that is a painful, yielding a limp)

Nursing Diagnosis for Osteomyelitis

 1. Acute pain related to inflammation and swelling
2. Impaired Physical Mobility related to pain and limitation of the load weight
3. Risk for Infection

Targets to be achieved:

1. Pain is reduced
2. Improvement of physical mobility within the limits of therapeutic
3. Infection control

Nursing interventions for Osteomyelitis

1.Immobilization of the affected area with a splint to reduce pain and muscle spasms.

2. Joints above and below the affected area should be made so that still can be moved according to the range yet gently. The wound itself is sometimes
very painful and must be handled carefully and slowly.

3. Elevate the affected area to reduce swelling and discomfort.

4. Monitor the affected extremity neurovascular status.

5. Do pain management techniques such as massage, distraction, relaxation, hypnosis to reduce pain perception and collaboration with medical for
providing analgesic.

6. Protect your bones by means of immobilization and avoid stress on the bone because bones become weak due to the infection process.
Acute leukemias have large numbers of immature leukocytes and overproduction of cells in the blast stage of
maturation.

 Acute lymphocytic leukemia (ALL), also known as acute lymphoblastic leukemia, refers to an
abnormal growth of lymphocyte precursors or lymphoblasts.
 Acute leukemia is a malignant proliferation of white blood cell precursors in bone marrow or lymph tissue,
and their accumulation in peripheral blood, bone marrow, and body tissues.
 About 20% of leukemias are acute.

Pathophysiology

Pathogenesis isn’t clearly understood, but the pathophysiology may be explained by the following:

 Accumulation. Due to the precipitating factors, immature, non-functioning WBCs appear to accumulate
first in the tissue where they originate (lymphocytes in lymphtissue, granulocytes in bone marrow).
 Infiltration. These immature WBCs then spill into the bloodstream and from there infiltrate other tissues.
 Malfunction. Eventually, this infiltration results in organ malfunction because of encroachment and
hemorrhage.
 Schematic diagram and pathophysiology

Statistics and Incidences

One of the most common forms of acute leukemia is acute lymphocytic leukemia.

 Acute lymphocytic leukemia is more common in males than in females, in whites (especially in people of
Jewish descent), in children (between ages 2 and 5), and in people who live in urban and industrialized
areas.
 80% of all leukemias between 2 and 5 years old are ALL.
 Acute leukemias account for 20% of adult leukemias.
 Among children, however, it is the most common form of cancer.
 Incidence is 6 out of every 100, 000 people.

Causes

Research on predisposing factors isn’t conclusive but points to some combination of viruses, immunologic factors,
genetic factors, and exposure to radiation and certain chemicals.

 Congenital disorders. Down syndrome, Bloom syndrome, Fanconi anemia, congenital

agammaglobulinemia, and ataxia-telangiectasia usually predisposes to ALL.
 Familial tendency. Genetics also play a part in the development of ALL.
 Viruses. Viral remnants have been found in leukemic cells, so they are likely one of the causes of ALL.

Clinical Manifestations

Signs of acute lymphocytic leukemia may be gradual or abrupt.

  High fever. High fever accompanied by thrombocytopenia and abnormal bleeding (such as nosebleeds and
gingival bleeding) manifests in the patient.
 Bruising. Easy bruising after minor trauma is a sign of leukemia.
 Dyspnea. A decrease in the mature blood components leads to dyspnea.
 Anemia. Anemia is present in ALL because of a decrease in mature RBCs.
 Fatigue. The patient experiences fatigue more frequently than normal.
 Tachycardia. As the oxygen-carrying component of the blood decreases, the body compensates by
pumping out blood faster than normal.

Complications

Untreated, acute leukemia is invariably fatal, usually because of complications that result from leukemic cell
infiltration of the bone marrow and vital organs.

 Infection. Immature WBCs are not fit to defend the body against pathogens, so infection is always a
possible complication to watch out for.
 Organ malfunction. Encroachment or hemorrhage occurs when immature WBCs spill into the bloodstream
and other tissues and eventually lead to organ or tissue malfunction.

Assessment and Diagnostic Findings

The diagnosis of ALL can be confirmed with a combination of the following:

  Bone marrow aspiration. Typical clinical findings and bone marrow aspirate showing a proliferation of
immature WBCs confirm ALL.
 Bone marrow biopsy. A bone marrow biopsy, usually of the posterior superior iliac spine, is part of the
diagnostic workup.
 Blood counts. Blood counts show severe anemia, thrombocytopenia, and neutropenia.
 Differential leukocyte count. Differential leukocyte count determines cell type.
 Lumbar puncture. Lumbar puncture detects meningeal involvement.
 Uric acid levels. Elevated uric acid levels and lactic dehydrogenase levels are commonly found.

Medical Management

With treatment, the prognosis varies.

 Systemic chemotherapy. Systemic chemotherapy aims to eradicate leukemic cellsand induce remission
(less than 5% of blast cells in the marrow and peripheral blood are normal).
 Radiation therapy. Radiation therapy is given for testicular infiltrations.
 Platelet transfusion is performed to prevent bleeding and RBC transfusion to prevent anemia.

Pharmacologic Therapy

ALL chemotherapy includes the following drugs and also other drugs included in the treatment:

 Vincristine. Vincristine is an anti-cancer (antineoplastic or cytotoxic) chemotherapy drug and is classified

as a plant alkaloid.
  Prednisone. This drug works is by altering the body’s normal immune system responses.
 Cytarabine. Cytarabine belongs to the category of chemotherapy called antimetabolites, wherein When the
cells incorporate these substances into the cellular metabolism, they are unable to divide and they attack
cells at very specific phases in the cycle.
 L-asparaginase. Asparaginase breaks down asparagine in the body, so since the cancercells cannot make
more asparagine, they die.
 Daunorubicin. Daunorubicin is classified as an antitumor antibiotic which is made from natural products
produced by species of the soil fungus Streptomyces, and these drugs act during multiple phases of the cell
cycle and are considered cell-cycle specific.
 Antibiotic, antifungal, and antivirals. These control infection, a common complication of acute
leukemias.

Surgical Management

Aggressive treatment may include surgical management through:

 Bone marrow transplant. Bone marrow transplant is a choice that can be considered for a patient with
ALL.
 Stem cell transplant. Stem cell transplant in ALL is one of the latest development in the treatment of
acute leukemias

Nursing Management
The care plan for the leukemic patient should emphasize comfort, minimize the adverse effects of chemotherapy,
promote preservation of veins, manage complications, and provide teaching and psychological support.

Nursing Assessment

The clinical picture varies with the type pf leukemia as well as the treatment implemented, so the following must be
assessed:

 Health history. The health history may reveal a range of subtle symptoms reported by the patient before
the problem is detectable on physical examination.
 Physical examination. A thorough, systematic assessment incorporating all body systems is essential.
 Laboratory results. The nurse also must closely monitor the results of laboratory studies and culture
results need to be reported immediately.

Nursing Diagnosis

Based on the assessment data, major nursing diagnoses for the patient with ALL may include:

 Risk for infection related to overproduction of immature WBCs.

 Risk for impaired skin integrity related to toxic effects of chemotherapy, alteration in nutrition, and
impaired immobility.
 Imbalanced nutrition, less than body requirements, related to hypermetabolic state, anorexia,
mucositis, pain, and nausea.
 Acute pain and discomfort related to mucositis, leukocyte infiltration of systemic tissues, fever, and
infection.
 Hyperthermia related to tumor lysis or infection.
  Fatigue and activity intolerance related to anemia, infection, and deconditioning.

Nursing Care Planning & Goals

Main Article: 5 Leukemia Nursing Care Plans

The major goals for the patient may include:

 Absence of pain.
 Attainment and maintenance of adequate nutrition.
 Activity tolerance.
 Ability to provide self-care and to cope with the diagnosis and prognosis.
 Positive body image.

Nursing Interventions

The interventions included in the care plan of the patient follows.

Before treatment:

 Education. The nurse should explain the disease course, treatment, and adverse effects.
 Infection. The nurse should teach the patient and his family how to recognize symptoms of infection such
as fever, chills, cough, and sore throat.
 Bleeding. The nurse should educate the patient and the family how to recognize abnormal bleeding through
bruising and petechiae and how to stop it with direct pressure and ice application.
  Promote good nutrition. The nurse should explain that chemotherapy causes weight loss and anorexia, so
the patient must be encouraged to eat and drink high-calorie and high-protein foods and beverages.
 Rehabilitation. The nurse should help establish and appropriate rehabilitation program for the patient
during remission.

Plan meticulous, supportive care:

 Meningeal leukemia. Watch out for meningeal leukemia (confusion, lethargy, headache) and know how to
manage care after intrathecal chemotherapy.
 Hyperuricemia. Prevent hyperuricemia, a possible result of rapid, chemotherapy-induced leukemia cell
lysis through encouraging fluids to 2000 ml daily, giving acetazolamide and sodium bicarbonate tablets, and
allopurinol.
 Infection control. Control infection by placing the patient in a private room and instituting neutropenic
precautions.
 Skincare. Provide thorough skin care by keeping the patient’s skin and perianal area clean, applying mild
lotions and creams to keep skin from cracking and drying, and thoroughly cleaning skin before all invasive
skin procedures.
 Constipation. Prevent constipation by providing adequate hydration, a high-residue diet, stool softeners,
and mild laxatives, and by encouraging walking.
 Mouth ulcers. Control mouth ulceration by checking often for obvious ulcers and gum swelling, and by
providing frequent mouth care and saline rinses.
 Psychological support. Provide psychological support by establishing a trusting relationship to promote
communication.
 Manage stress. Minimize stress by providing a calm, quiet atmosphere that is conducive to rest and
relaxation.
Evaluation

Expected patient outcomes may include:

 Shows no evidence of infection.

 Experiences no bleeding.
 Attains optimal level of nutrition.
 Reports satisfaction with pain and comfort levels.
 Has less fatigue and increased activity.
 Copes with anxiety and grief.
 Absence of complications.

Discharge and Home Care Guidelines

Most patients cope better when they have an understanding of what is happening to them.

 Education. Based on the patient’s education, literacy level, and interest, teaching of the patient and family
should focus on the disease, its treatment, and certainly the resulting significant risk of infection
and bleeding.
 Vascular access device. Management of a vascular access device can be taught to most patients or family
members, and the nurses may need to provide follow-up care for the patient.
 Home care services. Coordination of home care services and instruction can help alleviate anxiety about
managing the patient’s care at home.

Documentation Guidelines
The focus of documentation should include:

 Recent or current antibiotic therapy.

 Signs and symptoms of infectious process.
 Individual risk factors that may potentiate blood loss.
 Baseline vital signs, mentation, urinary output, and subsequent assessments.
 Results of laboratory tests or diagnostic procedures.
 Client’s description of response to pain, specifics of pain inventory, expectations of pain management, and
acceptable level of pain.
 Caloric intake.
 Individual cultural or religious restrictions and personal preferences.
 Plan of care.
 Teaching plan.
 Responses to interventions, teaching, and actions performed.
 Attainment or progress toward desired outcome.
 Modifications to plan of care.
 Discharge needs.
 Specific referrals made.
Pneumonia is an infection that inflames the air sacs in one or both lungs. The air sacs may fill with fluid or pus (purulent
material), causing cough with phlegm or pus, fever, chills, and difficulty breathing. A variety of organisms, including bacteria,
viruses and fungi, can cause pneumonia.

Pneumonia can range in seriousness from mild to life-threatening. It is most serious for infants and young children, people older
than age 65, and people with health problems or weakened immune systems.

Symptoms

The signs and symptoms of pneumonia vary from mild to severe, depending on factors such as the type of germ causing the
infection, and your age and overall health. Mild signs and symptoms often are similar to those of a cold or flu, but they last
longer.
Signs and symptoms of pneumonia may include:

 Chest pain when you breathe or cough

 Confusion or changes in mental awareness (in adults age 65 and older)

 Cough, which may produce phlegm

 Fatigue

 Fever, sweating and shaking chills

 Lower than normal body temperature (in adults older than age 65 and people with weak immune systems)

 Nausea, vomiting or diarrhea

 Shortness of breath
Newborns and infants may not show any sign of the infection. Or they may vomit, have a fever and cough, appear restless or
tired and without energy, or have difficulty breathing and eating.

When to see a doctor

See your doctor if you have difficulty breathing, chest pain, persistent fever of 102 F (39 C) or higher, or persistent cough,
especially if you're coughing up pus.

It's especially important that people in these high-risk groups see a doctor:

 Adults older than age 65

 Children younger than age 2 with signs and symptoms

 People with an underlying health condition or weakened immune system

  People receiving chemotherapy or taking medication that suppresses the immune system
For some older adults and people with heart failure or chronic lung problems, pneumonia can quickly become a life-threatening
condition.

Request an Appointment at Mayo Clinic

Causes

Many germs can cause pneumonia. The most common are bacteria and viruses in the air we breathe. Your body usually
prevents these germs from infecting your lungs. But sometimes these germs can overpower your immune system, even if your
health is generally good.

Pneumonia is classified according to the types of germs that cause it and where you got the infection.

Community-acquired pneumonia

Community-acquired pneumonia is the most common type of pneumonia. It occurs outside of hospitals or other health care
facilities. It may be caused by:

 Bacteria. The most common cause of bacterial pneumonia in the U.S. is Streptococcus pneumoniae. This type of
pneumonia can occur on its own or after you've had a cold or the flu. It may affect one part (lobe) of the lung, a condition
called lobar pneumonia.

 Bacteria-like organisms. Mycoplasma pneumoniae also can cause pneumonia. It typically produces milder symptoms
than do other types of pneumonia. Walking pneumonia is an informal name given to this type of pneumonia, which typically
isn't severe enough to require bed rest.

 Fungi. This type of pneumonia is most common in people with chronic health problems or weakened immune systems, and
in people who have inhaled large doses of the organisms. The fungi that cause it can be found in soil or bird droppings and
vary depending upon geographic location.
  Viruses. Some of the viruses that cause colds and the flu can cause pneumonia. Viruses are the most common cause of
pneumonia in children younger than 5 years. Viral pneumonia is usually mild. But in some cases it can become very
serious.
Hospital-acquired pneumonia

Some people catch pneumonia during a hospital stay for another illness. Hospital-acquired pneumonia can be serious because
the bacteria causing it may be more resistant to antibiotics and because the people who get it are already sick. People who are
on breathing machines (ventilators), often used in intensive care units, are at higher risk of this type of pneumonia.

Health care-acquired pneumonia

Health care-acquired pneumonia is a bacterial infection that occurs in people who live in long-term care facilities or who receive
care in outpatient clinics, including kidney dialysis centers. Like hospital-acquired pneumonia, health care-acquired pneumonia
can be caused by bacteria that are more resistant to antibiotics.

Aspiration pneumonia

Aspiration pneumonia occurs when you inhale food, drink, vomit or saliva into your lungs. Aspiration is more likely if something
disturbs your normal gag reflex, such as a brain injury or swallowing problem, or excessive use of alcohol or drugs.

Risk factors

Pneumonia can affect anyone. But the two age groups at highest risk are:

 Children who are 2 years old or younger

 People who are age 65 or older

Other risk factors include:
  Being hospitalized. You're at greater risk of pneumonia if you're in a hospital intensive care unit, especially if you're on a
machine that helps you breathe (a ventilator).

 Chronic disease. You're more likely to get pneumonia if you have asthma, chronic obstructive pulmonary disease (COPD)
or heart disease.

 Smoking. Smoking damages your body's natural defenses against the bacteria and viruses that cause pneumonia.

 Weakened or suppressed immune system. People who have HIV/AIDS, who've had an organ transplant, or who receive
chemotherapy or long-term steroids are at risk.
Complications

Even with treatment, some people with pneumonia, especially those in high-risk groups, may experience complications,
including:

 Bacteria in the bloodstream (bacteremia). Bacteria that enter the bloodstream from your lungs can spread the infection to
other organs, potentially causing organ failure.

 Difficulty breathing. If your pneumonia is severe or you have chronic underlying lung diseases, you may have trouble
breathing in enough oxygen. You may need to be hospitalized and use a breathing machine (ventilator) while your lung
heals.

 Fluid accumulation around the lungs (pleural effusion). Pneumonia may cause fluid to build up in the thin space
between layers of tissue that line the lungs and chest cavity (pleura). If the fluid becomes infected, you may need to have it
drained through a chest tube or removed with surgery.

 Lung abscess. An abscess occurs if pus forms in a cavity in the lung. An abscess is usually treated with antibiotics.
Sometimes, surgery or drainage with a long needle or tube placed into the abscess is needed to remove the pus.
Prevention

To help prevent pneumonia:

  Get vaccinated. Vaccines are available to prevent some types of pneumonia and the flu. Talk with your doctor about
getting these shots. The vaccination guidelines have changed over time so make sure to review your vaccination status
with your doctor even if you recall previously receiving a pneumonia vaccine.

 Make sure children get vaccinated. Doctors recommend a different pneumonia vaccine for children younger than age 2
and for children ages 2 to 5 years who are at particular risk of pneumococcal disease. Children who attend a group child
care center should also get the vaccine. Doctors also recommend flu shots for children older than 6 months.

 Practice good hygiene. To protect yourself against respiratory infections that sometimes lead to pneumonia, wash your
hands regularly or use an alcohol-based hand sanitizer.

 Don't smoke. Smoking damages your lungs' natural defenses against respiratory infections.

 Keep your immune system strong. Get enough sleep, exercise regularly and eat a healthy diet.

CAUSES ATOPIC ECZEMA

Seasonal allergies, sometimes called "hay fever" or seasonal allergic rhinitis, are allergy symptoms that occur during certain times of the year,
usually when outdoor molds release their spores, and trees, grasses, and weeds release tiny pollen particles into the air to fertilize other plants.
Symptoms
The symptoms of allergic rhinitis may at first feel like those of a cold. But in the case of hay fever, symptoms usually appear when a person
encounters an allergen, such as pollen or mold.
Symptoms include itchy eyes, itchy nose, itchy throat, itchy ears, sneezing, irritability, nasal congestion and hoarseness. People may also
experience cough, postnasal drip, sinus pressure or headaches, decreased sense of smell, snoring, sleep apnea, fatigue and asthma, Josephson
said.
Many of these symptoms are an immune overreaction by the body attempting to protect the vital and sensitive respiratory system from outside
invaders. The antibodies produced by the body succeed in keeping the foreign invaders out, but also cause the symptoms characteristic of allergic
responses.
People can develop hay fever at any age, but most people are diagnosed with the disorder in childhood or early adulthood. Symptoms typically
become less severe as people age.
Often, children may first experience food allergies and eczema before developing hay fever. This then worsens over the years, and patients then
develop allergies to indoor allergens like dust and animals, or seasonal rhinitis, like ragweed (hay fever), grass pollen, molds and tree pollen.
Hay fever can also lead to other medical conditions. People who are allergic to weeds are more likely to get other allergies and develop asthma as
they age. But those who receive immunotherapy, such as allergy shots that help people's bodies get used to allergens, are less likely to develop
asthma, he said.
Tests & diagnosis
A physician will take patient history and do a thorough physical examination if a person reports having hay fever-like symptoms. If necessary, the
physician will do an allergy test. People can get a skin prick test, in which doctors prick the skin on a person's arm or upper back with different
substances to see if any cause an allergic reaction, such as a raised bump called a hive.
A person can also do an allergy blood test. This test rates the immune system's response to a particular allergen by measuring the amount of
allergy-causing antibodies in the bloodstream
Hay fever treatments
Short of staying indoors through hay fever season, allergy sufferers may choose to combat symptoms with medication designed to shut down or
trick the immune sensitivity in the body. Whether over-the-counter or prescription, most allergy pills work by sending chemicals that bind naturally to
histamine — the protein that reacts to the allergen and causes an immune response — coursing through the body, negating the proteins effect.
Other allergy remedies attack the symptoms at the source. Nasal sprays contain active ingredients that decongest by soothing irritated blood
vessels in the nose, while eye drops both moisturize and reduce inflammation. Doctors may also prescribe allergy shots for those particularly
afflicted, Josephson said.
Alternative and holistic options, along with acupuncture, may also help people with hay fever. People can also avoid pollen by keeping their
windows closed in the spring, and by using air purifiers and air conditioners at home.
For allergy sufferers, the best treatment is to avoid the offending allergens altogether. This may be possible if the allergen is a specific food, like
peanuts, which can be cut out of the diet, but not when the very air we breathe is loaded with allergens, such as ragweed pollen. Air purifiers,
filters, humidifiers, and conditioners provide varying degrees of relief, but none is 100 percent effective. Various over-the-counter or prescription
medications offer relief, too.
 Antihistamines.These medications counter the effects of histamine, the substance that makes eyes water and noses itch and causes sneezing
during allergic reactions. Sleepiness was a problem with the first generation of antihistamines, but the newest drugs do not cause such a
problem.
 Nasal steroids.These anti-inflammatory sprays help decrease inflammation, swelling, and mucus production. They work well in combination
with antihistamines and, in low doses for brief periods of time, are relatively free of side effects.
 Cromolyn sodium. A nasal spray, cromolyn sodium can help stop hay fever, perhaps by blocking release of histamine and other symptom-
producing chemicals. It has few side effects.
 Decongestants. Available in capsule and spray form, decongestants thin nasal secretions and can reduce swelling and sinus discomfort.
Intended for short-term use, they are usually used in combination with antihistamines. Long-term usage of spray decongestants can actually
make symptoms worse, while decongestant pills do not have this problem.
 Immunotherapy. Immunotherapy (allergy shots) might provide relief for patients who dont find relief with antihistamines or nasal steroids.
They alter the bodys immune response to allergens, thereby helping to prevent allergic reactions. Current immunotherapy treatments are limited
because of potential side effects.
Learn Do-It-Yourself Measures
It may sound obvious, but avoiding the allergens is the No.1 measure suggested by allergy experts. There are many steps you can take to
eliminate or minimize your exposure to allergens and improve seasonal allergy symptoms. Among the often-cited measures:
 Wear a protective mask when gardening or doing yard work.
 Modify the indoor environment to keep out allergens.
 Check pollen counts before you travel. Or check your local weather report; some provide pollen and mold spore counts.
 Protect your eyes. On vacation and at home, wear sunglasses when outdoors to reduce the amount of pollen coming into the eyes.
 Wash your hair at the end of the day to wash out pollens. That will help avoid pollen transfer to the pillowcase.
 Exercise in the morning or late in the day when pollen counts are typically lower than at other hours. Know that pollen counts typically are higher
on a hot, windy, sunny day compared with a cool day without much wind.

Beware of Foods That Trigger Your Symptoms

If you have seasonal allergies to ragweed, be aware that eating certain foods may trigger your symptoms. About one-third of people with fall
seasonal allergies will have a cross-reaction to certain foods. Foods that migh

Hypertension is another name for high blood pressure. It can lead to severe complications and increases the risk of heart disease, stroke, and
death.
Blood pressure is the force exerted by the blood against the walls of the blood vessels. The pressure depends on
the work being done by the heart and the resistance of the blood vessels.

Medical guidelines define hypertension as a blood pressure higher than 130 over 80 millimeters of mercury
(mmHg), according to guidelines issued by the American Heart Association (AHA) in November 2017.
 Around 85 million people in the United States have high blood pressure.

Hypertension and heart disease are global health concerns. The World Health Organization (WHO) suggests that
the growth of the processed food industry has impacted the amount of salt in diets worldwide, and that this plays a
role in hypertension.

Fast facts on hypertension:

Here are some key points about hypertension. More detail is in the main article.

 Normal blood pressure is 120 over 80 mm of mercury (mmHg), but hypertension is higher than 130 over 80
mmHg.

 Acute causes of high blood pressure include stress, but it can happen on its own, or it can result from an
underlying condition, such as kidney disease.

 Unmanaged hypertension can lead to a heart attack, stroke, and other problems.

 Lifestyle factors are the best way to address high blood pressure.

Treatment
Regular health checks are the best way to monitor your blood pressure.

While blood pressure is best regulated through the diet before it reaches the stage of hypertension, there is a range of
treatment options.

Lifestyle adjustments are the standard first-line treatment for hypertension.

Regular physical exercise

Doctors recommend that patients with hypertension engage in 30 minutes of moderate-intensity, dynamic, aerobic exercise.
This can include walking, jogging, cycling, or swimming on 5 to 7 days of the week.

Stress reduction

Avoiding stress, or developing strategies for managing unavoidable stress, can help with blood pressure control.

Using alcohol, drugs, smoking, and unhealthy eating to cope with stress will add to hypertensive problems. These should be
avoided.

Smoking can raise blood pressure. Giving up smoking reduces the risk of hypertension, heart conditions, and other health
issues.

Medications
People with blood pressure higher than 130 over 80 may use medication to treat hypertension.

Drugs are usually started one at a time at a low dose. Side effects associated with antihypertensive drugs are usually minor.
 Eventually, a combination of at least two antihypertensive drugs is usually required.

A range of drug types are available to help lower blood pressure, including:

 diuretics, including thiazides, chlorthalidone, and indapamide

 beta-blockers and alpha-blockers

 calcium-channel blockers

 central agonists

 peripheral adrenergic inhibitor

 vasodilators

 angiotensin-converting enzyme (ACE) inhibitors

 angiotensin receptor blockers

The choice of drug depends on the individual and any other conditions they may have.

Anyone taking antihypertensive medications should be sure to carefully read labels, especially before taking any over-the-
counter (OTC) medications, such as decongestants.

These may interact with medications used to lower blood pressure.

Causes
 The cause of hypertension is often not known.

Around 1 in every 20 cases of hypertension is the effect of an underlying condition or medication.

Chronic kidney disease (CKD) is a common cause of high blood pressure because the kidneys do not filter out fluid. This fluid
excess leads to hypertension.

Risk factors
A number of risk factors increase the chances of having hypertension.

 Age: Hypertension is more common in people aged over 60 years. With age, blood pressure can increase steadily as the
arteries become stiffer and narrower due to plaque build-up.

 Ethnicity: Some ethnic groups are more prone to hypertension.

 Size and weight: Being overweight or obese is a key risk factor.

 Alcohol and tobacco use: Consuming large amounts of alcohol regularly can increase a person's blood pressure, as can
smoking tobacco.

 Sex: The lifetime risk is the same for males and females, but men are more prone to hypertension at a younger age. The
prevalence tends to be higher in older women.

 Existing health conditions: Cardiovascular disease, diabetes, chronic kidney disease, and high cholesterol levels can lead to
hypertension, especially as people get older.
Other contributing factors include:
 physical inactivity

 a salt-rich diet associated with processed and fatty foods

 low potassium in the diet

 alcohol and tobacco use

 certain diseases and medications

A family history of high blood pressure and poorly managed stress can also contribute.

Signs
Blood pressure can be measured by a sphygmomanometer, or blood pressure monitor.

Having high blood pressure for a short time can be a normal response to many situations. Acute stress and intense exercise,
for example, can briefly elevate blood pressure in a healthy person.

For this reason, a diagnosis of hypertension normally requires several readings that show high blood pressure over time.

The systolic reading of 130 mmHg refers to the pressure as the heart pumps blood around the body. The diastolic reading of
80 mmHg refers to the pressure as the heart relaxes and refills with blood.

The AHA 2017 guidelines define the following ranges of blood pressure:
 Systolic (mmHg) Diastolic (mmHg)

Normal blood pressure Less than 120 Less than 80

Elevated Between 120 and 129 Less than 80

Stage 1 hypertension Between 130 and 139 Between 80 and 89

Stage 2 hypertension At least 140 At least 90

Hypertensive crisis Over 180 Over 120

If the reading shows a hypertensive crisis when taking blood pressure, wait 2 or 3 minutes and then repeat the test.

If the reading is the same or higher, this is a medical emergency.

The person should seek immediate attention at the nearest hospital.

Symptoms
A person with hypertension may not notice any symptoms, and it is often called the "silent killer." While undetected, it
can cause damage to the cardiovascular system and internal organs, such as the kidneys.

Regularly checking your blood pressure is vital, as there will usually be no symptoms to make you aware of the
condition.

It is maintained that high blood pressure causes sweating, anxiety, sleeping problems, and blushing. However, in most cases,
there will be no symptoms at all.

If blood pressure reaches the level of a hypertensive crisis, a person may experience headachesand nosebleeds.

Complications
Long-term hypertension can cause complications through atherosclerosis, where the formation of plaque results in the
narrowing of blood vessels. This makes hypertension worse, as the heart must pump harder to deliver blood to the body.
 High blood pressure raises the risk of a number of health problems, including a heart attack.

Hypertension-related atherosclerosis can lead to:

 heart failure and heart attacks

 an aneurysm, or an abnormal bulge in the wall of an artery that can burst, causing severe bleeding and, in some cases, death

 kidney failure

 stroke

 amputation

 hypertensive retinopathies in the eye, which can lead to blindness

Regular blood pressure testing can help people avoid the more severe complications.

Diet
Some types of hypertension can be managed through lifestyle and dietary choices, such as engaging in physical activity,
reducing alcohol and tobacco use, and avoiding a high-sodium diet.

Reducing the amount of salt

Average salt intake is between 9 grams (g) and 12 g per day in most countries around the world.

The WHO recommends reducing intake to under 5 g a day, to help decrease the risk of hypertension and related health
problems.
 This can benefit people both with and without hypertension, but those with high blood pressure will benefit the most.

Moderating alcohol consumption

Moderate to excessive alcohol consumption is linked to raised blood pressure and an increased risk of stroke.

The American Heart Association (AHA) recommend a maximum of two drinks a day for men, and one for women.

The following would count as one drink:

 12 ounce (oz.) bottle of beer

 4 oz. of wine

 1.5 oz. of 80-proof spirits

 1 oz. of 100-proof spirits

A healthcare provider can help people who find it difficult to cut back.

Eating more fruit and vegetables and less fat

People who have or who are at risk of high blood pressure are advised to eat as little saturated and total fat as possible.

Recommended instead are:

 whole-grain, high-fiber foods

 a variety of fruit and vegetables

 beans, pulses, and nuts

 omega-3-rich fish twice a week

 non-tropical vegetable oils, for example, olive oil

 skinless poultry and fish

 low-fat dairy products

It is important to avoid trans-fats, hydrogenated vegetable oils, and animal fats, and to eat portions of moderate size.

Managing body weight

Hypertension is closely related to excess body weight, and weight reduction is normally followed by a fall in blood pressure. A
healthy, balanced diet with a calorie intake that matches the individual's size, sex, and activity level will help.

The DASH diet

The U.S. National Heart Lung and Blood Institute (NHLBI) recommends the DASH diet for people with high blood pressure.
DASH, or "Dietary Approaches to Stop Hypertension," has been specially designed to help people lower their blood pressure.

It is a flexible and balanced eating plan based on research studies sponsored by the Institute, which says that the diet:

 lowers high blood pressure

 improves levels of fats in the bloodstream

 reduces the risk of developing cardiovascular disease
There is a cookbook written by the NHLBI called Keep the Beat Recipes with cooking ideas to help achieve these results.

Some evidence suggests that using probiotic supplements for 8 weeks or more may benefit people with hypertension.

Types
High blood pressure that is not caused by another condition or disease is called primary or essential hypertension. If it occurs
as a result of another condition, it is called secondary hypertension.

Primary hypertension can result from multiple factors, including blood plasma volume and activity of the hormones that
regulate of blood volume and pressure. It is also influenced by environmental factors, such as stress and lack of exercise.

Secondary hypertension has specific causes and is a complication of another problem.

It can result from:

 diabetes, due to both kidney problems and nerve damage

 kidney disease

 pheochromocytoma, a rare cancer of an adrenal gland

 Cushing syndrome, which can be caused by corticosteroid drugs

 congenital adrenal hyperplasia, a disorder of the cortisol-secreting adrenal glands

 hyperthyroidism, or an overactive thyroid gland

 hyperparathyroidism, which affects calcium and phosphorous levels

 pregnancy

 sleep apnea

 obesity

 CKD
Treating the underlying condition should see an improvement in b
Amoebiasis is a parasitic infection caused by Entamoebahistolytica. It is the third most common cause of death
(after Schistosomiasis and Malaria) from parasitic infections. This disease generally occurs in young to middle
aged adult. Amoebiasis is usually transmitted by contamination of drinking water and foods with fecal matter, but
it can also be transmitted indirectly through contact with dirty hands or objects as well as by oral-anal contact.
Amoebiasis is mostly associated with people living in areas of poor sanitation and it is a common cause of diarrhea
among people living or traveling to developing countries, specially those located in tropical or subtropical areas,
but also coming from domestic suburbs with non hygienic conditions.

Approximately 500 cases are reported each year in New York State. About 500 million people worldwide are
believed to carry E. histolytica in their intestines. Amoebiasis is believed to cause between 40,000 and 100,000
deaths worldwide each year. The symptoms of intestinal amoebiasis include diarrhoea, abdominal cramps, bowel
movements streaked with blood or mucus, nausea or vomiting and occasionally fever. Most patients with liver
abscess are febrile and have right-upper-quadrant pain, which may be dull or pleuritic in nature and radiate to the
shoulder. Point tenderness over the liver and right-sided pleural effusion are common. Jaundice is rare It can also
spread to other organs like the liver, lungs, and brain by invading the venous system of the intestines.

General therapy relieves symptoms, replaces blood, and corrects fluid and electrolyte losses. Asymptomatic
patients can be treated with luminal agents like Liodoquinol or DiloxanideFuroate. Anti-diarrhoeal medication
may also be prescribed. Metronidazole can produce a metallic taste in the mouth and may give rise to nausea.
Several drugs are available for treating intestinal infections, the most effective of which has been shown to be
Paromomycin and diloxanidefuroate is used in the US.Clean bathrooms and toilets often. Wash hands thoroughly
with soap and hot running water for at least 10 seconds after using the toilet or changing a nappy.
Avoid eating uncooked foods, particularly vegetables and fruit which cannot be peeled before eating.

Ameobiasis Treatment and Prevention Tips

1. Cut and keep your nails clean

2. Wash hands before food and after using the toilet

3. Avoid solids because they can cause cramps.

4. Wash vegetables and fruits well in flowing water before intake or cooking

5. Avoid sharing towels with infected persons

6. Avoid alcohol for preventing intestinal complications while having amoebiasis

7. Take care of drinking water - either opt for mineral water or water boiled for 20 minutes

8. Avoid eating uncooked foods, particularly vegetables and fruit which cannot be peeled before eating.
Practice Essentials
Viral conjunctivitis, or pinkeye (see the image below), is a common, self-limiting condition that is typically caused
by adenovirus. Other viruses that can be responsible for conjunctival infection include herpes simplex virus (HSV),
varicella-zoster virus (VZV), picornavirus (enterovirus 70, Coxsackie A24), poxvirus (molluscumcontagiosum,
vaccinia), and human immunodeficiency virus (HIV).

Viral conjunctivitis.Image courtesy of Wikimedia Commons.

Viral conjunctivitis is highly contagious, usually for 10-12 days from onset as long as the eyes are red. Patients
should avoid touching their eyes, shaking hands, and sharing towels, napkins, pillow cases, and other fomites,
among other activities. Transmission may occur through accidental inoculation of viral particles from the patient's
hands or by contact with infected upper respiratory droplets, fomites, or contaminated swimming pools. The
infection usually resolves spontaneously within 2-4 weeks.
Signs and symptoms
Signs and symptoms of viral conjunctivitis may include the following:
 Itchy eyes
 Tearing
 Redness
 Discharge
 Light sensitivity (with corneal involvement)
See Clinical Presentation for more details.
Diagnosis
Generally, a diagnosis of viral conjunctivitis is made on the clinical features alone. Laboratory tests are typically
unnecessary, but they may be extremely helpful in some cases, particularly when an epidemic of adenoviral
keratoconjunctivitis threatens a community or clinic. Specimens can be obtained by culture and conjunctival
cytology smear if inflammation is severe, in chronic or recurrent infections, with atypical conjunctival reactions, and
in patients who fail to respond to treatment. Giemsa staining of conjunctival scrapings may aid in characterizing
the inflammatory response. A rapid point-of-service immunoassay is now readily available to guide the clinician’s
recommendations upon initial presentation (Adenoplus, RPS, Sarasota, FL).
See Workup for more details.
Management
Treatment of adenoviral conjunctivitis is supportive. Patients should be instructed to use cold compresses and
lubricants, such as chilled artificial tears, for comfort. Topical vasoconstrictors and antihistamines may be used for
severe itching but generally are not indicated. For patients who may be susceptible, a topical astringent or
antibiotic may be used to prevent bacterial superinfection. There is clinical evidence that topical ganciclovir is
effective against at least Adenovirus serotype 8, thus compelling many clinicians to prescribe this agent off-label
for compelling cases of epidemic keratoconjunctivitis (EKC), particularly when corneal lesions are noted.
Virus-specific treatments
Patients with conjunctivitis caused by HSV usually are treated with topical antiviral agents, including ganciclovir
(Zirgan, Bausch & Lomb, Bridgewater, NJ), idoxuridine solution and ointment, vidarabine ointment, and trifluridine
solution (Viroptic, Alcon, Fort Worth, TX).
Treatment of VZV eye disease includes high-dose oral acyclovir to terminate viral replication.
For conjunctivitis associated with molluscumcontagiosum, disease will persist until the skin lesion is treated.
Removal of the central core of the lesion or inducement of bleeding within the lesion usually is enough to cure the
infection.
Prevention
Preventing transmission of viral conjunctivitis is important. Both patient and provider should wash hands
thoroughly and often, keep hands away from the infected eye and contralateral eye, and avoid sharing towels,
linens, and cosmetics. Infected patients should be advised to stay home from school and work. Those who wear
contact lenses should be instructed to discontinue lens wear until signs and symptoms have resolved.
See Treatment and Medication for more details.
 Angina Pectoris
Angina pectoris is a clinical syndrome characterized by paroxysms of pain or a feeling of
pressure in the anterior chest. The cause is insufficient coronary blood flow, resulting in an
inadequate supply of oxygen to meet the myocardial demand.
Angina is usually a result of atherosclerotic heart disease and is associated with a significant
obstruction of a major coronary artery. Factors affecting anginal pain are physical exertion,exposure
to cold, eating a heavy meal, or stress or any emotion-provoking situation that increases blood
pressure, heart rate, and myocardial workload. Unstable angina is not associated with the above and
may occur at rest.
Clinical Manifestations
• Pain varies from a feeling of indigestion to a choking or heavy sensation in the upper chest
ranging from discomfort to agonizing pain. The patient with diabetes mellitus may not experience
severe pain with angina.
• Angina is accompanied by severe apprehension and a feeling
of impending death.
• The pain is usually retrosternal, deep in the chest behind the upper or middle third of the sternum.
•Discomfort is poorly localized and may radiate to the neck,jaw, shoulders, and inner aspect of the
upper arms (usually the left arm).
• A feeling of weakness or numbness in the arms, wrists, and hands, as well as shortness of breath,
pallor, diaphoresis,dizziness or lightheadedness, and nausea and vomiting, may accompany the
pain. Anxiety may occur with angina.
• An important characteristic of anginal pain is that it subsides
when the precipitating cause is removed or with nitroglycerin.
 Assessment and Diagnostic Methods
• Evaluation of clinical manifestations of pain and patient history
• Electrocardiogram changes (12-lead ECG), stress testing,blood tests
• Echocardiogram, or invasive procedures such as cardiac catheterization and coronary
angiography
Medical Management
The objectives of the medical management of angina are to decrease the oxygen demand of the
myocardium and to increase the oxygen supply. Medically, these objectives are met through
pharmacologic therapy and control of risk factors.Alternatively, reperfusion procedures may be used
to restore the blood supply to the myocardium.
These include PCI procedures (eg, percutaneous transluminal coronary angioplasty [PTCA],
intracoronary stents, and atherectomy)
Pharmacologic Therapy
•Nitrates, the mainstay of therapy (nitroglycerin)
• Beta-adrenergic blockers (metoprolol and atenolol)
• Calcium channel blockers/calcium ion antagonists (amlodipine)
• Antiplatelet and anticoagulant medications (aspirin,heparin, glycoprotein )
• Oxygen therapy
NURSING PROCESS
THE PATIENT WITH ANGINA
Assessment
Gather information about the patient’s symptoms and
activities, especially those that precede and precipitate
attacks of angina pectoris. In addition, assess the
patient’s risk factors for CAD, the patient’s response to
angina, the patient’s and family’s understanding of the diagnosis,
and adherence to the current treatment plan.
Diagnosis
Nursing Diagnoses
• Ineffective cardiac tissue perfusion secondary to CAD as
evidenced by chest pain or other prodromal symptoms
• Death anxiety
• Deficient knowledge about underlying disease and methods
for avoiding complications
• Noncompliance, ineffective management of therapeutic
regimen related to failure to accept necessary lifestyle
changes
Collaborative Problems/Potential Complications
Potential complications of angina include ACS and/or MI,
dysrhythmias and cardiac arrest, heart failure, and
cardiogenic shock.
Planning and Goals
Goals include immediate and appropriate treatment when
angina occurs, prevention of angina, reduction of anxiety,
awareness of the disease process and understanding of the
prescribed care, adherence to the self-care program, and
absence of complications.
Nursing Interventions
Treating Angina
• Take immediate action if patient reports pain or if the
person’s prodromal symptoms suggest anginal ischemia
• Direct the patient to stop all activities and sit or rest in
bed in a semi-Fowler’s position to reduce the oxygen
requirements of the ischemic myocardium.
• Measure vital signs and observe for signs of respiratory
distress.
• Administer nitroglycerin sublingually and asses the
patient’s response (repeat up to three doses).
• Administer oxygen therapy if the patient’s respiratory
rate is increased or if the oxygen saturation level is
decreased.
64 Angina Pectoris A
Angina Pectoris 65 A
• If the pain is significant and continues after these
interventions, the patient is further evaluated for acute
MI and may be transferred to a higher-acuity nursing unit.
Reducing Anxiety
• Explore implications that the diagnosis has for patient.
• Provide essential information about the illness and methods
of preventing progression. Explain importance of following
prescribed directives for the ambulatory patient at
home.
• Explore various stress reduction methods with patient (eg,
music therapy).
Preventing Pain
• Review the assessment findings, identify the level of activity
that causes the patient’s pain or prodromal symptoms,
and plan the patient’s activities accordingly (Box A-1).
• If the patient has pain frequently or with minimal activity,
alternate the patient’s activities with rest periods. Balancing
activity and rest is an important aspect of the educational
plan for the patient and family.
Teaching Patients Self-Care
• The teaching program for the patient with angina is designed
so that the patient and family understand the illness, identify
the symptoms of myocardial ischemia, state the actions
to take when symptoms develop, and discuss methods to
prevent chest pain and the advancement of CAD.
• The goals of education are to reduce the frequency and
severity of anginal attacks, to delay the progress of the
Factors that Trigger Angina Episodes
• Sudden or excessive exertion
• Exposure to cold
• Tobacco use
• Heavy meals
• Excessive weight
• Some over-the-counter drugs, such as diet pills, nasal
decongestants, or drugs that increase heart rate and
blood pressure