Arthritis Australia

By O. Will. Villanova University.

If diverticulitis occurs cheap 0.5 mg dutasteride otc, it can cause: • Abdominal pain (severe and sudden onset) • Constipation or diarrhea • Fever discount dutasteride 0.5mg otc, nausea, vomiting • Rectal bleeding Note: Complications of diverticulitis include blockage in the colon and abscess or fistula formation. If a pouch ruptures, the waste material can spill into the abdominal cavity, leading to peritonitis, which is a serious medical problem that needs immediate attention. Prior to the 1900s when refining of grains started, diverticular disease was rare in North America. A high-fibre diet can reduce your risk of diverticular disease and also help prevent flare-ups in those who already have it. For those with mild symptoms, dietary changes and antibiotics for the infection may be all that is needed. During a flare-up, your doctor will advise a temporary low-fibre diet to allow the colon to heal. Surgery is a last resort, but may be necessary for those with bowel obstruction or severely damaged intestine. Foods to avoid: • Fast foods and processed foods contain chemicals that can damage intestinal health. In the past, those with diverticular disease were told to avoid nuts or seeds, but there is no evidence that these foods trigger flare-ups, so they can be enjoyed as part of a healthy diet. Avoid holding it in as that can create dry, hard stools that are hard to pass, increasing colon pressure. Top Recommended Supplements Fibre: Helps prevent constipation and improve bowel function. One study of glucomannan, a water-soluble dietary fibre derived from konjac root, found that it reduced symptoms of diverticular disease. Probiotics: Beneficial bacteria help to reduce the risk of gut infection and also aid digestion and nutrient absorption. Dosage: Take one to three capsules daily of a product that provides at least one billion live cells. Include healthy fats (fish and flaxseed) and fermented milk products (yogurt and kefir) in your diet. Ear infections, known medi- cally as Otitis Media, are a non-contagious infection of the middle ear, just behind the eardrum. If the middle ear becomes inflamed from the infection, fluid builds up behind the eardrum, creat- ing a breeding ground for infection. These infections can also occur when there is swelling or problems with the eustachian tubes (the tubes that connect the middle ear to inner nose). In chil- dren, the eustachian tubes are narrower and shorter, making it easier for fluid to get E trapped in the middle ear during an infection. More serious infec- tions, particularly in infants and toddlers, may require medical treatment. A healthy diet and lifestyle can help support proper immune function and reduce the risk of developing ear infections. Statistics show that three out of four children younger than three have had at least one ear infection. When this happens, the skin inside the ear becomes watery, reducing the natural acidity that fights incoming pathogens and infection may result. Swimmer’s ear usually clears up on its own, but requires a trip to the doctor if there is pain. For infants older than six months who are otherwise healthy and have mild symptoms, it is recommended to just keep an eye on your child for 72 hours. Once symptoms are detected, the ear infection is treated with a course of antibiotics to avoid complica- tions. For severe cases where a child has recurrent ear infections, surgery may be rec- ommended to place small tubes inside the ears to drain fluid and relieve pressure. The concern is that hearing loss from chronic ear infections may delay language and speech development. Children are under general anaesthesia during surgery, and usually recover quickly with little pain. There are maintenance issues and minor complications that may result from ear tubes, so it is important to discuss all factors with your doctor before proceeding with surgery. Children involved in this long-term study were followed from approximately age three to age 11. Over the years, the researchers tested the children for reading, writing, spelling, behavioural issues, social skills, and intelligence, and found that there 214 was no significant difference between the two groups. As a result of this groundbreaking study, guidelines regarding the treatment of chronic ear infections with tubes were re- evaluated and changed to encourage a watchful, waiting approach to treatment.

While technology has made circuits and machines safer cheap 0.5 mg dutasteride fast delivery, haemofiltration is highly invasive cheap 0.5 mg dutasteride, exposing patients to various complications and dangers. Nurses unfamiliar with using haemofiltration are encouraged to find out how to use it in practice before having to care on their own for patients receiving haemofiltration. Some useful articles have appeared in specialist journals; Kirby and Davenport (1996) offer a useful recent overview; despite their age, articles by Miller et al. He developed rhabdomyolysis and acute renal failure from compression injury as a result of collapsing, lying on the floor for over 18 hours and ingesting nephrotoxic medication. Identify and explain any differences in equipment and patient application between haemofiltration and haemodiafiltration (e. Describe and explain the observational assessment of Mr Sinclair’s coagulation status. Chapter 36 Gastrointestinal bleeds Fundamental knowledge Gastrointestinal anatomy Introduction The importance of gastrointestinal failure to critical care pathophysiology has been increasingly recognised; major gastrointestinal bleeding poses more obvious threats to survival. Most clotting factors are produced by the liver, and so hepatic dysfunction disrupts haemostasis. Oesophageal varices can haemorrhage so rapidly and profusely that one-half of patients die from their first bleed (Schoenfield & Butler 1998). Variceal bleeding The portal vein carries blood (and nutrients) from the stomach to the liver; portal hypertension can be caused by portal vein thrombosis or (more often) cirrhosis (McCaffrey 1991). Alcoholic liver disease, the main cause of cirrhosis (Quinn 1995), is often complicated by malnourishment and gastric ulceration. Pressures exceeding 15 mmHg can cause rupture (Lisicka 1997); obstruction may create pressures exceeding 30 mmHg (McCaffrey 1991), Rupture of varices can cause massive haemorrhage, with 30–50 per cent mortality (Sung et al. Urgent treatment should: ■ stop the haemorrhage ■ provide fluid resuscitation ■ replace clotting factors Haemorrhage is usually stopped by: Intensive care nursing 356 ■ balloon tamponade ■ sclerosis ■ stents Medical treatments Direct pressure to bleeding points is possible using balloon tamponade (Sengstaken, Sengstaken-Blakemore, Minnesota tubes; see Figure 36. Tubes usually have four ports: ■ oesophageal balloon (to stop bleeding) ■ oesophageal aspiration port (omitted on 3-port tubes) ■ gastric balloon (to anchor tubes) ■ gastric aspiration port Balloon tamponade controls 85–92 per cent of bleeds, but re-bleeds are common (Boyer & Henderson 1996), so that balloon tamponade is often only a temporary (emergency) treatment. Tubes are large and relatively difficult to introduce, especially during major haemorrhaging. Despite oesophageal aspiration channels, patients will usually be intubated to prevent aspiration; decreased consciousness and other complications usually necessitate ventilation. Unlike digital pressure on radial arteries, balloon pressure on oesophageal varices creates various problems: ■ surrounding tissue cannot be seen, and so ischaemia from arterial/capillary occlusion may remain undetected until damage occurs Gastrointestinal bleeds 357 ■ Figure 36. Recommended pressures vary from 25–40 mmHg (McCaffrey 1991) to 50–60 mmHg (Sung 1997) (see section on capillary occlusion pressure in Chapter 5). Pressure can be measured by connecting a sphygmomanometer or continuous monitoring system to the Oesophageal inflation port. McCaffery (1991) recommends measuring oesophageal pressure half-hourly, but higher priorities may prevent this aspect of care, and with lack of consensus on optimal pressure, frequent measurement has dubious benefits. Using external traction (weights) to further compress oesophageal varices with the gastric balloon (Hudak et al. Gastric varices, already compressed by the gastric balloon, should prevent flow to higher varices. Many centres avoid using traction, but, if used, lifting weights should be avoided as tube movement may dislodge clots. Since deflation can traumatise friable healing tissue, some centres avoid inflating oesophageal balloons, relying on occlusion of flow from inflation of gastric balloons to stop the haemorrhage. They can temporarily control haemorrhage for 28–70 per cent of patients, although up to one-third may re-bleed during treatment (Boyer & Henderson 1996); like tamponade, vasopressin can buy time for more definitive treatments. Vasopressin causes systemic vasoconstriction, and extravasation may cause necrosis, and so it should be given into central veins (Boyer & Henderson 1996). The hormone somatostatin inhibits gastrin secretion, reducing gastric acid secretion. Schoenfield and Butler (1998) claim that the longer-acting synthetic analogue octreotide is as effective as endoscopy, but anecdotal reports suggest it is ineffective. Cold water may also cause vagal stimulation, increasing gastric motility and irritation to ulcers. Treatment may be preventative (protecting against gastric acidity), supportive (replacing blood volume and clotting factors), medical (treating bacteria—see below) or surgical. Gastric mucus maintains wide pH differences between gastric acid (or alkaline bile) and epithelium. Mucosal failure may be caused by ■ excess acid production (from gastromas) ■ lack of neutralising factors (absence of enterai nutrition) ■ bile reflux ■ irritant drugs (e. The bacterium Helicobacter pylori is particularly associated with peptic ulceration. About one-half of the population harbour this gram negative bacterium, with colonisation often starting in childhood (MacConnachie 1997a). As it is found in water, enteric transmission seems likely (Cotterill 1996), and it is particularly prevalent when sanitation is poor. Most people colonised by Helicobacter pylori remain asymptomatic (Cotterill 1996), but most people with ulcers are infected by it (MacConnachie 1997a), and it appears to cause gastritis, ulcers and gastromas (Cotterill 1996). According to MacConnachie (1997a) it provokes: ■ local inflammatory responses (disrupting mucosal barriers) ■ systemic immune response and inhibits endogenous somatostatin release (so increasing acid production).

Other hormones purchase 0.5mg dutasteride visa, such as growth factor purchase dutasteride 0.5 mg without prescription, insulin, and thyroid hormone, are also implicated. While this condition can be painful, the lumps are benign and do not increase F your risk of breast cancer. If you do discover a lump in your breast tissue, it is impor- tant to consult with your doctor. There are a number of lifestyle modifications and natural treatments that can help reduce the symptoms of fibrocystic breasts and promote good breast health. Fibrocystic lumps move freely when touched and they get worse with the men- strual cycle. In contrast, a cancerous growth in the breast is often not tender or freely movable when touched. To rule out breast cancer, a needle aspiration of the cyst and/or mammogram can be done. Onions, garlic, beets, arti- chokes, and lemon help support liver function and the elimination of hormones. Flax- seed also contains lignans which act as a phytoestrogen and help to block the effects of estrogen. Aside from coffee, it is also in black tea (and, to a lesser extent, in green tea), cola, chocolate, and some over-the-counter medications. Women who are obese have higher levels of estrogen be- cause this hormone can be stored in fat tissue. Ask your doctor to check your thyroid as low thyroid can worsen symptoms of fibrocystic breasts. Top Recommended Supplements Chasteberry (vitex): Helps to balance hormone levels of estrogen, progesterone, and prolactin. Fish oils: Contain beneficial omega-3 fatty acids, which have anti-inflammatory effects, help reduce breast pain, and also help the body absorb iodine. Indole-3-carbinol: A compound found naturally in cruciferous vegetables that aids in de- toxification of estrogen, protects liver function, and may protect against hormonal cancers. Complementary Supplements Magnesium: Helps reduce pain and inflammation of fibrocystic breast changes, particularly symptoms associated with the menstrual cycle. Studies have shown that it can reduce breast pain and swelling associated with the menstrual cycle. Reduce exposure to xenoestrogens (plastics, pesticides, non-organic meat, and dairy). Despite their name, fibroids are not fibrous; they are comprised of connective tissue and muscle. In rare cases fibroids can develop into cancer; however, most often they are not harmful, but may cause pain and discomfort when they be- come large and put pressure on the abdomen and bladder. Fibroids typically appear during the child-bearing years, particularly between the ages of 30 and 40 years, and then shrink in menopause. While the actual cause of fibroids is uncertain, it is known that their growth is stimulated by estrogen. Fibroids are becoming increasingly common today, which has been attributed to high amounts F of xenoestrogens (estrogen-like compounds) in our food supply and environment. They are present in foods (fish, meat, and dairy) and in the environment (plastics, pesticides, and skin care products). Research suggests that xenoestrogens may play a role in uterine fibroids, certain cancers, and premature sexual maturity in young girls. Studies have also found a link between consump- tion of red meat and ham with the presence of fibroids. Pregnancy and childbirth may have a protective effect, but more research is needed. Since fibroids tend to grow slowly and then shrink after menopause, surgical procedures are recom- mended only if the fibroids are large and cause heavy bleeding and pain, or if they are impairing fertility. Surgical options include myomectomy (incision into abdomen and removal of fibroids), hysterectomy (removal of uterus), and uterine artery emboliza- tion (procedure that cuts off blood supply to the uterus to cause the fibroid to shrink). Medications are also used to reduce estrogen levels and shrink fibroids; however, F there are many side effects with these drugs. Progesterone cream is popularly used for fibroid treatment; however, in some women it can cause fibroids to grow, so it should be used only under a physician’s supervision. Dietary Recommendations Foods to include: • Fibre-rich foods such as fruits, vegetables, and whole grains will help extract excessive estrogen stores from the body. The best food sources of iron include clams, oysters, organ meats, beef, pork, poultry, and fish. Iron is also present in eggs, dried beans, fortified cereals, and dark green leafy vegetables. Foods to avoid: • Meat, dairy, and fish (farmed salmon) may contain dioxins and other xenoestrogens that can stimulate fibroid growth and worsen symptoms.

For this edition I am particularly grateful to Derek Johnston and Amanda Williams for pointing me in the right direction discount dutasteride 0.5mg line, to David Armstrong for conversation and cooking purchase 0.5mg dutasteride otc, to Cecilia Clementi for help with all the new references and for Harry and Ellie for being wonderful and for going to bed on time. Take advantage of the study tools offered to reinforce the material you have read in the text, and to develop your knowledge of Health Psychology in a fun and effective way. Study Skills Open University Press publishes guides to study, research and exam skills, to help under- graduate and postgraduate students through their university studies. Get a £2 discount off these titles by entering the promotional code app when ordering online at www. The chapter highlights differences between health psychology and the biomedical model and examines the kinds of questions asked by health psychologists. Then the possible future of health psychology in terms of both clinical health psychology and becoming a professional health psychologist is discussed. Finally, this chapter outlines the aims of the textbook and describes how the book is structured. This chapter covers: ➧ The background to health psychology ➧ What is the biomedical model? Darwin’s thesis, The Origin of Species, was published in 1856 and described the theory of evolution. This revolutionary theory identified a place for Man within Nature and suggested that we were part of nature, that we developed from nature and that we were biological beings. This was in accord with the biomedical model of medicine, which studied Man in the same way that other members of the natural world had been studied in earlier years. This model described human beings as having a biological identity in common with all other biological beings. The biomedical model of medicine can be understood in terms of its answers to the following questions: s What causes illness? According to the biomedical model of medicine, diseases either come from outside the body, invade the body and cause physical changes within the body, or originate as internal involuntary physical changes. Such diseases may be caused by several factors such as chemical imbalances, bacteria, viruses and genetic predisposition. Because illness is seen as arising from biological changes beyond their control, individuals are not seen as responsible for their illness. The biomedical model regards treatment in terms of vaccination, surgery, chemotherapy and radiotherapy, all of which aim to change the physical state of the body. Within the biomedical model, health and illness are seen as qualitatively different – you are either healthy or ill, there is no continuum between the two. According to the biomedical model of medicine, the mind and body function independently of each other. From this perspective, the mind is incapable of influencing physical matter and the mind and body are defined as separate entities. The mind is seen as abstract and relating to feelings and thoughts, and the body is seen in terms of physical matter such as skin, muscles, bones, brain and organs. Changes in the physical matter are regarded as independent of changes in state of mind. Within traditional biomedicine, illness may have psychological consequences, but not psychological causes. These developments have included the emergence of psychosomatic medicine, behavioural health, behavioural medicine and, most recently, health psychology. These different areas of study illustrate an increasing role for psychology in health and a changing model of the relationship between the mind and body. Psychosomatic medicine The earliest challenge to the biomedical model was psychosomatic medicine. This was developed at the beginning of the twentieth century in response to Freud’s analysis of the relationship between the mind and physical illness. At the turn of the century, Freud described a condition called ‘hysterical paralysis’, whereby patients presented with paralysed limbs with no obvious physical cause and in a pattern that did not reflect the organization of nerves. Freud argued that this condition was an indication of the individual’s state of mind and that repressed experiences and feelings were expressed in terms of a physical problem. This explanation indicated an interaction between mind and body and suggested that psychological factors may not only be consequences of illness but may contribute to its cause. Behavioural health Behavioural health again challenged the biomedical assumptions of a separation of mind and body. Behavioural health was described as being concerned with the main- tenance of health and prevention of illness in currently healthy individuals through the use of educational inputs to change behaviour and lifestyle. The role of behaviour in determining the individual’s health status indicates an integration of the mind and body. Behavioural medicine A further discipline that challenged the biomedical model of health was behavioural medicine, which has been described by Schwartz and Weiss (1977) as being an amalgam of elements from the behavioural science disciplines (psychology, sociology, health edu- cation) and which focuses on health care, treatment and illness prevention. Behavioural medicine was also described by Pomerleau and Brady (1979) as consisting of methods derived from the experimental analysis of behaviour, such as behaviour therapy and behaviour modification, and involved in the evaluation, treatment and prevention of physical disease or physiological dysfunction (e. Behavioural medicine therefore included psychology in the study of health and departed from traditional biomedical views of health by not only focusing on treatment, but also focusing on prevention and intervention. In addition, behavioural medicine challenged the traditional separation of the mind and the body.