Arthritis Australia

By T. Ugolf. Carlow College. 2018.

Enforcing the practice of good personal hygiene purchase 5 mg montelukast with amex, such as regular bathing montelukast 10 mg mastercard, laundering clothes, not sharing towels, soaps and wearing sandals in communal showers. Arthropods and skin disease Arthropods have been associated with human beings since the age of antiquity. Although arthropods are important in maintaining the ecosystem we live in, they can adversely affect our health in several ways: 170 ª By causing direct, non-allergic, local tissue damage through stings, bites, exposure of toxic body fluid (blister beetles), and tissue invasion (sand flea and brown recluse spider). It is therefore a family disease spreading amongst those living in close association, especially when they sleep together in the same bed. Methods aimed at killing the mites will do little to immediately alleviate the nuisance and irritation caused by the rash, although this will eventually disappear. Separate medical treatment however, may be necessary especially if secondary infections have become established. In the past, a common procedure was to give the patient a hot bath and a vigorous scrubbing with a brush until the patient bled, but this is not very effective at either removing or killing the mites. However, as many but certainly not all, patients with scabies are dirty, an ordinary bath before treatment may be advisable for general hygienic reasons. However, if large numbers of patients suffering from scabies are to be treated, such as in epidemic situations, bathing may not be practical. Decreasing the humidity in rooms, improving ventilation and removing dust can control mites and associated fungi. Bedrooms and living rooms should be aired regularly, or other measures should be taken to reduce dampness. The shaking of bedclothes and frequent washing of sheets and blankets reduces the availability of food and therefore 171 the number of mites. General insecticides used for pest control are not effective but a special product containing benzyl benzoate is available, which destroys mites when applied to mattresses, and upholstery. Cutaneous Leishmaniasis Known under a variety of common names, such as oriental sore in old world, uta or chiclero ulcer in new world. It is caused by leishmania major, leishmania tropica and leishmania aethiopica in old world and by leishmania braziliensis, leishmania mexicana and leishmania peruana in new world. It is characterized by typical ulcer that starts as a nodule at the site of bite, and then a crust develops in the middle which exposes the ulcer. It is recommended that personal protection measures be taken, such as repellents, fine mesh screens, insecticide treated clothing and/ or insecticide treated bed nets are used. Application of basic sanitation This is aimed at abolishing the breeding sites around human habitation, such as proper disposal of refuse; filling of cracks and holes in the soils and walls. Control of Animal Reservoir In Ethiopia, control measures were carried out against the rock hyrax, a wild animal reservoir of leishmaniasis, where by reduction of the prevalence of leishmaniasis was occurred. Case treatment: Treatment is more effective when a partnership develops that includes the patient, family members and doctor. Hunter, savin, and dahi clinical dermatology voli1 and 2 oxford, black well scientific publication 1989. National technical guideline for integrated disease surveillance and response disease prevention and control department A. Monica chesbrough, District laboratory practice in Tropical countries, part I, Cambrige university press, 1998. First edition 2009 Revised first edition 2009 Second edition 2014 For comments and feedback, please contact the author at chiangyizhen@gmail. Dr Chiang is to be congratulated for her exceptional industry and enthusiasm in converting an idea into a reality. Julian Verbov Professor of Dermatology Liverpool 2009 Preface to the 2nd edition Nicole and I are gratifed by the response to this Handbook which clearly fulfils its purpose. The positive feedback we have received has encouraged us to slightly expand the text and allowed us to update where necessary. Julian Verbov Professor of Dermatology Liverpool 2014 5 British Association of Dermatologists Dermatology: Handbook for medical students & junior doctors Foreword to First edition There is a real need for appropriate information to meet the educational needs of doctors at all levels. The hard work of those who produce the curricula on which teaching is based can be undermined if the available teaching and learning materials are not of a standard that matches the developed content. Any handbook must meet the challenges of being comprehensive, but brief, well illustrated, and focused to clinical presentations as well as disease groups. It should find a home in the pocket of students and doctors in training, and will be rapidly worn out. I wish it had been available when I was in need, I am sure that you will all use it well in the pursuit of excellent clinical dermatology! Dr Mark Goodfield President of the British Association of Dermatologists 6 British Association of Dermatologists Dermatology: Handbook for medical students & junior doctors What is dermatology? Ability to examine skin, hair, nails and mucous membranes systematically showing respect for the patient 5.

On the basis of these three dimensions a group of activities that pursue the following general objectives are planned: − Promote among youth stable leisure and free time alternatives on weekend nights that are playful in nature generic 10mg montelukast with visa, participatory and about relationships discount montelukast 5 mg with visa. Fernandez-Hermida and Secades (2002) conducted an evaluation of the "Abierto Hasta el Amanecer", applying a pre-test/post-test control group design in a sample of 330 youth of both sexes with a mean age of 18. Only in tobacco consumption was it found that the control group consumed significantly more than the experimental group did after participating in the program. Other measures of alcohol and illegal drug consumption and risk perception of drug use showed no difference between both groups. They describe themselves as a group of people concerned about the use of drugs in youth leisure spaces, and provide information in order to reduce the risks of drug consumption. Their interventions are focused on leisure spaces (disco nightclubs, festivals, concerts and bar districts) and are characterized by low demands of and integration with drug users. For this reason, they utilize collaborators who share ways of having fun and tastes with young people, the target population of preventive interventions. Energy Control´s basic principles of action are: - Uncritical stance on the consumption of drugs, recognizing the possibility of responsible drug use, and the right of users to have preventive information in order to make decisions about their health. As a group, they do not adopt a position in favor of or against drugs and understand drug use as a health issue, not a moral one. Interventions are based on providing objective information about drugs that facilitates taking responsibility in the decision on whether or not to consume. For this, they use information materials (postage-free, comics, phone line, leaflets…) that adapt to the demands of people who go to these particular places of leisure. In them, suggestions are offered on detecting and avoiding the adverse effects of drugs, both in self consumption, and in that of others. Energy Control Group is well known for its pill testing service, which determines the composition of a drug within a few minutes. People who want can solicit the analysis of any substance, by going to the stand set up for this purpose at points frequented by young people (club parking lots, festival grounds, nightlife zones. This service is particularly interesting and facilitates the ability to provide information in other formats, talks or written information to people who would otherwise not heed it. The waiting time for the analytical results is the ideal moment to devote to chatting about drugs and their effects. Energy Control has the collaboration of professionals from bars and nightclubs (disc jockeys, party planners and other professionals) who are concerned about the growing presence of drugs on the night scene. They require in general less commitment and effort on behalf of the participants than selective programs. Find out what drug prevention programs are carried out in your community and explain one of them in detail: Example: Bilbao Gaua (Bilbao, Spain) 35 Bilbao Gaua is an alternative leisure proposal for weekend nights aimed at youngsters between the ages of 16 and 35 who want to participate in a different option on Friday and Saturday nights. The cultural activities are free and no pre-registration is required, you just have to show up at the scheduled time of the activity. Redes para el tiempo libre (guía metodológica para la puesta en marcha de programas de ocio de fin de semana). Assessing the impact of antidrug advertising on adolescent drug consumption: Results from a behavioral economic model. A meta-analysis of the effectiveness of mass-communication for changing substance use knowledge, attitudes, and behaviour. Special issue: The message and the media: Alcohol portrayal on television affects actual drinking behaviour. Environmental Strategies for Substance Abuse Prevention: Analysis of the Effectiveness of Policies to Reduce Alcohol, Tobacco and Illicit Drug Problems. Mandated server training and reduced alcohol-involved traffic crashes: a time series analysis of the Oregon experience. By means of an open search or an advanced search composed of 13 subject and context categories, both descriptions of content and related information can be obtained. The role and importance of the risk and protective factors: and of the explicative models of drug use. The role of the school as an appropriate medium to develop and promote preventive actions against drug use has been repeatedly highlighted. An example is the state of the problem that the European Monitoring Centre for Addiction provides us in its 2005 Annual Report, in which the following stands out: “In all Member States, schools are considered the most important setting for universal prevention, and there has been a noticeable increase in the emphasis placed on school-based prevention in national strategies and in the structured implementation of this approach. Despite the limitation that working solely with adolescents entails, there are important grounds that justify this inclination. Among which, we can highlight the following: - From an evolutionary standpoint, it is essential that attitudes and habits (lifestyles) be formed and educated from the earliest age, and the school has the means and resources to carry out this formation. In this sense, the educational system provides for the comprehensive education of the person through the development of skills, values and attitudes.

Treatment Can be corrected by breathing into a plastic bag generic montelukast 10 mg overnight delivery, or insufflation of carbon dioxide discount 10mg montelukast with visa. Acidosis (accumulation of acid or loss of base) Metabolic Acidosis Causes Increase in fixed acids due to: • Anaerobic tissue metabolism (shock, infection, tissue injury) • Retention of metabolites in renal insufficiency • Formation of ketone bodies in diabetes or starvation Loss of bases in: ƒ Chronic diarrhea, gastro colic or high intestinal fistula, excess intestinal aspiration Clinical Features Besides signs and symptoms of the primary etiology like shock and infection, rapid, deep, noisy breathing is found. Treatment ƒ Tissue hypoxia should be treated by reperfusion ƒ Sodium bicarbonate can be given where bases have been lost or where the degree of acidosis is so severe that myocardial function is compromised. Respiratory Acidosis Causes Impaired alveolar ventilation due to: - Airway obstruction - Thoracic and upper abdominal incisions, abdominal distention in ileus - Pulmonary diseases (pneumonia, atelectasis especially post operative - Inadequate ventilation of the anesthetized patient Clinical Features Restlessness, hypertension and tachycardia may indicate inadequate ventilation with hypercapnia. Renal (slow) Diarrhea, As in respiratory acidosis Small-bowel fistula Metabolic Loss of fixed Vomiting Pulmonary (rapid) alkalosis acids Gastric suction Decrease rate and depth of Gain of base (pyloric obstruction) breathing bicarbonate Excessive bicarbonate Renal (slow) Potassium intake As in respiratory alkalosis depletion Diuretics 14 Review Questions 1. Know blood transfusion reactions and their preventions Definition Blood transfusion is the procedure of introducing the blood of a donor, or pre-donated blood by a recipient into the recipient’s bloodstream. Indications for blood transfusion The need for blood transfusion in patients with acute hemorrhage is based on • The volume lost • The rate of bleeding • The hemodynamic status of the patient; hematocrit may be normal if determined. It must be remembered that crystalloid infusions should be provided while the blood compound is obtained. Symptomatic patients exhibiting air hunger, dizziness, significant tachycardia or cardiac failure should, of course, be transfused. Component therapy is indicated when specific factor deficiencies are demonstrated. Compatibility tests If administrated blood is incompatible with the patients own blood, life threatening reactions may result. Group-A contains anti-B antibodies, Group-B contains anti-A antibodies, Group-O contains anti-A and anti B antibodies. In some instances when fully cross- matched compatible blood is depleted or unavailable; type specific or O negative blood should be given. Irregular recipient antibodies cannot be detected and extra vascular hemolysis can also occur. Overall, O negative blood, if randomly transfused, has a serologic safety of about 99. Component therapy Treatment of specific hematologic abnormality often requires only a single component of whole blood. Blood banks reduce the whole blood received from donors to a variety of components. The available products include whole blood, red blood cells, white blood cells, platelet concentrates and plasma in several forms. When it is used within 24 hours it is considered fresh, whole blood and after this time it is referred to as stored. In acute massive hemorrhage transfusion with one unit of whole blood raises the recipient’s hematocrite by 3%. Platelet concentrate Platelets are separated from one unit of blood and suspended in a small volume of the original plasma. Cryoprecipitate 0 This is a protein fraction removed from a unit of fresh frozen plasma that is thawed at 4 c. Plasma protein fraction Similar to albumin but contains additional protein molecules. Complications and risks of blood transfusion Hemolytic transfusion reactions Intravascular hemolytic transfusion reactions; are potentially life threatening reactions that can occur by blood transfusion. Pathophysiology During hemolytic transfusion reaction all donor cells hemolyze, leading to hemoglobinemia, hemoglobinuria and renal failure. These reactions also activate the complement system with subsequent release of vasoacative amines causing hypotension. Treatment ƒ Stop transfusion immediately ƒ Administration of fluids and diuresis with mannitol or frusemide ƒ Transfused blood with patients blood sample should be sent for analysis ƒ Sodium bicarbonate may prevent precipitation of hemoglobin in the renal tubules ƒ Steroids may ameliorate the immunologic consequences. Transfusion reactions from mismatches involving the Rh system or minor antibodies usually induce extravascular hemolysis, since these reactions occur slowly, serious complications do not often develop. Non-hemolytic transfusion reaction Non-hemolytic reaction may occur after transfusions. Allergic reaction: occurs in 2-3% of all transfusion and manifests by urticaria and rashes. Other complications: Complications that can occur with massive transfusion include • Citrate toxicity • Acidosis • Hyperkalemia N. B:- As blood transfusion is accompanied by various complications mentioned above, the decision to transfuse should only be made when it is believed to be life saving. What factors determine the need for blood transfusion in patients with chronic blood loss or chronic anemia? But in addition to this, the patient’s pre-operative situation should be well evaluated so as to make the patient able to withstand the stress of surgery.

Still order montelukast 5mg line, it was not until the late nineteenth century that medical researchers discovered non-surgical methods to look inside the living body order montelukast 5 mg with visa. X-Rays German physicist Wilhelm Röntgen (1845–1923) was experimenting with electrical current when he discovered that a mysterious and invisible “ray” would pass through his flesh but leave an outline of his bones on a screen coated with a metal compound. In 1895, Röntgen made the first durable record of the internal parts of a living human: an “X-ray” image (as it came to be called) of his wife’s hand. Scientists around the world quickly began their own experiments with X-rays, and by 1900, X-rays were widely used to detect a variety of injuries and diseases. The X-ray is a form of high energy electromagnetic radiation with a short wavelength capable of penetrating solids and ionizing gases. As they are used in medicine, X-rays are emitted from an X-ray machine and directed toward a specially treated metallic plate placed behind the patient’s body. X-rays are slightly impeded by soft tissues, which show up as gray on the X-ray plate, whereas hard tissues, such as bone, largely block the rays, producing a light-toned “shadow. Like many forms of high energy radiation, however, X-rays are capable of damaging cells and initiating changes that can lead to cancer. This danger of excessive exposure to X-rays was not fully appreciated for many years after their widespread use. Although often supplanted by more sophisticated imaging techniques, the X-ray remains a “workhorse” in medical imaging, especially for viewing fractures and for dentistry. The disadvantage of irradiation to the patient and the operator is now attenuated by proper shielding and by limiting exposure. Modern Medical Imaging X-rays can depict a two-dimensional image of a body region, and only from a single angle. In contrast, more recent medical imaging technologies produce data that is integrated and analyzed by computers to produce three-dimensional images or images that reveal aspects of body functioning. The technique was invented in the 1970s and is based on the principle that, as X-rays pass through the body, they are absorbed or reflected at different levels. It is especially useful for soft tissue scanning, such as of the brain and the thoracic and abdominal viscera. Its level of detail is so precise that it can allow physicians to measure the size of a mass down to a millimeter. In 1970, a physician and researcher named Raymond Damadian noticed that malignant (cancerous) tissue gave off different signals than normal body tissue. This has helped scientists learn more about the locations of different brain functions and more about brain abnormalities and diseases. Ultrasonography Ultrasonography is an imaging technique that uses the transmission of high-frequency sound waves into the body to generate an echo signal that is converted by a computer into a real-time image of anatomy and physiology (see Figure 1. Ultrasonography is the least invasive of all imaging techniques, and it is therefore used more freely in sensitive situations such as pregnancy. Ultrasonography is used to study heart function, blood flow in the neck or extremities, certain conditions such as gallbladder disease, and fetal growth and development. The main disadvantages of ultrasonography are that the image quality is heavily operator-dependent and that it is unable to penetrate bone and gas. In the past, anatomy has primarily been studied via observing injuries, and later by the dissection of anatomical structures of cadavers, but in the past century, computer-assisted imaging techniques have allowed clinicians to look inside the living body. The two disciplines are typically studied together because form and function are closely related in all living things. Therefore, molecules combine to form cells, cells combine to form tissues, tissues combine to form organs, organs combine to form organ systems, and organ systems combine to form organisms. These processes include: organization, in terms of the maintenance of essential body boundaries; metabolism, including energy transfer via anabolic and catabolic reactions; responsiveness; movement; and growth, differentiation, reproduction, and renewal. Although the body can respond to high temperatures by sweating and to low temperatures by shivering and increased fuel consumption, long-term exposure to extreme heat and cold is not compatible with survival. The body requires a precise atmospheric pressure to maintain its gases in solution and to facilitate respiration—the intake of oxygen and the release of carbon dioxide. Homeostasis is regulated by negative feedback loops and, much less frequently, by positive feedback loops. Both have the same components of a stimulus, sensor, control center, and effector; however, negative feedback loops work to prevent an excessive response to the stimulus, whereas positive feedback loops intensify the response until an end point is reached. Regions of the body are identified using terms such as “occipital” that are more precise than common words and phrases such as “the back of the head. Images of the body’s interior commonly align along one of three planes: the sagittal, frontal, or transverse. The body’s organs are organized in one of two main cavities—dorsal (also referred to posterior) and ventral (also referred to anterior)—which are further sub-divided according to the structures present in each area.

Outside this is a layer of bipo- • The inferior obliqueaarises from the floor of the orbit cheap montelukast 10mg, passes lar neurones and then the receptor layer of rods and cones order 4 mg montelukast otc. Near the under the eyeball like a hammock and is inserted into its lateral posterior pole of the eye is the yellowish macula lutea, the receptor area side. Since the subarachnoid space and its contained (the ‘muscle with the pulley’) is supplied by the trochlear nerve. All the cerebrospinal fluid reach to the back of the eyeball, any increase in others, including levator palpebrae superioris, are supplied by the ocu- intracranial pressure can give rise to changes in the optic disc which lomotor nerve. The orbit and eyeball 155 70 The ear, and lymphatics and surface anatomy of the head and neck Ridge produced by lateral semicircular canal Tegmen tympani Stapes Geniculate ganglion Facial nerve Greater petrosal nerve Aditus Incus Lesser petrosal nerve Malleus Auditory tube Tympanic plexus Chorda Promontory tympani Internal carotid artery Tympanic membrane Round window Tympanic branch Internal jugular vein Glossopharyngeal nerve Fig. The inset (right) shows the two major groups into which the others eventually drain 156 Head and neck The ear mandible and also deep to sternomastoid. They drain the head and the The ear is subdivided into the outer ear, the middle ear and the inner ear. The outer ear • The lower deep cervical nodes (): in the The outer third of this is cartilaginous and the inner two-thirds is bony. They drain the lower part of the neck and also receive lymph from the upper deep cervical nodes, from the breast and some of the lymph The middle ear from the thorax and abdomen. The • The runs backwards and then downwards in a bony may be represented on the surface by a pencil placed behind the canal in the medial wall. Its function • The supraorbital, infraorbital and mental nerves: all lie on a ver- is to equalize the pressure between the middle ear and the pharynx. It consists of two • The sternomastoid muscle (with the on its sur- components: face) may be made to contract by asking the patient to turn his head to • The osseous labyrinth: comprises the , the the side against resistance. The labyrinth itself consists of spaces in the • The trunks of the brachial plexus can be palpated in the angle petrous temporal bone and it contains the. The utricle and saccule are con- • The hyoid bone, and the thyroid and cricoid cartilages are easily cerned with the sense of position and the semicircular ducts are con- felt. Abduction of the upper limb (assisted by supraspinatus and • serratus anterior), flexion (anterior fibres) and extension (posterior From the common flexor origin on the medial epicondyle of the fibres) of the arm. Acting together, these muscles maintain the stability of the • shoulder joint as well as having their own individual actions, as From the common flexor origin. Produced in collaboration with the Ethiopia Public Health Training Initiative, The Carter Center, the Ethiopia Ministry of Health, and the Ethiopia Ministry of Education. Important Guidelines for Printing and Photocopying Limited permission is granted free of charge to print or photocopy all pages of this publication for educational, not-for-profit use by health care workers, students or faculty. Under no circumstances is it permissible to sell or distribute on a commercial basis, or to claim authorship of, copies of material reproduced from this publication. Except as expressly provided above, no part of this publication may be reproduced or transmitted in any form or by any means, electronic or mechanical, including photocopying, recording, or by any information storage and retrieval system, without written permission of the author or authors. This material is intended for educational use only by practicing health care workers or students and faculty in a health care field. Human Anatomy and Physiology Preface There is a shortage in Ethiopia of teaching / learning material in the area of anatomy and physicalogy for nurses. To help get the students and instructions involved in the study of this subject, a number of special features are incorporated throughout the lecture note. Each chapter contains: - The Learning objectives: what the students are expected to accomplish upon completion of a particular chapter. We would like to extend our appreciation to the different professionals involved in reviewing this manuscript through its process specially Dr. Our gratitude also goes to the assistance offered by Jimma and Alemaya Universities for facilitating the opportunities and resources utilized to develop the lecture note. Equipping the student nurse with the knowledge of anatomy and physiology will further assist the student in understanding what happens and what to do when the body is injured, diseased or placed under stress. This teaching and learning material (lecture note) for nursing students at a diploma level is prepared in line with this concept. Therefore, the students are expected to achieve the following general educational objectives after completion of the course: - Understand and use anatomical terms. Systemic anatomy studies functional relationships of organs within a system whereas Regional anatomy studies body part regionally. Both systemic and regional approaches may be used to study gross anatomy Microscopic anatomy (Histology) requires the use of microscope to study tissues that form the various organs of the body. Homeostasis When structure and function are coordinated the body achieves a relative stability of its internal environment called homeostasis / staying the same. Although the external environmental changes constantly, the internal environment of a healthy body remains the same with in normal limits. Under normal conditions, homeostasis is maintained by adaptive mechanisms ranging from control center in the brain to chemical substances called hormones that are secreted by various organs directly into the blood streams. Some of the functions controlled by homeostasis mechanisms are blood pressure, body temperature, breathing and heart rate.