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By L. Jose. California State University, San Bernardino.

The musculature is greatly thickened safe cardura 4 mg pulse pressure 70-80, and the resulting tumor like mass constricts the lumen of the pyloric canal discount 4 mg cardura mastercard heart attack proove my heart radio cut. Clinical manifestations and x-ray, finding The symptoms appear in infants 2-4 weeks old. The vomiting is at first mild, becomes progressively more forceful until it is projectile. The signs of pyloric stenosis, dehydration with poor skin turgor, distention of the epigastrium and an olive-shaped mass, located by palpation, in the right upper quadrant of the abdomen. If barium is added to the feeding, an x-ray film will show the enlargement of the stomach, and the narrowing and enlargement of the pylorus, increased peristaltic waves, and an abnormal retention of the barium in the stomach. Treatment 66 Pediatric Nursing and child health care Pyloromyotomy involving longitudinal splitting of the hypertrophied circular muscle of the pylorus without incising the mucus membrane allow more food to pass through. Preoperative care • Correction of fluid and electrolyte imbalance since a dehydrated infant is at surgical risk. The mortality rate is low, proceeded operation is undertaken before the infant has become too dehydrated and malnurished. In severe case this will prevent the scape of urine, so that the fore skin is distended during mictaration, and the infant screams with pain and strains during the act. Paraphimosis, a condition due to a tight foreskin being pushed up and constrict the circulation, causing swelling of the parts below so that the foreskin cannot be pushed down again, and requiring operative treatment. Treatment: - Circumcision, cutting away the foreskin - After this operation the wound must be kept clean, antiseptic dressing applied, and the parts cleansed after passing of the urine. It may occur in almost in any area of the spina but most common in lumbosacral region. It is the most common developmental defect of the central nervous system occurring in about one of 1000 newborn infant. Meningocele, in which the meninges protrude through the opening in the spinal canal. Meningomylocele, in which both the spinal cord and the meninges protrude through the defect in the bony rings of the spinal canal. Spina bifida occulta: The majority of patients with spina bifida occulta have no symptoms. There is no need for treatment unless neurological symptoms indicate that the 69 Pediatric Nursing and child health care defect is greater than was thought. If there is possibility that the spinal cord may be involved in the defect, surgical treatment is indicated. Meningocele: On examination the newborn infant is found to have a defect on the spinal column large enough to protrude through the opening. There is generally no evidence of weakness of the legs, the infant straitens and kicks in normal manner, or if lack of spincter control, though this is difficult to a certain in the newborn. Hydrocephalus may be an associated finding or may be aggravated after operation for a meningocele. Meningomyelocele: In this condition an imperfectly developed segment of the spinal cord as well as the meninges, protrudes through the spina bifida in the lumbosacral region. There may be a minimal weakness to a complete flaccid paralysis of the legs and absence of sensation in the feet. Operation removes a cosmetically unacceptable deformity, prevents infection and in many instance improves the neurological deficit since obstruction is removed from the nerve path ways. Prompt surgical closure of the skin defect preferably within 24 to 48 hours after birth is done to prevent meningeal irritation. Responsibilities of Nurse post operatively: • Observing and reporting of all signs and symptom of the infant’s condition. The accumulation of fluid in the ventricles generally enlarges the infants skull, since the suture are not closed and the bones are soft. Treatment: should be started as soon as the clinical manifestations are observed, before damage to the brain itself.

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Immunology Influenza causes an acute infection of the host and initiates a cascade of immune reactions activating almost all parts of the immune defense system cardura 4 mg cheap blood pressure ranges for males. Innate immunity is an essential prerequisite for the adaptive immune response buy cardura 2mg low cost heart attack questions to ask doctor, firstly, to limit the initial viral replication and antigen load, and secondly, because the antigen-specific lymphocytes of the adaptive immune response are activated by co-stimulatory molecules that are induced on cells of the innate immune system during their interaction with viruses (Figure 3). The adaptive immune response requires some days to be effective but then helps to contain the viral spread, to eradicate the virus, and finally to establish a memory response resulting in a long-lived resistance to re-infection with homologous virus. Cross-protection within a subtype of influenza has only rarely been observed and infections essentially induce no protection across subtypes or between types A and B (Treanor 2005). Influenza infection induces both systemic and local antibody (humoral immunity), as well as cytotoxic T cell responses (cellular immunity), each of which is important in recovery from acute infection and resistance to reinfection. The humoral branch of the immune system comprises B-lymphocytes (left), which after interac- tion with influenza differentiate into antibody-secreting plasma cells. These cells gain effector cell function to either help directly, release cytokines, or mediate cytotoxicity following recognition of antigen (Adapted from Flint 2004). Not shown is the formation of a cellular memory immune response and the various forms of innate immunity induced by influenza. The antigen specificity arises from random rearrangements of genes coding for the hypervariable region of immuno- globulins in the cells, whilst still in the bone marrow. The naïve B cells then enter the circulation and travel via the blood stream and lymphatics through tissue and lymphoid organs. In the lymph nodes, naïve B cells recognize cognate antigen by their surface antibodies, become activated, switch from IgM to IgG production (class-switch), increase their immunoglobulin specificity and affinity, and differen- tiate into plasma cells or memory B cells as the cell continues to divide in the pres- ence of cytokines. While IgA is transported across the mucosal epithelium of the upper airway, where it serves to neutralize and clear viral infection, IgG is primarily responsible for the protection of the lower respiratory tract (Palladino 1995, Rene- gar 2004). The peak in antibody titers are seen between 4-7 weeks after infection, and are followed by a steady decline. This is because neuraminidase cleaves the cellular-receptor sialic acid residues to which the newly formed particles are attached. Similar effects have been proposed for antibodies against M2 protein of influenza A, although in general, antibodies against internal antigens are non- neutralizing, disappear more rapidly and do not appear to play a role in protective immunity. Either mucosal or systemic antibody alone can be protective if present in sufficient con- centrations, and optimal protection occurs when both serum and nasal antibodies are present (Treanor 2005). Antibodies act in immunity against influenza by neu- tralization of the virus or lysis of infected cells via complement or antibody- dependent cellular toxicity. Hosts that survive an acute virus infection and clear the virus are in general immune to infections by the same virus. Nevertheless, acute infections caused by influenza virus occur repeatedly, despite active immune clearance. This is because influenza displays a structural plasticity as it can tolerate many amino acid substitutions in its structural proteins without losing its infectivity. These changes are the reason for the annual epidemic spread of influenza and require new vaccines to be formulated before each annual epidemic. In contrast, antigenic shift is a major change in the surface protein of a virion, as genes encoding completely new surface proteins arise after recombination or reassortment of genomes or genome segments. In contrast, antigenic shift can only occur under certain circumstances, is relatively rare and the likely reason for pandemics. The cellular immune response Dendritic cells have been shown to play a central role in initiating and driving T lymphocyte responses. They are a sparsely distributed, migratory group of bone- marrow derived leukocytes that are specialized for the uptake, transport, processing and presentation of antigens to T cells (Figure 3). The basic paradigm is that lung- resident dendritic cells acquire antigen from the invading pathogen, become acti- vated, and subsequently travel to the local draining lymph nodes (Legge & Braciale 2003). The newly activated T cells acquire effector cell functions and migrate 104 Pathogenesis and Immunology to the site of infection in the lung where they mediate their antiviral activities (Fig- ure 3). Following recovery from an infection, a state of immunological memory ensues in which the individual is better able to control a subsequent infection with the same pathogen (Ahmed & Gray 1996). Memory is maintained by antigen-specific T cells that persist at increased frequencies, have reduced requirements for co-stimulatory signals in comparison to naïve T cells, and respond quickly to antigenic re- stimulation (Woodland & Scott 2005). Th cells can be further sub- divided into at least Th1 and Th2 cells, based on the type of cytokines they produce.

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The growing numbers of paralytic and coma patients can be controlled only if blood pressure order cardura 4 mg without a prescription arrhythmia natural remedies, diabetes discount cardura 2mg amex heart attack young man, obesity etc. Along with the right treatment proper nourishment and care, love and prayers can also give miraculous results. The will-power of the patient, which remains strong even in the unconscious state and the doctor’s loving care can also help the patient recover faster. After remaining in a comatose state, for a considerable period when the patients recover, some may lose their speech or memory. This may be a case of Epilepsy: You would have noticed people attending to such persons in a very funny manner for observing curiously without helping the person correctly. This chapter deals with the problem: its causes, its correct approach and the myths associated with it. Epilepsy is a disease of the brain in which excessive electrical impulses are produced in the brain for a short period of time resulting in tremors or seizures. One in every hundred persons suffers from epilepsy and thus over l o million people in our country are afflicted with this disease. According to a survey, 4 out of every 100 persons h ave suffered from a convulsion at least once in his lifetime e. Grandmal epilepsy or seizure of the entire body: In this type of epilepsy, loss of consciousness, screaming, frothing from the mouth, tremors, tongue biting may occur and sometimes urine and stool are also passed unconsciously. After regaining consciousness, the patient remains in a semiconscious state for some time or goes to sleep He may be paralyzed temporarily. Petitmal: In this type of epilepsy the patient suddenly becomes momentarily blank, stunned and blacks out for a few moments. Myoclonic seizure: In these cases the person experiences sudden shock like momentary jerks in the limbs and the things held in hand may fall down, but there is no loss of consciousness. Besides these there are tonic-clonic and akinetic seizures, which are classified as Generalized seizures. Simple Partial Seizure: The patient remains conscious, but jerking or tingling is felt in one half side of the body. Complex Partial Seizure: If the patient loses momentary consciousness along with-* the symptoms of simple partial seizure, it is known as complex partial seizure. In this type, the patient loses consciousness or behaves abnormally for a few moments and immediately becomes normal again. This disease can be cured with proper treatment by a psychiatrist as well as by tackling the underlying socio - economic problem. In children who get convulsions during fever, it is necessary to ascertain that they do not suffer from fever as far as possible. If fever does occur, Paracetamol or Nimesulide as well as Clobazam should be administered immediately. The medicine called Direc-2 or any other similar kind can be administered rectally if a convulsion seems imminent. It is essential to prevent such seizures because frequent attacks can get converted into complex partial seizures or generalized seizures in future. To prevent an injury to the tongue, a handkerchief or a gauge piece may be placed in the mouth, but one should not insert it forcibly. If necessary, intravenous administration of Diazepam can be done or the patient may immediately be admitted to a hospital. During pregnancy certain medicines taken for epilepsy do not cause any substantial harm to the Foetus e. Actually if the drug is stopped and a seizure occurs, the harm to the Foetus due to the lack of oxygen is much greater. This gives immense information about the type, speed and seriousness of disease to the doctor, apart from telling whether it was a seizure or hysteria or syncope or any other brief event. Treatment of Epilepsy : After investigating the causes of the disease, planning proper treatment is essential. Encorate, Valparin, Epilex) As per the new technology, now slow release formulation drugs are available in Carbamazepine and Valproic acid e. This helps to maintain adequate blood level all through out the day, by taking drugs only twice a day. In the last few years many new researches have been conducted on this disease and new drugs have been developed for effective control of Epilepsy. Newer Drugs : The second generation anti-epileptic drugs, now being used to treat patients not responding to conventional drugs include Gabapentin, Lamotrigine, Vigabatrine, Felbamate, Topiramate.

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Occasional occurances are generally transitory and nonlife threatening cheap cardura 4 mg with visa prehypertension cure, but if the condition becomes chronic cheap 4 mg cardura mastercard heart attack symptoms in men, it may lead to either an arrhythmia, a deviation from the normal pattern of impulse conduction and contraction, or to fibrillation, an uncoordinated beating of the heart. In general, the size of the electrical variations, the duration of the events, and detailed vector analysis provide the most comprehensive picture of cardiac function. Additionally, it will not reveal the effectiveness of the pumping, which requires further testing, such as an ultrasound test called an echocardiogram or nuclear medicine imaging. External Automated Defibrillators In the event that the electrical activity of the heart is severely disrupted, cessation of electrical activity or fibrillation may occur. In fibrillation, the heart beats in a wild, uncontrolled manner, which prevents it from being able to pump effectively. The most common treatment is defibrillation, which uses special paddles to apply a charge to the heart from an external electrical source in an attempt to establish a normal sinus rhythm (Figure 19. These devices contain simple and direct verbal instructions that can be followed by nonmedical personnel in an attempt to save a life. In order to speed up the heart rate and restore full sinus rhythm, a cardiologist can implant an artificial pacemaker, which delivers electrical impulses to the heart muscle to ensure that the heart continues to contract and pump blood effectively. These artificial pacemakers are programmable by the cardiologists and can either provide stimulation temporarily upon demand or on a continuous basis. Oxygen from the lungs is brought to the heart, and every other organ, attached to the hemoglobin molecules within the erythrocytes. Normally, these two mechanisms, circulating oxygen and oxygen attached to myoglobin, can supply sufficient oxygen to the heart, even during peak performance. Both fatty acid droplets and glycogen are stored within the sarcoplasm and provide additional nutrient supply. The period of contraction that the heart undergoes while it pumps blood into circulation is called systole. Both the atria and ventricles undergo systole and diastole, and it is essential that these components be carefully regulated and coordinated to ensure blood is pumped efficiently to the body. Pressures and Flow Fluids, whether gases or liquids, are materials that flow according to pressure gradients—that is, they move from regions that are higher in pressure to regions that are lower in pressure. Accordingly, when the heart chambers are relaxed (diastole), blood will flow into the atria from the veins, which are higher in pressure. As blood flows into the atria, the pressure will rise, so the blood will initially move passively from the atria into the ventricles. When the action potential triggers the muscles in the atria to contract (atrial systole), the pressure within the atria rises further, pumping blood into the ventricles. During ventricular systole, pressure rises in the ventricles, pumping blood into the pulmonary trunk from the right ventricle and into the aorta from the left ventricle. Again, as you consider this flow and relate it to the conduction pathway, the elegance of the system should become apparent. Phases of the Cardiac Cycle At the beginning of the cardiac cycle, both the atria and ventricles are relaxed (diastole). Blood is flowing into the right atrium from the superior and inferior venae cavae and the coronary sinus. The two atrioventricular valves, the tricuspid and mitral valves, are both open, so blood flows unimpeded from the atria and into the ventricles. The two semilunar valves, the pulmonary and aortic valves, are closed, preventing backflow of blood into the right and left ventricles from the pulmonary trunk on the right and the aorta on the left. As the atrial muscles contract from the superior portion of the atria toward the atrioventricular septum, pressure rises within the atria and blood is pumped into the ventricles through the open atrioventricular (tricuspid, and mitral or bicuspid) valves. At the start of atrial systole, 862 Chapter 19 | The Cardiovascular System: The Heart the ventricles are normally filled with approximately 70–80 percent of their capacity due to inflow during diastole. Atrial contraction, also referred to as the “atrial kick,” contributes the remaining 20–30 percent of filling (see Figure 19. Atrial systole lasts approximately 100 ms and ends prior to ventricular systole, as the atrial muscle returns to diastole. At the end of atrial systole and just prior to atrial contraction, the ventricles contain approximately 130 mL blood in a resting adult in a standing position. Initially, as the muscles in the ventricle contract, the pressure of the blood within the chamber rises, but it is not yet high enough to open the semilunar (pulmonary and aortic) valves and be ejected from the heart. This increase in pressure causes blood to flow back toward the atria, closing the tricuspid and mitral valves.

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