Introduction to Salmonellosis

A common infection in the United States, salmonellosis is caused by gram-negative bacilli of the genus Salmonella, a member of the Enterobacteriaceae family. It occurs as enterocolitis, bacteremia, localized infection, typhoid, or paratyphoid r.
Nontyphoidal forms usually produce mild to moderate illness with low mortality.
Typhoid, the most severe form of salmonellosis, usually lasts from 1 to 4 weeks. Mortality is about 3% in persons who are treated and 10% in those untreated, usually as a result of intestinal perforation or hemorrhage, cerebral thrombosis, toxemia, pneumonia, or acute circulatory failure.
An attack of typhoid confers lifelong immunity, although the patient may become a carrier. Most typhoid patients are younger than age 30; most carriers are women older than age 50. Incidence of typhoid in the United States is increasing as more travelers return from endemic areas.
Enterocolitis and bacteremia are common (and more virulent) among infants, elderly people, and people already weakened by other infections; paratyphoid fever is rare in the United States.
Salmonellosis is 20 times more common in patients with acquired immunodeficiency syndrome. Features are increased incidence of bacteremia, inability to identify the infection source, and tendency of the infection to recur after therapy is stopped.
Of an estimated 1,700 serotypes of Salmonella, 10 cause the diseases most common in the United States; all 10 can survive for weeks in water, ice, sewage, or food. Nontyphoidal salmonellosis generally follows the ingestion of contaminated or inadequately processed foods, especially eggs, chicken, turkey, and duck. Proper cooking reduces the risk of contracting salmonellosis.
Owning a pet turtle, lizard, iguana, or snake increases the risk factor because reptiles are carriers of salmonella. Salmonellosis may occur in children younger than age 5 from fecal-oral spread.
Typhoid results most commonly from drinking water contaminated by excretions of a carrier.
Signs and symptoms
Signs and symptoms of salmonellosis vary depending on the patient but usually include fever, Continue reading “Introduction to Salmonellosis”

Brief Summary of Cataract

CataractA common cause of vision loss, a cataract is a gradually developing opacity of the lens or lens capsule of the eye. Cataracts commonly occur bilaterally, with each progressing independently. Exceptions are traumatic cataracts, which are usually unilateral, and congenital cataracts, which may remain stationary.
Cataracts are a part of aging and are most prevalent in patients older than age 70. Surgical intervention improves vision in 95% of affected people.
Cataracts have various causes, depending on their type:
  • Senile cataracts develop in elderly patients, probably because of degenerative changes in the chemical state of lens proteins.
  • Congenital cataracts occur in neonates as genetic defects or as a result of maternal rubella during the 1st trimester.
  • Traumatic cataracts develop after a foreign body injures the lens with sufficient force to allow aqueous or vitreous humors to enter the lens capsule.
  • Complicated cataracts develop as secondary effects in patients with uveitis, glaucoma, retinitis pigmentosa, or a detached retina or in the course of a systemic disease, such as diabetes, hypoparathyroidism, or atopic dermatitis. These cataracts can also result from exposure to ionizing radiation or infrared rays.
  • Toxic cataracts result from prolonged drug or chemical toxicity from prednisone, ergot Continue reading “Brief Summary of Cataract”

Introduction to Burns

A major burn is a horrifying injury, necessitating painful treatment and a long period of rehabilitation. It’s often fatal or permanently disfiguring and incapacitating (emotionally and physically). In the United States, about 2.5 million people annually suffer burns. It’s the nation’s third leading cause of accidental death.
Thermal burns, the most common type, are caused by flame, flash, scald or contact with hot objects. Examples are residential fires, motor vehicle accidents, playing with matches, improperly stored gasoline, space heater or electrical malfunctions, or arson. Other causes include improper handling of firecrackers, scalding accidents, and kitchen accidents (such as a child climbing on top of a stove or grabbing a hot iron). Burns in children are sometimes traced to parental abuse.
Chemical burns result from the contact, ingestion, inhalation, or injection of acids, alkalis, or vesicants that cause tissue injury and necrosis. Electrical burns result from coagulation necrosis caused by intense heat; they usually occur after contact with faulty electrical wiring or high-voltage power lines or when electric cords are chewed (by young children). Friction or abrasion burns happen when the skin is rubbed harshly against a coarse surface. Sunburn, of course, follows excessive exposure to sunlight.
Signs and symptoms
Symptoms will vary depending on the degree of burn. Suspect burn injury when the patient presents with blisters, pain, peeling skin, red skin, edema, white or charred skin, or signs of shock. Suspect an airway burn if you see charred mouth, burned lips, burns on the head, neck, or face; wheezing, change in voice, difficulty breathing and coughing; singed nose hairs or eyebrows; or dark carbon- Continue reading “Introduction to Burns”

Arterial occlusive disease

With arterial occlusive disease, the obstruction or narrowing of the lumen of the aorta and its major branches causes an interruption of blood flow, usually to the legs and feet. Arterial occlusive disease may affect the carotid, vertebral, innominate, subclavian, mesenteric, or celiac artery. Occlusions, which may be acute or chronic, often cause severe ischemia, skin ulceration, and gangrene.
Arterial occlusive disease is more common in males than in females. The prognosis depends on the location of the occlusion, the development of collateral circulation to counteract reduced blood flow and, if the patient has acute disease, the time elapsed between occlusion and its removal.
Arterial occlusive disease is a common complication of atherosclerosis. The occlusive mechanism may be endogenous, due to embolus formation or thrombosis, or exogenous, due to trauma or fracture. Predisposing factors include smoking; aging; conditions such as hypertension, hyperlipidemia, and diabetes; and a family history of vascular disorders, myocardial infarction, or stroke.
Signs and symptoms
Evidence of this disease varies widely, according to the occlusion site.
Clinical features of arterial occlusive disease Continue reading “Arterial occlusive disease”

Ménière’s disease

Also known as endolymphatic hydrops, Ménière’s disease is a labyrinthine dysfunction that produces severe vertigo, sensorineural hearing loss, and tinnitus. It usually affects adults, slightly more men than women, between ages 30 and 60. After multiple attacks over several years, this disorder leads to residual tinnitus and hearing loss.
Ménière’s disease may result from overproduction or decreased absorption of endolymph, which causes endolymphatic hydrops or endolymphatic hypertension, with consequent degeneration of the vestibular and cochlear hair cells.
This condition may stem from autonomic nervous system dysfunction that produces a temporary constriction of blood vessels supplying the inner ear. In some women, premenstrual edema may precipitate attacks of Ménière’s disease.
Signs and symptoms
Ménière’s disease produces three characteristic effects: severe vertigo, tinnitus, and sensorineural hearing loss. Fullness or blocked feeling in the ear is also quite common. Violent paroxysmal attacks last from 10 minutes to several hours. During an acute attack, other signs and symptoms include severe nausea, vomiting, sweating, giddiness, and nystagmus. Also, vertigo may cause loss of balance and falling to the affected side.
To lessen these signs and symptoms, the patient may assume a characteristic posture—lying on the unaffected ear and looking in the direction of the affected ear. Initially, the patient may be asymptomatic between attacks, except for residual tinnitus that worsens during an attack.
The presence of all three typical symptoms suggests Ménière’s disease. Audiometric studies indicate a sensorineural hearing loss and loss of discrimination and recruitment. Electronystagmography, electrocochleography, a computed tomography scan, magnetic resonance imaging, and X-rays of Continue reading “Ménière’s disease”

Special considerations in Patients with Abortion

Before an abortion, perform the following:
  • Thoroughly explain all procedures to the patient.
  • After the patient uses the bedpan, inspect the contents carefully for intrauterine

    material. (The patient shouldn’t have bathroom privileges because she may inadvertently expel uterine contents.)
After spontaneous or elective abortion, perform the following:
  • Note the amount, color, and odor of vaginal bleeding. Save all the pads the patient uses, for evaluation, and provide perineal care.
  • Administer oxytocin and an analgesic as ordered.
  • Obtain vital signs every 15 minutes for 1 hour, every 30 minutes for 2 hours, every hour for 2 hours, then every 4 hours for 24 hours.
  • Monitor urine output.
Caring for a patient who has had a spontaneous abortion includes emotional support and counseling during the grieving process. Encourage the patient and her partner to express their feelings. Some couples may want to talk to a member of the clergy or, depending on their religion, may wish to have the fetus baptized.
The patient who has had a therapeutic abortion also benefits from support. Encourage her to verbalize her feelings. Remember, she may feel ambivalent about the procedure; intellectual and emotional acceptance of abortion aren’t the same. Refer her for counseling, if necessary.
Before the patient is discharged, perform the following:

Schizoaffective disorder

Patients who show concurrent symptoms of both mood disorders (bipolar or depressive types) and psychotic disorder are given the diagnosis of schizo-affective disorder. Onset is usually during young adulthood. The chronic symptoms are typically fewer and less severe than among those patients with schizophrenia.
Schizoaffective disorder may result from a combination of physiologic and psychological causes. The specific cause is unknown.
Signs and symptoms
The patient must show clear symptoms of schizophrenia. During both the active and residual phases of the illness, symptoms of mood disturbance must also occur. These symptoms may not be caused by substance abuse or by a medical condition. Patients may experience difficulty functioning in the workplace. They have a restricted range of social contacts and may also have difficulty performing self-care.
According to the classification found in the Diagnostic and Statistical Manual of Mental Disorders, 4th edition – Text Revision, a schizoaffective disorder is diagnosed if the patient’s symptoms meet the following criteria:
  • The patient experiences a period of uninterrupted illness in which there’s a major depressive episode (with depressed mood), a manic episode, or a mixed episode, concurrent with symptoms of schizophrenia.
  • During the same period of illness, the patient experiences delusions or hallucinations for at least 2 weeks, without prominent mood symptoms.
  • The patient experiences symptoms of the mood episode, and they’re pres-ent for a substantial portion of the total duration of the active and residual periods of the illness. Continue reading “Schizoaffective disorder”