Malaria its Diagnostic and Treatment

Malaria is a contagious disease that infects red blood cells by a parasite known as plasmodium. It is characterized by cycles of chills, fever, pain and sweating.
Parasite enters into the human body when a infected mosquito bite a healthy person. Female anopheles mosquito is the vector for transmission.

Incubation period
It is based on the types:
P. Falciparum-12 days
P.Vivax-14 days
P. Malariae- 30 days

Mode of transmission 

• Mechanical transmission: Bite of an infected female anopheles mosquito is the vector medium to transmit disease.
• Parenteral transmission: It is through blood transfusion.
• Transplacental transmission: It is congenital and ia very rare.

Pathogenesis:
When mosquito sting on  the infected human and suck the blood parasite enters into the mosquito stomach.
The parasite undergoes sexual conjugation. A number of young parasites get release after 10-14 days which finds their way to salivary gland of the mosquito. The parasites are now present in the saliva which get transmitted if the infected mosquito bites the healthy person.
The female anopheles mosquito alone plays the role of a vector and definitive host in conveying the disease from man to man.
In human the parasite attack the RBC where they grow and undergo sexual schizogony.
Erythrocytic merozoites are produced leading to the rupture of the RBC upon the release of the tiny organisms.
Young merozoites attack a new batch of RBC to start another schizonic cycle.

Signs and symptoms:

•   Rapidly increasing fever with severe headache
• Paroxysms with shaking chills
• Profuse sweating
• Spleenomegaly (enlargement of spleen)
• Hepatomegaly (enlargement of liver)
• Hypotension in upright position
• Muscle pain
• Paroxysms may last for 12 hours then may be repeated daily or after a day or two

In children:  

• Continuous fever
• Convulsions
• Gastrointestinal symptoms are prominent
• Spleenomegaly
• In case of cerebral malaria
• Change in sensorium
• Severe headache
• Vomiting
• Jacksonian or grand mal seizure may be present

Diagnostic procedure: 

1. Malarial smear : A flim of blood is placed on a slide, stained and examined microscopically.
2. Rapid diagnostic test : It can be done outside the laboratory and in the field. It gives result within 10-15 minites. Malarial parasite antigen in the blood can be detected by this test.
   

Treatment:
Treatment choice depends upon two categories uncomplicated malaria and complicated malaria.
Uncomplicated malaria: Patient has no signs of complications. The treatment consists of:
A. Early and appropriate  antimalarial drugs:  The choice of drugs should be based on the drug sensitivities of malarial parasites in that area.
WHO (2006) has recommended Artemisinin based combination treatment as a first like drugs for P. Falciparum.
Quinine combined with doxycycline, for non pregnant adults and children > 8 years old, or clindamycin for pregnant women and children <8 years old given for 7 days  as a second line drugs.
If first line treatment dose is vomited within one hour it should be given again.
B. Symptomatic treatment
Treatment symptoms includes fever, body pain, nausea, vomiting or headaches with appropriate medicines.
Nursing care 

• Provide supportive care and symptomatic treatment such as tepid sponging for fever.
• Give health education regaeding personal protection, prevention of malaria and compliance for treatment.
• The patient should be told to return if there is fever, especially in the 2 months after treatment or with P. Vivax or P. Ovale infection.
• Advise patient to take full course of medication to prevent relapse of malaria.
• If vomiting occurs during the antimalarial drug take an antiemetics half hour or one hour prior the drugs.
• If there is fever take an antipyretic 1 hour prior taking the anti malarial medicine.
• The patient should rest for 1-2 hours after taking the drugs due to risk of dizziness, vomiting and hypotension.
• Give psychological support to the patient.
• All the cases of malaria should be recorded and reported to the appropriate health authorities to help to control malarial disease.
• Follow up is compulsory required to know the therapeutic response to the drugs and to evaluate the evidence of drug resistance.

Nursing Diagnosis:
Imbalanced nutrition less than body requirements related to inadequate food intake, anorexia, nausea/ vomiting
Risk for infection related to decreased immune system; invasive procedures
Hyperthermia related to increased metabolism, dehydration, a direct effect on the hypothalamic circulation of germs.

Complicated malaria
Criteria are listed below:  

• Impaired consciousness
• Multiple convulsions
• Respiratory distress
• Circulatory collapse
• Pulmonary edema
• Abnormal bleeding
• Haemoglobinuria
• Jaundice
• Prostration

Laboratory Tests: 

• Acidosis
• Hypoglycemia
• Severe anemia
• Renal impairment
• Hyperlactatemia
• Hyperparasitemia

Nursing care 

• Monitor the patient closely.
• Keep patient in lateral or semi prone position to avoid aspiration of fluid.
• Insert nasogastric tube and withdraw the stomach content to minimize risk of aspiration pneumonia.
• Give life support assessing the patient condition.
• Monitor intake and output every hourly, by placing a foleys catheter to measure output.
• Provide psychological support to the family, patient and the relatives.
• Assure that the airway is clear.
• Suction to clear the airway if necessary.
• Note any appearance of black urine ( hemoglobinuria)
• Monitor vital signs and level of consciousness.
• Check for the fluid infusion whether its going to fast or slow.
• Treat fever with tepid sponging and antipyretic drugs.
• Give 10% dextrose is blood sugar level is low.
• In case of seizures give diazepam.
• Encourage patient to complete full course of drugs.
• Educate patient and family members about preventive measures such as use of mosquito nets, repellent, mosquito coil etc.

SCABIES and its Treatment

It is an itching disorder and  highly contagious skin condition by an infestation of itch mite Sarcoptes scabiei. Mites are small eight legged parasites (in contrast to insects, which have six legs). They are tiny and burrow into the skin to produce intense itching, which tends to be worse at night.
A scabies infection begins as small, itchy bumps, blisters, or pus filled bumps that break when scratched. Itchy skin may become thick, scaly, scrabbed, and crisscrossed with scratch marks. Itching is caused due to a hypersensitivity reaction to the mite and/or its feces and eggs.

Transmission
Direct skin to skin contact: Mites can only live off the human body for 24-36 hours under most conditions. Transmission of the mites involves close person to person contact of the skin to skin variety.
Sexual physical contact: It is the most common form of transmission among sexually active young people, and it has been considered to be a sexually transmitted disease.

Other forms of physical contact: It includes mother hugging their children to spread the mites.

Common sites for scabies
Skin fold is the common for the appearance of burrows or tracks. In adults it is most often found in
Between fingers
In armpits
Around waist
Along the insides of wrists
On inner elbow
On the soles of feet
Around breasts
Around the male genital area
On buttocks
On knees
On shoulder blades
In children common sites includes:
Scalp
Face
Neck
Palms of the hands
Soles of the feet

Signs and symptoms:
Itching, which is often severe and worse at night
Thin, irregular burrow tracks made up of tiny blisters or bumps on skin

Signs and tests
Physical examination of skin shows signs of scabies.
Tests include a microscopic examination of skin scrapings taken from a burrow to look for the mites.

Treatment and nursing management:
Medicated creams: permethrin 5% is the common used cream for scabies. Other creams include benzyl benzoate, sulfur in petrolatum, and crotamiton. Creams are applied all over the skin.

STOMACH CANCER SYMPTOMS AND TREATMENT

It is the abnormal enlargement of cells of stomach that may spread throughout the stomach and metastasize (spread) to other organs especially the oesophagus, lungs, lymph nodes and liver. It is the fourth leading cancer globally. Metastasis occurs in 80-90% of people with stomach cancer.

Risk factors
It depends on
Age: 72 years or older are most common   
Sex: Men are more prone than women to develop it
Diet: Smoked foods, salted or pickled food consumers may be at high risk
Bacteria: Helicobacter pylori infection increases risk
Smoking: People consuming more cigarettes develop stomach cancer
Certain health problems: Stomach surgery, chronic gastritis, APD by H. Pylori etc

Note:
Most people who have known risk factors do not develop stomach cancer. For example, people have H. Pylori in their stomach but never develop cancer.
Sometimes people developing cancers do not have known risk factors.
Symptoms:
Asymptomatic, only nonspecific symptoms in its early stages
Early symptoms:

• Indigestion or burning sensation
• Loss of appetite

Late symptoms:

• Abdominal pain or discomfort in the upper abdomen
• Nausea and vomiting
• Diarrhoea or constipation abdominal area, the patient feels a full and tight abdomen, which may cause abdominal pain)
• Decrease in weight, weakness and fatigue
• Bleeding
• Dysphagia ( difficulty in swallowing)

Diagnosis:
Physical examination: checks abdomen for fluid collection, swelling, or other changes and also palpate for swollen lymph nodes.
Upper GI series: Using contrast medium i.e drinking a barium solution and taking x-rays of the oesophagus and stomach that gives clear image of stomach.
Endoscopy: visualisation of oesophagus and stomach
Biopsy: To identify if cancer cells are present.
Blood tests: Complete blood count to check for anemia.
Chest x-ray: To confirm the spread of cancer to lungs.
CT scan: To confirm whether the tumors is present in liver, pancreas, or elsewhere in the body.

Staging:
Stage 0: limited to inner lining of the stomach.

Stage 1: penetration to the second or third layers of the stomach (stage 1A) or to the second layer and nearby lymph nodes ( stage 1B). Stage 1A is treated by surgery, stage 1B may be treated  with chemotherapy ( 5 fluorouracil) and radiation therapy.

Stage 2: penetration to the second layer and more distant lymph nodes, or the third layer and only nearby lymph nodes, or all four layers but not the lymph nodes.

Stage 3: penetration to the third layer and more distant lymph nodes, or penetration to the fourth layer and either nearby tissues or nearby or more distant lymph nodes.

Stage 4: metastasis to nearby tissues and more distant lymph nodes, or has metastasized to other organs. Cure is rare at this stage.

Treatment:
It depends upon the size place of tumour stage of disease and individual general health status.
It can be treated either by local therapy or systemic therapy.
Local therapy: surgery and radiation
Systemic therapy: chemotherapy
Radiation therapy: radiation therapy has side effects  that depends mainly on the dose of radiation and the part of the body that is treated. Abdominal radiation therapy may cause
Pain in the stomach or the intestine
Nausea and diarrhoea
Skin in the treated area may becone red, dry, and tend

Surgery: stomach cancer can be treated by two main surgery

Partial (subtotal) gastrectomy: removal of the part of the stomach with cancer. It also include removal of the part of the esophagus or part of the small intestine. Nearby lymph nodes and other tissues may be removed.

Total gastrectomy: removal of the entire stomach, nearby lymph nodes, parts of the esophagus and small intestine, and other tissues near the tumor. The spleen also may be removed. The surgeon then connects the esophagus directly to the small intestine.

Chemotherapy: Radiation therapy may be given along with chemotherapy. Anticancer drugs for stomach cancer are injected through blood vessel. But some of the drugs may be given by mouth. Some people may need to stay in hospital during treatment.

BONE AND MUSCLE TUMORS SYMPTOMS AND TREATMENNTS

A bone tumor is an abnormal enlargement of cells within the bone. It may be benign (noncancerous) or malignant (cancerous).

Classification

It may be classified as

• Primary bone tumors

• Secondary bone tumors

Primary bone tumors: It originates in bone or bone derived cells and tissues.It can be divided into benign and malignant.

     Causes of  Common benign primary bone tumors

• neoplastic

• developmental

• traumatic

• infectious

• inflammatory

Examples are osteoma, osteoid osteoma, osteochondroma, osteoblastoma, enchondroma, gaint cell tumor of bone, aneurysmal bone cyst and fibrous dysplasia of bone. 

Malignant primary bone tumors are

Osteosarcoma: It is most common and affects males of age 10-25years old. It is rare in older adults. It is seen in long bones of the arms and legs around the kness where rapid growth takes place and shoulders of children. It has high risk of spreading to the lungs.

Ewing's sarcoma: It is most dangerous bone tumor which affects younger people of age 4-15 years. It is more common in males and very rare in  people age above 30 years. Middle of the long bones of arms and legs is most common sites for its occurance.

Chondrosarcoma: It is the second most common bone tumors. 25% of it accounts for malignant bone tumors.It originates from the cartilage cells and may be rapid growing or slow growing.It is most common in people above 40 years of age.It is more common in males than females and can potentially spread to the lungs and lymph nodes. It most ly affects the bones of pelvis and hips.

Malignant fibrous histiocytoma: It affects the soft tissues, including muscle, ligaments, tendons and fat. It is most common soft tissue malignancy seen in people between 50-60 years of age. It most commonly affects the extremities and is about twice as common in males as females.

Fibro sarcoma: It is a rare form of bone tumors which is most common in people of age 35-55 years.It most commonly affects the soft tissues of leg behind the knee. It is more common in males than females.

Chordoma: It is a very rare tumor with an average survival of about six years after diagnosis. It is seen in adults above 30 years of age and is twice as common in males as females. It most commonly affects either the lower or upper end of the spinal column.

Secondary bone tumors: It originates in other sites and spread to skeleton. Primary cancer are cancer of prostate, breasts, lungs, thyroid and kidney that metastasize (spread) to bone. Most commonly spreading cancer to the bone are breast, kidney, lung, prostate, thyroid.

Causes

• Unknown (Idiopathic)

• Radiation

• Trauma

Symptoms

• Bone fracture resulting from injury (trauma)

• Bone pain may be worst at night

• A mass and swelling may be felt at the tumor site

• In case of benign tumors no symptoms.

Diagnostic tests

• Alkaline phosphatase blood level

• Bone biopsy

• Bone scan

• MRI of bone including surrounding tissue

• X-ray of bone

Treatment

Benign bone tumors may not require treatment but may be checked regularly if they grow or shrink. Surgical removal of the gumor may be required.

Treatment for malignant tumors that have metastasize to bone depends on the involvement of primary tissue or organ. Radiation therapy can be used locally to prevent fractures or to reduce pain.

Tumors that start in bone are rare and needs treatment at experience cancer treating centers. After biopsy, a combination of chemotherapy and surgery is required. As well as radiation therapy may be required before or after surgery.

Possible complications

• Pain

• Side effects of chemotherapy

• Spread of the cancer to other nearby tissues

Common cold

Common cold is a viral infection of the upper respiratory tract  nose and throat. It is usually harmless. It is also known as nasopharyngitis, rhinopharyngitis , acute coryza, head cold , or a cold. It is recovered within one or two weeks. it's not a runny nose, sore throat and cough, it's the  watery eyes, sneezing and congestion or may be all of the above.

Cause:

The most common cold viruses include:

• Rhino viruses :causing 10% to 40% of colds

• Corona viruses :causing 20% of colds

• Respiratory syncytial virus ( RSV ) :responsible for 10% of cold

Transmission:

• Touching the skin or environmental surfaces, such as telephones and stair rails, that contain cold germs on them and then touching the eyes or nose.
• When coughing or sneezing by a infected person inhaling drops of mucus full of cold germs from the air.

Symptoms:

The typical symptoms of a cold include a cough , a runny nose , nasal congestion, fever and a sore throat ( pharyngitis ), sometimes accompanied by muscle ache , fatigue , headache , and loss of appetite and sinuses (sinusitis), occasionally involving either or both eyes via conjunctivitis.

Cold Diagnosis:

Common cold diagnosis is based on symptoms and a physical examination. Initial diagnosis is often made from symptoms. No blood tests or X-rays are required for diagnosis. The doctor gives careful attention to the head, neck, and chest. He examines the eyes, ears, throat, and chest to help determine if a bacterial source is causing the illness.

Treatment:

Pain relievers: In case of fever, sore throat and headache, many people take acetaminophen (Tylenol, others) or other mild pain relievers. But it can cause liver damage, especially if taken frequently or in larger than recommended doses. It is contraindicated to children under 3 months of age. Aspirin to be taken with caution for children or teenagers. Though aspirin is approved for use in children more than age 2, children and teenagers recovering from chickenpox or flu-like symptoms should never take aspirin as it has been linked to Reye's syndrome, a rare but potentially life- threatening condition.

Decongestant nasal sprays: Adults shouldn't use decongestant drops or sprays for prolonged time because it can cause chronic rebound inflammation of mucous membranes. And children shouldn't use decongestant drops or sprays at all.

It has side effects although it works in young children.

Cough syrups: The Food and Drug Administration (FDA) and the American Academy of Pediatrics strongly recommend against giving OTC cough and cold medicines to children younger than age 2. These medications also have potential side effects, including rapid heart rate and convulsions.