N-Trivia

Alopecia
Benign Prostatic Hypertrophy
Kwashiorkor
Annual Registration of Nurses

Posted: 07 Nov 2010 01:00 PM PST

Alopecia or hair loss may be idiopathic (alopecia areata), male pattern, physiologic, due to hair pulling (trichotillomania) or due to scarring from other skin or sytstemic disorders.

Physiologic alopecia may associated with hormonal changes such as childbirth, nutritional factors, or toxin exposure.

Also, chemotherapuetic agents cause some degree of alopecia. This is dependent on the drug dose, half-life of the drug and duration of therapy. Usually, alopecia begins 2 weeks after administration of chemotherapy. Hair regrowth takes about 3 to 5 months after the treatment.

Clinical Manifestations:

Patterned, patchy or diffuse hair loss
Inflammation and scarring with some types

Medical Management:

Determine the underlying cause and treat it based on its etiology.
Minoxidil may cause fine hair regrowth in male pattern baldness and alopecia areata. Finasteride, which is an oral agent, can be used by males only with good results..
Various methods of hair replacement can be done. This includes surgical grafting of hair follicles, hair weaving or use of hair pieces.

Nursing Management:

Explain that alopecia areata and physiologic hair loss are usually only temporary and self-limiting.
For alopecia due to chemotherapy, assure the client that the hair will eventually grow back a few months after the treatment.
Encourage the client to verbalize his/her fears and body-image concerns regarding alopecia, especially if the client is a teenager or a young adult.
For females, encourage them to change their hairstyle or to wear head pieces or beautiful head scarfs until their hair grows back.
Counsel male patients on the slow and limited effects of minoxidil and stress that when treatment is stopped, the effects are reversed.
Encourage to eat a well-balanced diet, especially rich in protein and iron to promote hair growth.
Promote hair growth by encouraging them to be gentle with their remaining hair and to always keep their scalp and hair clean.Photo credits: www.world-pharmacy-directory.com

Benign Prostatic Hypertrophy

Posted: 07 Nov 2010 11:00 AM PST

It is also called enlarged prostate. In approximately one half of men 50 years and older, the prostate gland enlarges, extending upward into the bladder and obstructing the outflow of urine by encroaching on the vesical orifice. One of four men who reaches 80 years of age will require treatment for BPH.

Pathophysiology and Etiology:

The process of aging and the presence of circulating androgens are required for the development of BPH.
The prostatic tissue forms nodules as enlargement occurs.
The normally thin and fibrous outer capsule of the prostate becomes spongy and thick as enlargement progresses.
The prostatic urethra becomes compressed and narrowed, requiring the bladder musculature to work harder to empty urine.
Effects of prolonged obstruction cause trabeculation of the bladder wall, decreasing its elasticity.

Clinical Manifestations:

In early or gradual prostatic enlargement, there may be no symptoms because the bladder musculature can initially compensate for increased urethral resistance.
Obstructive symptoms include:

urinary hesitancy

diminution in size and force of urinary stream

terminal dribbling

sensation of incomplete emptying of the bladder

urinary retention

Irritative voiding symptoms include:

Urgency

Frequency

Nocturia

Diagnostic Evaluation:

Rectal examination would reveal smooth, firm, symmetric enlargement of the prostate
Urinalysis to rule out hematuria and infection
Serum creatinine and BUN to evaluate renal function
Serum PSA to rule out cancer, but may also be elevated in BPH
Optional diagnostic studies for further evaluation include:

Urodynamics to measure peak urine flow rate, voiding time and volume, and status of the bladder’s ability to effectively contract

Measurement of post-voidal residual urine by ultrasound or catheterization

Cystourethroscopy to inspect urethra and bladder and to evaluate prostatic size

Complications:

acute urinary retention
involuntary bladder contractions
bladder diverticula
cystolithiasis
vesicoureteral reflux
gross hematuria and UTI

Management:

Patients with mild symptoms are follow-up annually as BPH does not necessarily worsen in all men.
Pharmacologic treatment:

Alpha-adrenergic blockers to relax the smooth muscle of bladder base and prostate to facilitate voiding

Finasteride has an anti-androgen effect on prostatic cells by reversing or preventing hyperplasia

Surgery such as transurethral incision of the prostate or open prostatectomy, usually by suprapubic approach
Newer approaches include laser surgery, transurethral electrovaporization, transurethral needle ablation, and thermotherapy

Photo credits: www.healthguide.howstuffworks.com

Nursing Management:

Provide privacy and time for the patient to void.
Assist with catheter introduction

Monitor intake and output.

Monitor patency of catheter

Administer medications as ordered and educate patient about its side and adverse effects.
Assess for and teach patient to report hematuria and signs of infection.
Explain the possible complications of BPH and to report this at once.
Advise patient to avoid drugs that impair voiding such as OTC cold medications containing sympathomimetics like phenylpropanolamine.
Encourage compliance to follow-up check ups.

Kwashiorkor

Posted: 07 Nov 2010 09:00 AM PST

Kwashiorkor is a form of malnutrition that occurs when there is not enough protein in the diet. It is usually an acute form of childhood protein-energy malnutrition. The presence of edema caused by poor nutrition defines kwashiorkor.

Kwashiorkor is most common in areas where there is famine, limited food supply and low levels of education. This disease is more common in very poor countries. It often occurs during a drought, other natural disasters or during political turbulence. These conditions are responsible for scarcity of food, which leads to malnutrition.

Symptoms:

Changes in skin pigment
Decreased muscle mass
Diarrhea
Failure to gain weight and grow
Fatigue
Changes in color and texture of hair
Increased and more severe infections due to damaged immune system
Irritability
Protruding abdomen
Lethargy or apathy
Loss of muscle mass
Rash
Swelling or edema

Diagnostic Evaluation:

The physical examination may show an enlarged liver or hepatomegaly and generalized swelling.

Other tests may include:

Arterial blood gas
BUN
Complete blood count (CBC)
Creatinine clearance
Serum creatinine
Serum potassium
Total protein levels
Urinalysis
Coma
Permanent mental and physical disability
Shock

Possible Complications:

Coma
Permanent mental and physical disability
Shock

Management:

Getting more calories and protein will correct this form of malnutrition, if treatment is started early enough. However, children who have condition will never reach their full potential for height and growth.
Treatment depends on the severity of the condition. Patients who are in shock need immediate treatment to restore blood volume and maintain blood pressure.
Calories are given first in the form of complex carbohydrates, simple sugars, and fats. Proteins are started after other sources of calories have already provided energy. Vitamin and mineral supplements are essential.
Since the patient has not taken in adequate food for a long period of time, eating can cause problems, especially if high caloric foods are given simultaneously. Food must be reintroduced slowly. Carbohydrates are given first to supply energy, followed by protein foods.
Many malnourished children will develop lactose intolerance. They need to be given supplements with the enzyme lactase, so that they can tolerate milk products.

As kwashiorkor is a nutrition problem, make sure that the diet is composed of 40-50% carbohydrates, 25-35% protein and 20-30% fat.

Photo credits: www.nlm.nih.gov

Annual Registration of Nurses

Posted: 06 Nov 2010 04:00 PM PDT

This article is about annual registration of nurses in the Philippines.

So here you are, falling in line in front of that building with three initials P. R. C. The efforts and candles you have burned were paid off with this well-kept privilege that goes along with that title: Registered Nurse under the Philippine Law.

Before you drown with the bliss that you feel about having that well coveted privilege professional practice, take in mind that you still have to register that or else you won't be recognized by health care institutions when you apply for a job.

Annual Registration is mandated by the Professional Regulation Commission. The professional must register and pay the prescribed fee for three years and it is paid on the birth month of the practitioner. It is a practical way isn't it? It is really designed this way so that professional will minimally forget the date of their registration.

There are circumstances however that a certain professional may not be able to pay on his or her birth month. There is a 20% surcharge is made on every calendar year being missed. It is also mandated that after five continuous year after the last paid annual registration there is a tendency for the professional's certificate of registration shall be suspended. Aside from that, the professional's name shall not be included in the roster list. After the professional have paid the dues, he or she is then able to gain the privilege without taking the examination again.

Many nurses might not now this, that with the advent of not practicing their profession it is still a must to send a letter to the Board within one year from the time he or she stopped practicing in order to avail exemptions of the annual registration fee.

It is therefore a responsibility of a nurse to be updated with the annual registration to prevent surcharges or worse than that not being included in the roster of professional nurses in the Philippines.