N-Trivia

Major Depressive Disorder Symptoms and Therapeutic Management
Anatomy and Physiology of Mammary Glands (Breast)
Throat Cancer

Major Depressive Disorder Symptoms and Therapeutic Management

Posted: 18 Nov 2010 09:51 PM PST

A mood disorder may include symptoms of depressed mood, feelings or hopelessness and helplessness, decreased interest in usual activities, disinterest in relationship with others or cycles of depression and mania.
Depression is often concurrent with other psychiatric diagnoses. Almost have of clients with major depressive disorders have histories of non-mood psychiatric disorders.
A high incidence exists for persons with chronic illness or prolonges hospitalization or institutional care.

Risk Factors

Biological factors – brainchemicals
Family genetics – parent with depression, child 10-13% risk of depression.
Gender – higher rate for women
Age – often less than 40 when begins
Marital status – more frequently single, widowed
Season of year – Seasonal Affective Disorder (SAD) occurs when client experiences recurrent depression that occurs annually at the same time.
Psychological influences – low self-esteem, unresolved grief.
Environmental factors – lack of social support, stressful life events.
Medical co-morbidity – clients with chronic or terminal illness, postpartum, and current substance abuse are especially prone to becoming depresses.

Signs and Symptoms

Sexual disinterest
Suicidal and homicidal ideations
Decrease in personal hygiene
Tearfulness, crying, and melancholy
Altered thought process; difficulty concentrating, self-destructive behavior.
Loss of energy or restlessness
Anhedonia or loss of pleasure
Gain or loss of weight
Anger, self-directed
Psychomotor retardation or agitation
Insomnia or hypersomnia
Feelings of hopelessness, worthlessness, and helplessness.

Nursing Diagnoses

Risk for violence, self-directed or directed at others
Impaired verbal communication
Decisional conflict
Altered role performance
Hopelessness
Deficit in diversional activity
Fatigue
Sel-care deficit
Altered thought processes
Self-esteem
Anxiety

Therapeutic Nursing Management

Safe environment
Psychological treatment

Individual psychotherapy – long –term therapeutic approach or short term solution-oriented, may focus on in-depth exploration, specific stress situations, or problem solving.
Behavioral therapy – modifying behavior to assist in reducing depressive symptoms and increasing coping skills.
Behavioral contacts – focus on specific client problems and need to help the client resolve them.

Social treatment

Milieu therapy – incorporates day to day living experiences in a therapeutic environment to expect changes in perception and behavior.
Family therapy – aimed at assisting the family cope with the client's illness and supporting the client in therapeutic ways.
Group therapy – focuses on assisting clients with interpersonal communication, coping, and problem-solving skills.

Psychopharmacologic and Somatic treatments

Administer antidepressant medications
Continued assessment by monitoring client's mental health status is critical, particularly interms of agitation and suicidal ideation.
Electroconvulsive therapy

Nursing Interventions

Priority for care is always the client's safety.
Use of behavioral contacts. Use this technique to meet outcomes relating to "no self-harm" or no suicidal ideation or plan.
Assess regularly for suicidal ideation or plan.
Observe client for distorted, negative thinking.
Assist client to learn and use problem solving and stress management skills.
Avoid doing too much for the client, as this will only increase client's dependence and decrease self-esteem.
The nurse's role in the physical care of the client experiencing major depressive disorder is to provide assessment and interventions related to appropriate nutrition, fluids, sleep, exercise, and hygieme, and to provide health education.
Explore meaningful losses in the client's life.
Help the client and family to identify the internal and external indicators of major depressive disorder.

Anatomy and Physiology of Mammary Glands (Breast)

Posted: 18 Nov 2010 09:36 PM PST

Mammary Glands (Breast)

Definition

The breast or mammary gland is a highly efficient organ mainly used to produce milk and is a mass of glandular, fatty, fibrous tissues. Mammary glands are exocrine glands that are enlarged and developmentally are modified sweat glands that are actually part of the skin. They are also classified as tubualveolar glands and are located in the breast lying on the top of the pectoralis major muscles. These glands are present in males and females; however, they normally function in the latter gender only.

Function

The biological role of the mammary glands is to produce milk to nourish a newborn baby and to pass antibodies needed for baby's protection against infections (passive immunity) while the immature immune is initiating its function.

Breast Anatomy

The breast is internally composed of the following parts:

Lobes and Lobules

Internally, the mammary gland is composed of 15-25 lobes that radiates around the nipple. Each lobe consists of about 20-40 lobules, a smaller milk duct that contains 10-100 supporting alveoli.

• Glandular tissue

Glandular tissues are responsible for milk production and transportation which is composed of:

Alveoli – epithelial grape-like cluster of cells where milk is produced.
Ductules – branch-like tubules extending from the clusters of alveoli and empties to larger ducts called lactiferous ducts.
Lactiferous ducts – widen underneath the areola and nipple to become lactiferous sinuses.
Lactiferous sinuses – collect milk from lactiferous ducts and narrows to an opening in the nipple (nipple pore).

• Connective tissue

Connective tissue supports the breast. Cooper's ligaments are fibrous bands that attach the breast to the chest wall and keep the breast from sagging.

• Blood – nourishes breast tissue and supplies the nutrients to the breast needed for milk production.

• Nerves – make the breast sensitive to touch, hence allowing the baby's suck to stimulate the release of hormones that trigger the let-down or milk ejection reflex (oxytocin) and the production of milk (prolactin).

Lymph nodes – removes waste products

• Adipose tissue (fat) – protects the breast from injury.

The breast is externally composed of the following parts:

Areola – pigmented area at the center of each breast.
Nipple – protruding area at the center of each breast.

Physiology

The function of producing milk is regulated by hormones. Stimulation of the female sex hormone, estrogen, causes the development of glandular tissue in the female breast during puberty. Increase estrogen levels during pregnancy causes the breast size to increase in size through the accumulation of adipose tissues.

Presence of progesterone stimulates the growth and maturation of the duct system. During pregnancy levels of estrogen and progesterone rises (levels are needed to sustain pregnancy) that further enhances the development of the mammary glands. This is the main reason why pregnant women has larger and more enhanced breast.

Another hormone important for the implementation of mammary gland function is the presence of prolactin and oxytocin. Without these hormones, milk will not be produced and ejected out of the breast. Prolactin from the anterior pituitary gland stimulates the production of milk in the glandular tissues while oxytocin causes the ejection of milk from the glands.

image from breastcancersource.com, green-beauty.info

Throat Cancer

Posted: 18 Nov 2010 09:25 PM PST

Throat cancer refers to a neoplasm that forms in tissues of the pharynx, which is the hollow tube inside the neck that starts behind the nose and ends at the top of the windpipe and esophagus. Most throat cancers are squamous cell carcinomas or those that begin in thin, flat cells that look like fish scales.

Types of Throat Cancer

The throat and the voice box are closely connected, with the voice box located just below the throat. More specific terms to describe the types of throat cancer include:

Nasopharyngeal cancer begins in the nasopharynx — the part of the throat just behind the nose.
Oropharyngeal cancer begins in the oropharynx — the part of the throat right behind the mouth that includes the tonsils.
Hypopharyngeal cancer or laryngopharyngeal cancer begins in the hypopharynx — the lower part of the throat, just above the esophagus and windpipe.
Glottic cancer begins in the vocal cords.
Supraglottic cancer begins in the upper portion of the larynx and includes cancer that affects the epiglottis, which is a piece of cartilage that blocks food from going into the windpipe.
Subglottic cancer begins in the lower portion of the voice box, below the vocal cords.

Risk factors:

Tobacco use, including smoking and chewing tobacco
Excessive alcohol use
Poor dental hygiene
Human papillomavirus (HPV)
A diet lacking in fruits and vegetables
Exposure to asbestos

Signs & Symptoms:

cough
hoarseness
Difficulty swallowing
Ear pain
A lump or sore that doesn’t heal
sore throat
Unexplained weight loss

Diagnostic Evaluation:

Endoscopy/laryngoscopy
Biopsy of a tissue sample
Imaging tests such as X-ray, computerized tomography (CT) scans, magnetic resonance imaging (MRI) and positron emission tomography (PET)

Medical Management:

Radiation therapy

Radiation therapy utilize high-energy particles, such as X-rays, to deliver radiation to the cancer cells, causing them to die. Radiation therapy can come from a large machine outside the body (external beam radiation) or from small radioactive seeds and wires that can be placed inside the body, near the locality of the cancer cells (brachytherapy).
Surgery
The types of surgical procedures you may consider to treat your throat cancer depend on the location and stage of your cancer. Options may include:

Surgery for early-stage throat cancer. Throat cancer that is confined to the surface of the throat or the vocal cords may be treated surgically using endoscopy.
Surgery to remove all or part of the voice box (laryngectomy).
Surgery to remove all or part of the throat (pharyngectomy).
Surgery to remove cancerous lymph nodes (neck dissection).

Chemotherapy
Chemotherapy uses chemicals to kill cancer cells. Chemotherapy is often used along with radiation therapy in treating throat cancers.
Targeted drug therapy
Targeted drugs treat throat cancer by altering specific aspects of cancer cells that fuel their growth. Cetuximab (Erbitux) is one targeted therapy approved for treating throat cancer in certain situations. Cetuximab stops the action of a protein that’s found in many types of healthy cells, but is more prevalent in certain types of throat cancer cells.

Nursing Considerations & Prevention

Avoid smoking or at least ask for help in stopping smoking.
Alcohol consumption should in moderation like twice a week.
Include fruits and vegetables in the diet since it includes antioxidants that would reduce the chances of throat cancer.
Use proper protection for breathing and the oral cavity when exposed to certain chemicals.
Assist the patient and the family in dealing with the psychological impact of the diagnosis of cancer, alteration of physical appearance, and possible need for altered methods of communication due to loss of voice.
The nurse can suggest interventions to reduce side effects of radiation therapy. Dry mouth (xerostomia) the most frequent and annoying problem. Pilocarpine hydrochloride can be used in increasing salivaPhoto credits: Mayo Foundation of Medical Education and Research

Photo credits: aurorahealthcare.org