| Types of Sickle Cell Crisis Posted: 04 Feb 2011 01:33 AM PST 
Overview Sickle cell anemia is an inherited disorder on the beta chain of the hemoglobin resulting to abnormally shaped red blood cells. RBC's assume a crescent or C-shape that decreases the cell's life span and ability to function thereby, producing various complications. In some cases, these sickled cells may block the flow causing pain and organ damage. A severe attack, known as sickle cell crisis, can cause pain because blood vessels can become blocked or the defective red blood cells can damage organs in the body. Most episodes of sickle cell crises last between five and seven days Types of Sickle Cell Crisis A. Vaso-occlusive Crisis – This type of sickle cell crisis is due to the presence of sickle shaped red blood cells that impede capillaries and restrict the blood flow to an organ. This results in ischemia, severe pain, necrosis (tissue death) and most of the time it damages an organ. The frequency, severity, and duration of these crises vary considerably. Treatment: Pain crises are managed and treated by the following measures. - Hydration
- Analgesics (Opioid administration at regular intervals until the crisis has settled). For milder crises, NSAIDs such as Diclofenac or Naproxen could be used. For severe crises, intravenous opioids are given such as patient-controlled analgesia (PCA).
- Blood transfusion
- Dipenhydramine. This medication is used for the management of itching associated with the opioid use.
- To minimize the development of atelectasis a technique that encourages deep breathing, incentive spirometry, is recommended.
B. Splenic Sequestration Crisis – This crisis is acute and painful enlargements of the spleen. The spleen is responsible for clearing defective red blood cells. However, because of its narrow vessels, defective RBC's pools down the spleen that leads to its infarction before the end of childhood in individuals suffering from sickle-cell anemia. During a splenic sequestration crisis the abdomen becomes bloated and very hard. Aside from that, the sinusoids and gates would open at the same time that result to the sudden pooling of the blood into the spleen which leads to a circulatory defects, thus, leading to sudden hypovolemia. Treatment Splenic sequestration crisis is considered an emergency condition and abrupt and prompt treatment is required or the patient may die within 1-2 hours because of the circulatory failure. - Blood transfusion
- Management is supportive
C. Aplastic Crisis – This crisis stimulated by parvovirus B19. This virus directly affects the production of RBCs through the invasion of the red cell precursors. The resulting condition is the multiplication of the virus and the destruction of the RBC's. The crisis is characterized by acute worsening of the patient's baseline anemia which produces pallor, tachycardia and fatigue. Treatment - Blood transfusion
- Supportive management
D. Hemolytic Crisis – When hemoglobin levels drop, hemolytic crisis is accelerated. Resulting to the speeding up of RBC destruction. Individuals with co-existent G6PD deficiency commonly suffers from this crisis. Treatment: - Blood transfusion
- Supportive management
Related posts: - Sickle Cell Anemia – Case Study
- Hypertensive Crisis
- Classifications of Anemia
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| The Integumentary System (SKIN) Posted: 03 Feb 2011 10:18 PM PST 
Definition The cutaneous membrane also called the skin serves coats the body externally. The skin and its derivatives such as the sweat and oil glands, hair and nails are generally called the integumentary system. The cutaneous membrane is a dry membrane and is exposed to air. Functions of the SKIN The integument or the skin with its derivatives serves the following function: - Covers the body.
- Protects the body from mechanical damage. This function is done by insulating and cushioning the deeper body organs. Examples of mechanical damage are bumps and cuts. When a person is bumped, the uppermost layer of the skin toughens or hardens the cells. The toughening of the cells is due to the presence of keratin in the upper layer of the skin. Pressure receptors in the skin send an impulse to the nervous system about a possible damage. These receptors alert an individual to bumps and provide a great deal of information about the external environment.
- 3. Protects the body from chemical damage. Acids and bases, when exposed to the body at high levels, can cause extreme damage to the internal organs. However, because of the presence of tough keratinized cells, damage to internal organs is prevented.
- Protects the body from bacterial damage. In preventing infection, one of the most important considerations to consider is an unbroken skin surface. The skin secretes urea, salt and water (acidic) when a person sweats, thus, inhibiting bacterial growth. Phagocytes are also located in the skin which is responsible for ingesting foreign substances and pathogens. Hence, bacterial penetration to deeper body tissues is prevented.
- Protects from ultraviolet radiation. The pigment or color of the skin depends on the presence of melanin. This melanin that is produced by the melanocytes is good at protecting the body from the damaging effects of the sunlight or UV damage.
- Protects the body from thermal damage. When the body is exposed to extreme heat or cold the heat and cold receptors located in the skin alerts the nervous system of the tissue-damaging factors. The brain, in response sends impulses to the site of damage or possible damage for the body's compensatory mechanism.
- Protects the body from drying out. The skin's outermost part, the epidermis, contains a waterproofing glycolipid and keratin in order to prevent water loss from the body surface.
- Regulation of heat loss and heat retention. The body must maintain a constant core temperature. Any change in the environmental temperatures could possibly alter the required core temperature. The skin contains a rich capillary network and sweat glands which are controlled by the nervous system. These mechanisms play an important role in regulating heat loss or retention in the body. When the body is needs to loss heat, the skin receptors alert the nervous system which in response activates the sweat glands (sweat helps cool the body in a hot environment). The blood is also flushed into the skin capillary beds, making heat loss possible. When the body needs to retain heat, the blood is NOT allowed to be flushed into the capillary skin beds. This is the main reason why during cold weather, the palms of the hands are pale.
- Acts as mini-excretory system. The perspiration contains urea, uric acid and salts.
- Synthesizes Vitamin D. The skin produces proteins that are vital for the synthesis of the Vitamin D. When a person is exposed to sunlight, modified cholesterol molecules in the skin are converted to Vitamin D.
Related posts: - DISEASES OF INTEGUMENTARY SYSTEM
- Impaired skin integrity r/t changes in the barrier function of the skin
- Impaired skin integrity r/t traction application
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| Genus Streptococcus Posted: 02 Feb 2011 11:30 PM PST 
Genus Streptococcus has a characteristic feature with a of a gram positive cocci in short or long chain. It grows best on blood agar plate in order to see the ability to hemolyze blood serves to differentiate the species. Classification: - Through clinical presentation
- Pyogenic streptococci
- Oral streptococci
- Intestinal streptococci
- Serologic Properties – This is developed by Lancefield in 1933 for differentiating pathogenic B-hemolytic strains. Most B-hemolytic strains and some alpha and nonhemolytic strains possess group specific antigens, which are aither C-carbohyradte or teichoic acids (cell wall components).
- Group A – Streptococcus pyogenes
- Group B – Streptococcus agalactiae
- Group D / Viridans group – consists of two subgroups:
- Enterococcus/ intestinal streptococci
- Nonenterococcal/oral streptococci
Hemolytic Patterns on Blood Agar Plate - Hemolytic streptococci or green streptococci – Produce a substance called ?-hemolysin that recudes haemoglobin (red coloring pigment of the blood) to methemoglobin (green); this reduction causes a greenish zone to surround the colony.
- Haemolytic streptococci – produce a hemolysin that forms a clear zone of hemolysis on blood agar. Species producing this pattern is the streptococcus pyogenes or Group A streptococcus considered as the most pathogenic.
- Haemolytic streptococci – produce no apparent effect on red blood cells. It is also known as non-haemolytic streptococci or streptococcus non-hemolyticus
Biochemical (physiologic) Properties - Streptococcus pyogenes
- S. Agalactiae
- S. Equisimilis
- Enterococcus faecalis
- E. Faecium
- S. Bovis
- S. Milleri group
- S. Pneumoniae
- S. Salivarius
- S. Sanguis
- S. Mutans
- S. Acidominimus
- S. Uberis
- S. Mitis
Pathogenic Species: These are medically important. - Streptococcus pneumonia
- Streptococcus pyogenes
- Streptococcus agalactiae
- Viridans streptococci
Related posts: - Throat Culture Procedure
- Escherichia Coli
- Salmonella Typhosa
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| Genus Neisseria Posted: 02 Feb 2011 11:25 PM PST 
Genus Neisseria has a specie called Neisseria gonorhea or commonly called Gonococcus. It has a gram negative, kidney or bean shaped intracellular diplococcic. This is usually killed when outside of the human body. It is transmitted through sexual intercourse, with an infected partner via infected birth canal of infected mother during delivery; indirectly transmitted via contaminated hands, fomites contaminated with purulent discharges; directly also via oral sex. Gonorrhea originated from the two Greek words: "gono" meaning semen and "rhein" which means flow. It is an acute, inflammatory and infectious disease o the mucus membrane of the genitor-urinary tracts of men and women as well as the eyes of the newborn due to N. Gonorrhoea. Its incubation period usually is 3-5 days after the contact with an infected partner. Asymptomatic gonococcal infection in women most frequently involves the endocervix. In decreasing order of occurrence, the urethra, anal canal, and the pharynx also can be infected. Extension of the disease to the fallopian tubes usually is accompanied by the signs and symptoms of acute salpingitis. Other infections: - Ophthalmia Neonatorum – an infection of the conjunctiva of the eye affecting the newborn babies during passage through an infected birth canal.
- Gonorrheal Ophthalmia - an acute painful inflammatory infection of the eyes which results when the gonococci are rubbed by the contaminated hands and to the eyes.
- Gonorrheal Vulvovaginitis – Occurs only among pre-pubertal girls when the vagina is lined with softer extremely susceptible epithelium to cornified stratified squamous type resistant to gonococci at puberty usually eliminates a childhood infection. This is the usual result in cases of rape.
- Gonococcal Pharyngitis - This is the result of the direct contact by oral sex of the infecting organism with the pharynx or their transmission to the oral cavity from infection elsewhere in the body.
- Anal Gonorrhea – an infection of the anus when the infecting organism is introduced through anal sex. Anorectal gonorrhoea has been reported to be 28 to 55% of the cases common among homnosexual males attending STD clinics.
Signs and Symptoms: - Dysuria/ Urethral discharge
- Prostatitis/inguinal lymphadenitis
- Pelvic pain
- Fever
Complication: Postgonococcal urethritis Diagnostic Evaluation: - Microscopic examination of Gram stained urethral or conjunctival smear and finding the characteristic gram (-), coffee/kidney-shaped, intracellular diplococcic.
- Endocervical, anal or urethral culture of pus and mucus on selective culture medium.
- For colony identification for oxidase test.
Medical Treatment: - Penicillin G inhibits the cell wall synthesis and it is the drug of choice.
- Triple sulphonamides is bacteriostatic.
- Tetracyclines inhibits protein synthesis
Related posts: - Neisseria Gonorrhea
- Genus Streptococcus
- Chlamydia Psittaci
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| Clostridium Botulinum Posted: 02 Feb 2011 10:09 PM PST 
DESCRIPTION - Large, obligate anaerobe, fastidious, gram (+), either in chain or occurs single, motile (peritrichous flagellation), sporeforming with spore located centrally;
- Grow well on meat-infusion medium and in blood agar producing hemolysis of the red blood cells when incubated under anaerobic conditions;
- Spores are easily destroyed by burning
- Exotoxin destroyed by boiling for 10 minutes
- Common inhabitant of the soil and intestinal tract of animals
- Responsible for spoilage of improperly processed canned foods
- Causes botulism
BOTULISM - It is a severe/serious intoxication due to ingestion of a potent neurotoxin from inadequately sterilized canned foods.
- Botulinin blocks the action of acetylcholine in the neuromuscular junction.
- The patient usually dies within 3 to 7 days from respiratory or cadia failure or from infectious complications.
- It is a rare kind of food poisoning but the mortality is very high.
TYPES AND CATEGORIES - Food-borne botulism
- It is an intoxication caused by the ingestion of preformed botulinin in contaminated canned foods with incubation period of 1 to 2 days.
- The toxin is absorbed from the small intestine and carried by the blood to the motor nerves.
- Death may occur within 24 hours due to respiratory paralysis.
- Infant botulism
- It is an intoxication due to absorption of toxin within the baby's body from dirt and dust.
- It is caused by the in vivo production of neurotoxin colonizing the gastrointestinal tract of young infants.
- It is common among infants less than 9 months old.
- Muscular involvement leads to respiratory insufficiency and death.
- Wound botulism
- This is the least common form of botulism which is caused by Type A botulinin.
- Develops in vivo toxin production in infected or contaminated traumatic wounds. Incubation period ranges from 4 to 14 days.
- Gastrointestinal symptoms are less prominent.
PREVENTION - Boil/cook home canned or preserved food for 10 minutes.
- Gas-containing, off-color, off-smelling, or foods from bulging cans should never be eaten or even-tasted.
- Regulation and inspection of commercial processing of canned and preserved foods.
- Maintain food in acid pH or storage at 4oC.
- Polyvalent toxoid for active immunization of high risk laboratory workers, at 0 to 10 weeks with booster injection after 1 year to stimulate solid immunity.
TREATMENT Medical care should be arranged at once. It is not possible to reverse the damage already done. - Intramuscular injection of botulinus antitoxin. If administered early in its course, the patient's chances of survival are better than after the disease is established.
- Adequate ventilatory support, elimination of the organisms from the gastrointestinal tract by the judicious use of gastric lavage.
- Penicillin therapy.
- Guanidine hydrochloride administration. It enhances acetylcholine release.
Related posts: - Staphylococcal Food Poisoning
- Clostridium Tetani
- Clostridium Perfringens
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| Chemotherapy Effects Posted: 02 Feb 2011 12:49 AM PST 
Definition Chemotherapy is a type of treatment for cancer that uses drugs or medications to destroy cancer cells. Cancer cells are rapidly dividing. Chemotherapy acts by killing these rapidly diving cancer cells. Objectives of Chemotherapy - To destroy all malignant cancer cells without excessive destruction of normal cells.
- To control the growth of the tumor if cure is no longer possible.
Mechanism of Action Cancer cells grow and divide quickly. Chemotherapy works by stopping or slowing the growth of these cancer cells. Chemotherapeutic agents work by impairing the mitosis or cell division of fast-dividing cells, thus they are termed cytotoxic as they cause damage to these cells. However, it can also damage healthy normal cells that are quickly dividing, such as the cells that line the mouth and intestines and those that cause the hair to grow. Damage to these normal cells poses side effects of the chemotherapy use. These side effects usually get better or go away after chemotherapy is over. What does chemotherapy do? - Chemotherapy CURES cancer. Chemotherapy destroys cancer cells to the point that your doctor can no longer detect them in your body and they will not grow back.
- Chemotherapy CONTROLS cancer. Chemotherapy keeps cancer from spreading, slows its growth, or destroys cancer cells that have spread to other parts of your body.
- Chemotherapy helps EASE cancer symptoms.
Contraindications of Chemotherapy - Infection. Chemotherapeutic drugs can cause immunosuppression. Cells in the bone marrow are rapidly dividing in normal circumstances. Thus, this results to decreased production of red and white blood cells (myelosuppression). As myelosuppression occurs, hence, immunosuppression also occurs.
- Impaired renal or hepatic function. Drugs used in chemotherapy are nephrotoxic and hepatotoxic.
- Pregnancy. Chemotherapeutic drugs are known to cause congenital defects to the unborn child.
- Bone marrow depression. Administering chemotherapeutic drugs may aggravate the condition.
Chemotherapy Treatment Schemes - Combined modality chemotherapy. In this type of treatment scheme, chemotherapeutic agents are used in combination with other cancer treatments such as radiation therapy or surgery. In present times, most cancers are treated in this way. It helps radiation therapy and biological therapy work better.
- Neoadjuvant chemotherapy (preoperative chemotherapy). In this type of treatment scheme, initial chemotherapy is designed to shrink the primary tumor. It makes a tumor smaller before surgery or radiation therapy.
- Adjuvant chemotherapy (postoperative treatment). This treatment is used to destroy cancer cells that may remain after surgery or radiation therapy.
- Palliative chemotherapy. This treatment is given without curative intent but simple to decrease the tumor load and increase life expectancy.
image courtesy of http://www-cancer.us Related posts: - Stomach Cancer (Gastric Cancer)
- Throat Cancer
- Nursing Care Plan – Breast Cancer
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