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By P. Gorn. Simpson College, Indianola Iowa.

No drug prevents the bruising quality zantac 300mg; the patient is often advised to avoid aspirin and aspirin-containing drugs zantac 150 mg online, but there is no evidence that bruising is related to their use. Senile Purpura A disorder affecting older patients, particularly those who have had excessive sun exposure, in whom dark purple ecchymoses, characteristically confined to the extensor surfaces of the hands and forearms, persist for a long time. Lesions slowly resolve over several days, leaving a brownish discoloration caused by deposits of hemosiderin; this discoloration may clear over weeks to months. Hereditary Hemorrhagic Telangiectasia (Rendu- Osler-Weber Disease) A hereditary disease of vascular malformation transmitted as an autosomal dominant trait affecting men and women. Diagnosis is made on physical examination by the discovery of characteristic small, red-to-violet telangiectatic lesions on the face, lips, oral and nasal mucosa, and tips of the fingers and toes. These fistulas may produce significant right-to-left shunts, which can result in dyspnea, fatigue, cyanosis, or polycythemia. However, the first sign of their presence may be a brain abscess, transient ischemic attack, or stroke, as a result of infected or noninfected emboli. Cerebral or spinal arteriovenous malformations occur in some families and may cause subarachnoid hemorrhage, seizures, or paraplegia. Biopsy of an acute skin lesion reveals an aseptic vasculitis with fibrinoid necrosis of vessel walls and perivascular cuffing of vessels with polymorphonuclear leukocytes. Granular deposits of immunoglobulin reactive for IgA and of complement components may be seen on immunofluorescent study. Therefore, deposition of IgA-containing immune complexes with consequent activation of complement is 374 Hematology thought to represent the pathogenetic mechanism for the vasculitis. The disease begins with the sudden appearance of a purpuric skin rash that typically involves the extensor surfaces of the feet, legs, and arms and a strip across the buttocks. Most patients also have fever and polyarthralgia with associated periarticular tenderness and swelling of the ankles, knees, hips, wrists, and elbows. The disease usually remits after about 4 wk but often recurs at least once after a disease-free interval of several weeks. In most patients, the disorder subsides without serious sequelae; however, some patients develop chronic renal failure. The presence of diffuse glomerular involvement or of crescentic changes in most glomeruli predicts progressive renal failure. Vascular Purpura Caused By Dysproteinemias Hypergammaglobulinemic purpura is a syndrome that primarily affects women. It is characterized by a polyclonal increase in IgG (broad-based or diffuse hypergammaglobulinemia on serum protein electrophoresis) and recurrent crops of small, palpable purpuric lesions on the lower legs. Cryoglobulinemia is characterized by the presence of immunoglobulins that precipitate when plasma is cooled (ie, cryoglobulins) while flowing through the skin and subcutaneous tissues of the extremities. In amyloidosis, deposits of amyloid within vessels in the skin and subcutaneous tissues produce increased vascular fragility and purpura. Periorbital purpura or a purpuric rash that develops in a nonthrombocytopenic patient after gentle stroking of the skin should arouse suspicion of amyloidosis. In some patients a coagulation disorder develops, apparently the result of adsorption of factor X by amyloid. Leukocytoclastic Vasculitis A necrotizing vasculitis accompanied by extravasation and fragmentation of granulocytes. Causes include hypersensitivity to drugs, viral infections (eg, hepatitis), and collagen vascular disorders. The most common clinical manifestation is palpable purpura, often associated with systemic symptoms, such as polyarthralgia and fever. Autoerythrocyte Sensitization (Gardner-Diamond Syndrome) An uncommon disorder of women, characterized by local pain and burning preceding painful ecchymoses that occur primarily on the extremities. However, most patients also have associated severe psychoneurotic symptoms, and psychogenic factors, such as self-induced purpura, seem related to the pathogenesis of the syndrome in some patients. Platelet disorders Platelet disorders may cause defective formation of hemostatic plugs and bleeding because of decreased platelet numbers (thrombocytopenia) or because of decreased function despite adequate platelet numbers (platelet dysfunction). Thrombocytopenia Thrombocytopenia is quantity of platelets below the normal range of 140,000 to 440,000/µL. Thrombocytopenia may stem from failed platelet production, splenic sequestration of platelets, increased platelet destruction or use, or dilution of platelets.

If an excess amount of acid is applied cheap 300mg zantac amex, the treated area should be powdered with talc purchase zantac 150 mg without a prescription, sodium bicarbonate, or liquid soap preparations in most cases if surgical removal is performed properly. This treatment can be repeated weekly, if therapy is most benefcial for patients who have a large number necessary. Nevertheless, some persons diagnosed with genital warts and their partners: infections do progress to genital warts, precancers, and • Genital warts are not life threatening. Ablative modalities usually are efective, but careful Special Considerations follow-up is essential for patient management. Pregnancy Imiquimod, sinecatechins, podophyllin, and podoflox Cervical Cancer Screening for should not be used during pregnancy. Pregnant women with genital cervical disease, or history of cervical disease compared with warts should be counseled concerning the low risk for warts women without these characteristics (419). No data suggest that treat- ommendation is based on the low incidence of cervical cancer ment modalities for external genital warts should be diferent for and limited utility of screening in younger women (98). However, to ensure the reliability of screening methods, the safety and response to the provision of adequate care, follow-up and referral sources treatments, and the programmatic considerations that would must be in place. When available, a copy of the Pap test result should women frequently equate having a pelvic examination with be provided. Women with abnormal screening or diagnostic having a Pap test; they erroneously believe that a sample for tests should be referred to clinic settings that employ providers Pap testing was taken, when in reality, only a pelvic examina- who are experienced in managing these cases (see Follow-Up). Additionally, these tests Guidelines for Management of Abnormal Cervical Cytology (429) can be used in conjunction with a Pap test (adjunct testing) for (information regarding management and follow-up care is cervical cancer screening of women aged ≥30 years. Clinics and of the lower genital tract and, if indicated, conduct a health-care providers who ofer cervical screening services but colposcopically directed biopsy. Colposcopy is appropriate if the provider has con- and results of follow-up appointment should be clearly docu- cerns about adherence with recommended follow-up or mented in the clinic record. Te test can be performed after care- should be referred immediately for colposcopy, and if ful removal of the discharge with a saline-soaked cotton indicated, directed cervical biopsy. In women whose cervix rapidly, and lesions caused by these infections also have high remains intact after a hysterectomy, regularly scheduled rates of regression to normal. Print materials are available at several Several studies have documented an increased prevalence websites (http://www. Additional testing exposure vaccination with widely available vaccines, including might be required to confrm these results. However, 10%–15% of patients experience a relapse of used with caution among persons with hepatitis A. By 1 month after the frst dose, 94%–100% of mentally infected animals, but transmission by saliva has not adults have protective antibody levels; 100% of adults develop been demonstrated. In randomized con- In the United States, almost half of all persons with hepatitis trolled trials, the equivalent of 1 dose of hepatitis A vaccine A report having no risk factor for the disease. Among adults administered before exposure has been 94%–100% efective in with identifed risk factors, most cases occur among interna- preventing clinical hepatitis A (2). Kinetic models of antibody tional travelers, household or sexual contacts, nonhousehold decline indicate that protective levels of antibody persist for contacts (e. A combined hepatitis A and hepatitis B vaccine has been developed and licensed for use as a 3-dose series in adults aged Diagnosis ≥18 years (Table 3). Patients with acute hepatitis A usually require only support- Prevaccination Serologic Testing for Susceptibility ive care, with no restrictions in diet or activity. Hospitalization might be necessary for patients who become dehydrated Approximately one third of the U. Te potential cost-savings of testing should Hepatitis B be weighed against the cost and the likelihood that testing will Hepatitis B is caused by infection with the hepatitis B virus interfere with initiating vaccination. This vaccine is recommended for persons aged ≥18 years who are at increased risk for both hepatitis B and hepatitis A virus infections. Periodic testing to determine antibody health-care provider should consider the need to achieve levels after routine vaccination in immunocompetent persons completion of the vaccine series. Approved adolescent and is not necessary, and booster doses of vaccine are not currently adult schedules for both monovalent hepatitis B vaccine (i.

Rheumatic fever or acute glomerulonephritis after streptococcal infection Treatment: 1 discount zantac 300mg mastercard. Sometimes this mechanism does not function properly and insteady of a barrier the chronically infected tonsils and adenoids become a focus of infection Clinical features 1 zantac 150mg otc. In case of marked adenoids, snoring, sleeping with open mouth, nasal speech, and pus from infected adenoids driping into the trachea causing cough 115 Pediatric Nursing and child health care 3. General symptoms of chronich infection (tiredness, poor appetite are common Indication for Adenoidectomy or /and tonsilectomy (over 3 years only) a. Assessment of ear problem Ask Look - Does the child have ear - Look for pus draining pain? Signs - Pus drainage from Pus draining from the ear - Tender swelling behind the ear <2 weeks or 2 weeks or more the ear ear pain or red immobile ear drum Mastoiditis Acute ear infection Chronic ear infection Treatment - Give oral antibiotic - Dry the ear by wicking - Refer urgently to - Dry the ear by - Paracetamol for pain hospital wicking treat fever - Give first dose or - Reassess in five antibiotic days - Paracetamol for pain, - Treat fever if present treat fever - Paracetamol for pain 117 Pediatric Nursing and child health care Study Questions 1. What steps would you take for a child with a very severe disease or sever pneumonia before referral? If you think the mother will not take the child who need referral or if the referral will be delayed, what steps will you take? Diarrheal disease is among the leading causes of morbidity and mortality among children < 5 years of age in Ethiopia. Diarrhea is most common in children, especially those between 6 months and 2 years of age. Acute diarrhea causes death because of dehydration Dysentery causes death because of a number of severe and potentially fatal complications occurring during dysentery such as Intestinal perforation - Toxic mega colon - Convulsions - Septicemia - Prolonged hyponatremia - Diarrhea is worse in person with malnutrition. Diarrhea can also cause malnutrition and make it worse because - Nutrients are lost from the body during diarrhea - Nutrients are used to repair damaged tissue rather than for growth 120 Pediatric Nursing and child health care - A person with diarrhea may not be hungry - Mothers may not feed children during diarrhea or even for some days after diarrhea stops To prevent malnutrition, food should be given to children with diarrhea as soon as, they eat it. Less water and salts pass into the blood, and more passes from the blood into the bowel. Thus, more than the normal amount of water and salts passed in the stool results in dehydration. Dehydration also can be caused by a lot of vomiting, which often accompanies diarrhea. Treating Diarrhea: The most important measures in treating diarrhea are to: - Prevent dehydration from occurring if possible - Treat dehydration quickly and well if it does occur - Feed the child 121 Pediatric Nursing and child health care 9. Mix well with a clean spoon until the powder is dissolved - Taste the solution so that you would know its taste like salt - Then give the child frequent small sips out of a cup or spoon. If the answer to either question is ‘yes’, use the following management chart to assess, classify and treat the child Calcifying Dehydration: - There are three possible calcifications of dehydrations for a child with diarrhea. If there is Falciparum malaria in the area and the child has any fever (38 or above) or history of fever in the past 5 days give anti-malarial treatment according to malaria program recommendation in your area 128 Pediatric Nursing and child health care 9. Treatment of Diarrhea Decide on appropriate treatment: After the examination, decide how to treat the child - if the child has any of the signs in the column labeled “for other problems” specific treatment is needed in addition to treatment given for dehydration - if there is blood in the stool and diarrhea for less than 14 days, the child has dysentry and appropriate antibiotics should be given - if there is diarrhea for longer than 14 days with or without blood in the stool and/or if there is severe under nutrition, continue feeding the child and refer for treatment. Determine the degree of dehydration Look at the upper row, the assessing and classifying chart. What important measures should be taken to prevent dehydration in children with diarrhea? What important pieces of advice would you give to the mother for home treatment of diarrhea? Older children are more likely to have acquired heart diseases such as rheumatic fever, endomyocardial fibrosis. Cyanosis can best be detected under the fingernails or on the mucus membranes of the mouth (lips, under side of the tongue). One of the main causes of this is chronic under saturation of the blood with oxygen. Signs of Cardiac Failure: ƒ Tachycardia-rapid pulse ƒ Tachyponea-rapid respiration ƒ Dyspnea-shortness of breath ƒ Edema and other signs of raised venous pressure ƒ Fatigue and failure to thrive ƒ Arrhythmia-irregular heart beat ƒ Systolic and more frequently diastolic murmurs ƒ Cough ƒ Orthophea Management: Any child with congestive heart failure should be referred to hospital whenever possible. In all cases where you have to start treatment: - check weight of the child ,record the pulse and respiration carefully at 2 hours intervals and indicate the exact time of any drugs given. Digitalization is most important In order to achieve effective blood levels quickly a digitizing dose is calculated and given over 24 hours. The only known cause is damage to the fetus by rubella Virus, when the mother is one to three months pregnant, or by chromosomal abnormality in children with Down’s syndrome.