WHAT IS A PEPTIC ULCER AND WHERE DOES IT OCCUR?
Peptic ulcers are craters or open sores in the lining of the upper gastrointestinal tract. They include duodenal ulcers (those that are located in the top of the small intestine or duodenum) and gastric ulcers (those found in the stomach).
Peptic ulcers are common and usually occur singly. But it is possible to have two or more, or even both duodenal and gastric ulcers at thesame time. Duodenal ulcers are more common than gastric ulcers.
¨ WHAT CAUSES PEPTIC ULCERS?
¨ Peptic ulcers are caused by acid and pepsin (an enzyme) produced in the stomach. Patients who develop ulcers often produce greater amounts of acid than people without ulcers. Also, the ulcer patient
may not have strong enough natural defenses in the stomach or intestinal wall to resist the effect of acid and pepsin. ¨ Doctors do not yet know all the reasons too much acid is produced,
but many believe the key to healing an ulcer is to control the amount of acid produced.
¨ WHAT ARE THE SYMPTOMS OF PEPTIC ULCER DISEASE?
¨ Duodenal Ulcer symptoms:
1. Pain that awakens patients from sleep
2. Burning or gnawing sensation in the upper abdomen
3. Pain in the back, lower abdomen or chest area may
occasionally occur
4. Pain that occurs when the stomach is empty (about two hours
after a mean or during the night). Relief frequently occurs
after eating
¨ Gastric Ulcer symptoms:
1. Gastric ulcer pain may be less severe than duodenal ulcer pain and is noticeably higher in the abdomen
2. Eating may increase pain rather than relieve pain
3. Pain is described as aching, nagging, cramping or dull
4. Other symptoms may include nausea, vomiting and weight loss
Some ulcers may produce no symptoms at all. However, occasional painless bleeding, anemia (low blood count), or the passage of black,tarry stool may be the first sign of peptic ulcer disease.
HOW ARE PEPTIC ULCER DIAGNOSED?
Diagnosis can often be made from the patient’s symptoms. X-ray – your doctor may have you drink barium, a chalky liquid that shows up on an x-ray and outlines your stomach and duodenum. The ulcer can be diagnosed by an indentation in the stomach or duodenal wall. You may still have an ulcer even though the x-ray fails to showit.
¨ Endoscopy – this is a more accurate method of diagnosing ulcer disease. This exam allows the doctor to look into your stomach and duodenum with a lighted flexible tube. Gastric ulcers, unlike duodenal ulcers, can occasionally be cancerous. Therefore,endoscopy and biopsy of the gastric ulcer are commonly used for the
diagnosis and follow-up of ulcers.
¨ WHAT ARE THE COMPLICATIONS?
¨ If ulcers remain untreated they may lead to:
¨ Bleeding
¨ Perforation (an actual puncture through the stomach)
¨ Obstruction (repeated attacks may cause scar tissue that can
block the digestive tract)
¨ IMMEDIATELY REPORT TO YOUR DOCTOR…¨ Any signs of bloody or black, tarry stools (digested blood)
¨ Vomiting of blood or “coffee ground” material
¨ Pain
¨ Fever
¨ HOW CAN YOU TREAT PEPTIC ULCER DISEASE?
¨ Medications – medications that decrease the amount of acid produced
by the stomach are used to provide quick pain relief and promote
rapid healing.
¨ Other equally effective medications, such as coating agents called
carafate, antacids, and one called omeprazole, are available
¨ Most peptic ulcers heal within 4 to 6 weeks of treatment. Take your
medications regularly as directed, otherwise your ulcer may not heal
completely and your symptoms could return. Symptoms may disappear in a few days, but DO NOT STOP taking your medication.
¨ Nighttime is the most important time to heal ulcers, since many people produce large amounts of stomach acid while they sleep.
Take antacids as needed between meals and at bedtime to neutralize stomach acid and reduce pain.
¨ Aspirin and anti-inflammatory products should be avoided. Let your doctor know if you have been taking these, so alternate medications may be prescribed.
¨ Side effects from the medication used to treat peptic ulcer disease are very infrequent (less than 5 percent), but many include mild diarrhea,dizziness, nausea, drowsiness, rash or headache.
¨ Remember, people are different and no single medicine is best for everyone. If your symptoms worsen, notify your doctor immediately.
¨ DIET
¨ The best diet to follow is a balanced nutritious one. Frequent meals and milk diets actually stimulate acid and can be less helpful. Avoid eating at least two hours before bedtime. Avoid whatever foods might cause discomfort, such as alcohol, caffeine beverages (coffee and pop), fatty foods, and highly seasoned foods.
¨ LIFE-STYLE CHANGES
¨ It is important to try to stop smoking, since smoking has been linked to ulcer formation, reduced healing, and ulcer recurrences.
¨ Also try to minimize stress in your life. Stress may worsen ulcer symptoms.
¨ Patients with a history of peptic ulcer disease may have frequent recurrences during their lifetime. Follow your doctor’s advice to minimize the frequency and severity of recurrences. Promptly report
any return of symptoms.
¨ If you have repeated occurrences of peptic ulcer disease, your doctor may use maintenance therapy and prescribe a low dose medication to minimize the risks and prevent painful symptoms.
A burn is an injury to the tissues of the body. Burns are classified according to the amount of tissue they affect and how deep they are. A third-degree burn is the most serious because it destroys all the layers of the skin.
Anyone can get a third-degree burn. Children and the elderly are more likely to experience complications from burns.
Causes of Burns Third Degree
People are more likely to suffer third-degree burns from contact with corrosive chemicals, flames, electricity, or extremely hot objects; immersion of the body in extremely hot water, or clothing that catches fire.
Symptoms of Burns Third Degree
Skin with a third-degree burn may appear white or black and leathery on the surface. Because the nerve endings in the skin are destroyed, the burned area may not be painful, but the area around the burn may be extremely painful. Pain causes the breathing rate and pulse to increase. Some areas of the burn may appear bright red, or may blister. Third-degree burns can also damage fat, muscle, and bone. Electrical burns damage the deep tissues. Often only the area of the skin where the electricity entered the body looks black and charred. Electrical shocks can make a person stop breathing and interrupt the rhythm of the heart. Third-degree burns can cause the victim to go into shock. Shock occurs when loss of fluids causes the blood pressure to become so low that not enough blood reaches the brain and other major organs. The symptoms of shock include fainting, general weakness, nausea and vomiting, rapid pulse and breathing, a blue tinge to the lips and finger nails, and pale, cold, moist skin. If the victim has been burned in a fire and has been exposed to large amounts of smoke, he or she may also have chest pain, red and burning eyes, and a cough. All third-degree burns require emergency medical treatment.Diagnosed of Third Degree Burns
Your doctor will examine the burned area and classify it according to the amount of tissue affected and the depth of the burn. He or she will ask how the burn occurred. The doctor will check for other conditions related to burn injuries, such as smoke inhalation, carbon monoxide poisoning, or other injuries. If the patient is a child, the doctor will ask further questions to ensure the patient is not a victim of child abuse. Doctors assess the severity of a burn by determining what percentage of the total body surface area (BSA) is affected. In patients older than nine years, they apply what’s called the “rule of nines” to determine the percentage of BSA. For example, the genital area is considered 1% of BSA. The head and neck are 9%. Burns on each arm, including the hand, is also 9% of BSA. Each leg, including the foot, is 18%. The front of the torso is 18%, as is the back of the torso, including the buttocks. In children younger than nine, the palm of the child’s hand is used as a measure of 1% of BSA. Third-degree burns that cover less than 2% of BSA are considered minor. Third-degree burns that cover 2 to 10% of BSA are considered moderate burns. Those that cover more than 10% of BSA, as well as those on the face, hands, feet, or genitals, are critical.
Treatment of Third Degree Burns
All third-degree burns require medical treatment. Minor third-degree burns can be treated in a doctor’s office, but all others should be considered a medical emergency that requires hospital treatment, or get the person to an emergency room as soon as possible. If the person is on fire, do not let him or her run. Smother any flames with a blanket, jacket, or water, if available, or have the victim use the “stop, drop, and roll” method. Remove any clothing or jewelry from the injured area, but DO NOT remove clothing if it is stuck to the burn. Very briefly immerse the burned area in cold water or use a clean towel or wash cloth moistened with cold water to stop the burning process. Don’t hold the burned area in cold water for too long or you will cool down the body too much. Also don’t use ice or ice water because they will further damage the tissue. Do not break open any blisters, or there will be a greater risk of infection. If the blisters are open, don’t remove any clothing that might be stuck to the burn, and don’t run water over the burn. This will increase the risk of shock. Whether the blisters are broken or not, you can place a dry, sterile gauze pad over the burn, but do not use any bandages with adhesive. If the burned area is larger, lightly drape a clean sheet over it to protect it until you get medical treatment. It is important for the bandage to be loose so the burn gets air.
Never apply butter, oils, or burn ointments. They make it more difficult for the burn to heal and can actually make the burn worse because the heat can’t escape. Arms or legs that are burned should be kept raised to reduce the amount of swelling. If the face or neck are burned, raise the person’s head slightly. This will also help if he or she is having trouble breathing. If the person appears to be going into shock, lay him or her flat on the ground, raise the feet around 12 inches (30 cm), and call for medical help. You can cover the patient with a blanket to keep him or her warm.
Do not give a person who is in shock anything to drink. Otherwise, you can provide the patient with small sips of clear liquid, such as water or juice.
Chemical burns are treated a little differently. For liquid chemicals, first remove any clothing or other items that the chemicals have spilled on. Then, thoroughly wash any chemicals off the skin under running water for 15 to 30 minutes. For dry chemicals, use large amounts of water to flush the chemicals from the skin. Never use small amounts of water because they may actually activate the chemicals. If no water is available, use a clean cloth to brush any dry chemicals off the skin. Loosely cover the burn with a dry, sterile bandage, and see a doctor for further treatment. Different chemicals have different effects, so you should always check the chemical label, if possible, for additional directions. Always see a doctor if the chemicals have gotten into the eyes or mouth. If a person has had contact with electricity, call 911 and make sure the source of the electrical current is disconnected before touching the victim. Administer emergency cardiopulmonary resuscitation (CPR) if the victim’s heart has stopped beating or he or she is having trouble breathing. Lightly cover the burned area with a dry, sterile bandage until medical help arrives.
Moderate and critical third-degree burns require hospitalization. The body loses a great deal of fluid through the burned area, so replacement fluids are given through an intravenous (IV) line, which is a tube placed into a vein. If the lungs are damaged, or breathing is difficult, a tube is inserted into the throat to help with breathing. The patient will need to take antibiotics to protect the burned area from infection, as well as a prescription pain medication. If the patient’s immunizations aren’t up to date, he or she may also need a tetanus booster. Sometime severe burns are treated by putting the patient into a special room that is filled with pure oxygen under high pressure. This is called a hyperbaric chamber, and the patient must receive this treatment within 24 hours of being burned for the treatment to be effective. The burned areas are cleaned and covered with an antibiotic cream, then covered in sterile bandages. These bandages are changed frequently and the burned area is carefully monitored for signs of infection. The dead tissue around the burn is surgically removed, called debridement.
As burned skin heals, it develops a thick, scabbed surface, called eschar, that makes it difficult for blood to flow to the injured area. Doctors often have to use a procedure called an escharotomy to cut through the eschar so the healthy tissue underneath can receive the blood flow it needs. Severe third-degree burns leave extensive scars because the burns are so deep. For this reason, the burned area may need to be covered with a skin graft, where a piece of healthy skin is taken from an unburned area of the body and transplanted permanently to the burned area. This is called an autograft. If the patient’s skin can’t be used, the plastic surgeon may use the skin of another human donor (called an allograft), or the skin of an animal, such as a pig (called a xenograft). Allografts and xenografts are temporary, but protect the skin as it heals. Critical third-degree burns may take weeks to months of hospital treatment and require physical therapy to help restore movement to the burned areas and to minimize scarring.
Prevented Mangment
Many burns occur at home and could have been prevented. You can avoid first-degree burns by handling hot liquids and objects carefully. Make sure electrical cords are in good condition, household chemicals are safely stored and labeled, and hot beverages and objects are out of reach of small children. When handling chemicals, wear protective gloves and eyewear, and follow label directions for safe handling. Never wear clothing with long, loose sleeves while cooking or around any type of open fire. Never put a child into a tub unless you have first tested the water temperature. You can guard against burns from hot water by keeping your hot water heater set lower than 120 degrees Fahrenheit (49 degrees Celsius). Children should also sleep in flame-resistant pajamas or nightgowns. Do not smoke, or make sure discarded cigarettes are completely extinguished. Teach your children fire safety and make sure they do not have access to matches or lighters. You can also protect you and your family from burns by making sure you have operating smoke detectors on every floor of your house. Also check the temperature of a child’s car seat or seat belt before buckling the child in. Even these objects can cause burns after a period of time in direct sunlight. Never allow children to handle fireworks without adult supervision. Fireworks are a leading cause of burns and other injuries. You can avoid sunburns by using a sunscreen of at least a 15 SPF rating. Apply sunscreen liberally at least 20 minutes before sun exposure and reapply after swimming or sweating. Avoid spending time in the sun from 10 a.m. to 3 p.m., when the rays are strongest. Always take shelter during severe storms to avoid being struck by lightning.
A burn is an injury to the tissues of the body. Burns are classified according to the amount of tissue they affect and how deep they are. A second-degree burn injures the top layers of skin, called the epidermis, and extends down to the deeper layers of skin, called the dermis.
Anyone can get a second-degree burn. Children and the elderly are more likely to experience complications from burns.
Causes of Second Degree Burns
Most second-degree burns are caused by contact with flames, hot liquids, or chemicals, or by severe sunburns. Burns caused by heat are called thermal burns. Burns caused by hot liquids or steam are called scalds.
Symptoms Second Degree Burns
Skin with a second-degree burn is extremely red and blistered, and may look wet because of fluid loss. Second degree burns are very painful, and the victim’s pulse rate usually increases in response to the pain. Small second-degree burns usually heal without scarring. Larger second-degree burns can cause the victim to go into shock. Shock occurs when loss of fluids causes the blood pressure to become so low that not enough blood reaches the brain and other major organs. The symptoms of shock include fainting, general weakness, rapid pulse and breathing, nausea and vomiting, a blue tinge to the lips and finger nails, and pale, cold, moist skin. See a doctor immediately if a second-degree burn is on the face, hands, feet, or genitals; is caused by an electrical source; or covers an area larger than two to three inches.
Diagnosed Second Degree Burns
Treatment Second Degree Burns
Minor burns are treated at home, while moderate and critical burns require hospital treatment. The goal of treatment for second-degree burns is to reduce pain and prevent infection. If the burn was caused by fire, and the victim’s clothing is on fire, smother any flames with a blanket or water, if available, or have the victim use the “stop, drop, and roll” method. If the burn has blisters that are not open, first remove any clothing or jewelry from the injured area. Then, hold the burned area under cool running water for around 10 minutes to stop the burning process. You can also use a clean towel or wash cloth moistened with cold water. However, don’t use ice or ice water because they will further damage the tissue. Do not break open the blisters, or there will be a greater risk of infection. If the blisters are open, don’t remove any clothing that might be stuck to the burn, and don’t run water over the burn. This will increase the risk of shock. Whether the blisters are broken or not, you can place a dry, sterile gauze pad over the burn, but do not use any bandages with adhesive. If the burned area is larger, lightly drape a clean sheet over it to protect it until you get medical treatment. It is important for the bandage to be loose so the burn gets air.
Never apply butter, oils, or burn ointments. They make it more difficult for the burn to heal and can actually make the burn worse because the heat can’t escape. Arms or legs that are burned should be kept raised to reduce the amount of swelling. If the face or neck are burned, raise the person’s head slightly. This will also help if he or she is having trouble breathing. If the person appears to be going into shock, lay him or her flat on the ground, raise the feet around 12 inches (30 cm), and call for medical help. You can cover the patient with a blanket to keep him or her warm.
Do not give a person who is in shock anything to drink. Otherwise, you can provide the patient with small sips of clear liquid, such as water or juice.
Chemical burns are treated a little differently. For liquid chemicals, first remove any clothing or other items that the chemicals have spilled on. Then, thoroughly wash any chemicals off the skin under running water for 15 to 30 minutes. For dry chemicals, use large amounts of water to flush the chemicals from the skin. Never use small amounts of water because they may actually activate the chemicals. If no water is available, use a clean cloth to brush any dry chemicals off the skin. Loosely cover the burn with a dry, sterile bandage, and see a doctor for further treatment. Different chemicals have different effects, so you should always check the chemical label, if possible, for additional directions. Always see a doctor if the chemicals have gotten into the eyes or mouth. If the area of the burn is larger than two to three inches, you should get immediate medical treatment. The body loses a great deal of fluid through the burned area, so replacement fluids are given through an intravenous (IV) line, which is a tube placed into a vein. If the lungs are damaged, or breathing is difficult, a tube is inserted into the throat to help with breathing. The patient will need to take antibiotics to protect the burned area from infection, as well as a prescription pain medication. If the patient’s immunizations aren’t up to date, he or she may also need a tetanus booster. If your doctor thinks there will be a great deal of scarring, he or she may recommend a skin graft, where a piece of healthy skin is taken from an unburned area of the body and transplanted to the burned area. This is called an autograft.
For smaller burns that can be treated at home, gently wash the area with an antiseptic cleanser, loosely bandage the burn, then leave it alone for at least 24 hours. You can apply an aloe-based cream to relieve pain before bandaging it. Pain relievers such as acetaminophen, ibuprofen, or aspirin can help with inflammation and pain, and should be used according to directions. Never give aspirin to a child under the age of 18 because of the risk of a serious illness called Reye’s syndrome. If you have seen a doctor, follow his or her instructions for changing the bandages. Make sure you wash your hands with soap and water. Be sure to remove the bandage slowly and carefully. You will need to soak it before removing if it is sticking to the burn. Gently wash the burn, check for signs of infection, apply a thin layer of antibiotic cream, then cover it with a clean bandage.
Signs of infection include increased swelling or redness, blisters filled with greenish or brownish fluid, oozing pus in the burned area, or red streaks spreading away from the burn, and are a reason to call your doctor. Also call your doctor if you have a fever, swollen lymph nodes, or notice numbness or a cold feeling in the arms or legs. A second-degree burn can take anywhere from 10 days to 3 weeks to heal. Call your doctor if it doesn’t heal within that time. Vitamins C and E, and zinc may help the burn to heal, but should be taken only in safe amounts.
Prevented Mangment
Many burns occur at home and could have been prevented. You can avoid first-degree burns by handling hot liquids and objects carefully. Make sure electrical cords are in good condition, household chemicals are safely stored and labeled, and hot beverages and objects are out of reach of small children. When handling chemicals, wear protective gloves and eyewear, and follow label directions for safe handling. Never wear clothing with long, loose sleeves while cooking or around any type of open fire. Never put a child into a tub unless you have first tested the water temperature. You can guard against burns from hot water by keeping your hot water heater set lower than 120 degrees Fahrenheit (49 degrees Celsius). Children should also sleep in flame-resistant pajamas or nightgowns. Do not smoke, or make sure discarded cigarettes are completely extinguished. Teach your children fire safety and make sure they do not have access to matches or lighters. You can also protect you and your family from burns by making sure you have operating smoke detectors on every floor of your house. Also check the temperature of a child’s car seat or seat belt before buckling the child in. Even these objects can cause burns after a period of time in direct sunlight. Never allow children to handle fireworks without adult supervision. Fireworks are a leading cause of burns and other injuries. You can avoid sunburns by using a sunscreen of at least a 15 SPF rating. Apply sunscreen liberally at least 20 minutes before sun exposure and reapply after swimming or sweating. Avoid spending time in the sun from 10 a.m. to 3 p.m., when the rays are strongest.
Burns: First Degree
What is it?
A burn is an injury to the tissues of the body. Burns are classified according to the amount of tissue they affect and how deep they are. A first-degree burn is the least serious type of burn because it injures only the top layers of skin, called the epidermis.
Who gets it?
Anyone can get a first-degree burn. It is difficult to say how many people are affected each year because most do not need to seek medical treatment. Children are especially at risk for first-degree burns from hot water that is greater than 120 degrees Fahrenheit (49 degrees Celsius). Children and the elderly are more likely to experience complications from burns.
What causes it?
First-degree burns are most often caused by brief contact with either dry or moist heat (called a thermal burn) or chemicals; spending too much time in the sun (sunburn); or friction (such as by rubbing the skin against a rug or rope). When a burn is caused by hot water or steam, it is called a scald. The most common sources of heat that cause first-degree burns are hot water, cigarettes, hot grease, and hot beverages.
What are the symptoms?
Skin with a first-degree burn is red, sore, and sensitive to the touch. It may also be moist, slightly swollen, or itchy. Sunburns are often accompanied by headache and low fever. When lightly pressed, the reddened skin whitens, which is called blanching. First-degree burns do not blister and do not leave a scar. See a doctor immediately if a burn is on the face, hands, feet, or genitals; is caused by an electrical source; or covers a very large area.
How is it diagnosed?
Your doctor will examine the burned area and classify it according to the amount of tissue affected and the depth of the burn. He or she will ask how the burn occurred. If the patient is a child, the doctor will ask further questions to ensure the patient is not a victim of child abuse. Doctors assess the severity of a burn by determining what percentage of the total body surface area (BSA) is affected. In patients older than nine years, they apply what’s called the “rule of nines” to determine the percentage of BSA. For example, the genital area is considered 1% of BSA. The head and neck are 9%. Burns on each arm, including the hand, is also 9% of BSA. Each leg, including the foot, is 18%. The front of the torso is 18%, as is the back of the torso, including the buttocks. In children younger than nine, the palm of the child’s hand is used as a measure of 1% of BSA. First-degree burns that cover less than 15% of an adult's body or less than 10% of a child's body are considered minor. First-degree burns that cover 15 to 25% of an adult's body, or 10 to 20% of a child's body, are moderate burns. Those that cover more than 25% of an adult's body or more than 20% of a child's body, as well as those on the face, hands, feet, or genitals, are critical.
What is the treatment?
Minor burns can be treated at home. First, remove any clothing or jewelry from the injured area. Then, hold the burned area under cool running water for around 10 minutes to stop the burning process. You can also use a clean towel or wash cloth moistened with cold water. However, don’t use ice or ice water because they will further damage the tissue. You can place a dry, sterile gauze pad over the burn, but do not use any bandages with adhesive. It is important for the bandage to be loose so the burn gets air. Never apply butter or oils. They make it more difficult for the burn to heal and can actually make the burn worse because the heat can’t escape. You can, however, gently wash the area with an antiseptic cleanser and apply an aloe-based cream to relieve pain. Pain relievers such as acetaminophen, ibuprofen, or aspirin can help with inflammation and pain, and should be used according to directions. Never give aspirin to a child under the age of 18 because of the risk of a serious illness called Reye’s syndrome. Chemical burns are treated a little differently. For liquid chemicals, first remove any clothing or other items that the chemicals have spilled on. Then, thoroughly wash any chemicals off the skin under running water for 15 to 30 minutes. For dry chemicals, use large amounts of water to flush the chemicals from the skin. Never use small amounts of water because they may actually activate the chemicals. If no water is available, use a clean cloth to brush any dry chemicals off the skin. Loosely cover the burn with a dry, sterile bandage. Different chemicals have different effects, so you should always check the chemical label, if possible, for additional directions. Always see a doctor if the chemicals have gotten into the eyes or mouth. First-degree burns usually heal very quickly. The burned skin may peel after a few days, but should not scar. Vitamins C and E, and zinc may help the burn to heal, but should be taken only in safe amounts. Call your doctor immediately if redness and pain do not decrease within a few days; if the redness, pain, swelling, or fever increase; or if there are signs of infection, such as red streaks radiating outward from the burn. Moderate and critical burns should be treated at a hospital. Use the above guidelines for emergency first aid.
Self-care tips
Many burns occur at home and could have been prevented. You can avoid first-degree burns by handling hot liquids and objects carefully. Make sure electrical cords are in good condition, household chemicals are safely stored and labeled, and hot beverages and objects are out of reach of small children. When handling chemicals, wear protective gloves and eyewear, and follow label directions for safe handling. Never wear clothing with long, loose sleeves while cooking or around any type of open fire. Never put a child into a tub unless you have first tested the water temperature. You can guard against burns from hot water by keeping your hot water heater set lower than 120 degrees Fahrenheit (49 degrees Celsius). Children should also sleep in flame-resistant pajamas or nightgowns. Do not smoke, or make sure discarded cigarettes are completely extinguished. Teach your children fire safety and make sure they do not have access to matches or lighters. You can also protect you and your family from burns by making sure you have operating smoke detectors on every floor of your house. Also check the temperature of a child’s car seat or seat belt before buckling the child in. Even these objects can cause burns after a period of time in direct sunlight. Never allow children to handle fireworks without adult supervision. Fireworks are a leading cause of burns and other injuries. You can avoid sunburns by using a sunscreen of at least a 15 SPF rating. Apply sunscreen liberally at least 20 minutes before sun exposure and reapply after swimming or sweating. Avoid spending time in the sun from 10 a.m. to 3 p.m., when the rays are strongest.
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A fracture is a break or crack in a bone.
Anyone can fracture a bone. Those with low bone density (osteoporosis), bone tumors, certain cancers, or a brittle bone disease called osteogenesis imperfecta are at higher risk for bone fractures. Children and adults who are extremely active and participate in contact sports are also more likely to experience bone fractures. After middle age, women are more likely than men to suffer bone fractures because of diseases that affect bone strength.
Causes of Bone Fracture
A fracture is most often caused by some type of trauma to a bone. This trauma might occur as a result of a fall, physical abuse, motor vehicle accident, or disease. Normal, everyday activities can cause bone fractures in people with diseases that weaken the bones.
Symptoms Bone Fracture
In general, a bone fracture results in pain, swelling, and, sometimes, bruising from internal bleeding. The patient cannot bear weight or pressure on the injured area, and may be unable to move it without severe pain. The soft tissues around the broken bone may also be injured. The area around or below the fracture may feel numb or paralyzed due to a loss of pulse in that area. There are many different types of fractures. These include a closed or simple, fracture, in which the skin around the fractured bone is not broken. An open, or compound, fracture, does include a break in the skin, revealing the bone and making the wound more susceptible to infection. A fracture is called complete if the break is the whole way through the bone, and incomplete (or greenstick) if the break is partial. Greenstick fractures are more commonly seen in children.
Stress fractures are small cracks in a bone that occur over time as a result of repeated activities that put stress on the bone. There are many other classifications of fractures according to characteristics such as where they occur and their appearance. A person can have just one fracture or multiple fractures at the same time.
Diagnosed of Bone Fracture
A bone fracture is diagnosed by a physical examination and x-rays of the injured area. However, some types of fractures are difficult to see on an x-ray. In this case, your doctor may order other diagnostic imaging tests, such as computed tomography (CT), magnetic resonance imaging (MRI), or bone scans. Open fractures require additional laboratory tests to determine whether blood has been lost and if there is infection.
Treatment of Bone Fracture
The treatment for a bone fracture depends upon the type and location of the fracture and the patient’s age and medical history. When a fracture is suspected, the affected area should be immobilized to prevent any further damage. Minor fractures can be treated in the office of an orthopedic specialist. Orthopedics is the branch of medicine that deals with the treatment of injuries to or disorders of the skeletal system. More severe fractures, such as those that are open, multiple, or to the hip or back, are treated in a hospital. Most fractures are immobilized with a cast, brace, splint, or sling. If there is severe swelling, your doctor may wait until the swelling has gone down before casting the fracture.
Stress fractures often require no more than rest, ice packs, anti-inflammatory medicines, and temporarily discontinuing the activity that has caused the injury. If a fracture results in the bone being misaligned, the doctor must realign the bone through a procedure called fracture reduction. This may be done manually and/or through traction, which holds the bone in place for period of time using weights and pulleys.
Surgery may be necessary when a fracture is open, severe, or has resulted in severe injury to the surrounding tissues. Severe fractures may require internal devices, such as screws, rods, or plates, to hold the bone in place or replace lost bone during the healing process. Bone grafts, where healthy bone is taken from another area of the body to fill in the fracture, may also be used. The length of time it takes for a bone fracture to heal and the need for physical therapy after treatment depend upon the severity of the fracture and the age and health of the patient.Prevented Mangment
Bone fractures should be treated as quickly as possible to avoid complications and ensure complete healing. Weight-bearing exercise and sufficient amounts of calcium in the diet help strengthen the bones and prevent bone fractures. You can also help prevent bone fractures and other automobile-related injuries by wearing a seat belt when riding in a motor vehicle. People who participate in contact sports should wear appropriate protective gear. Doctors recommend estrogen therapy for women over the age of 50. This, as well as calcium supplements, can help lower the risk of osteoporosis and related bone injuries.
Angina is a temporary pain or tightness that may start in the chest and will sometimes spread to other parts of your upper body. It may start suddenly and may last only a few minutes. Angina will usually occur when there are extra demands placed on the heart, such as during exercise, exposure to extreme hot or cold conditions, windy weather, or during periods of emotional stress. Some people may develop angina at rest or after eating large meals when blood flow must increase to aid in the digestion of foods.
Symptoms of Angina
The symptoms of angina may vary from person to person. The symptoms may even vary with each episode. They can include a tightness, pressure, aching, or burning behind the breastbone. This sensation may spread or radiate to the arms, neck, jaw, back, or between the shoulder blades.
Other symptoms may include nausea, sweating, shortness of breath, or weakness.
Causes of Angina
Angina is caused by a shortage of oxygen and other nutrients reaching the heart muscle. The pain of angina is produced when the heart muscle is starved for oxygen, a condition called ischemia.
Angina occurs most often when the coronary arteries of your heart become narrowed or clogged with deposits of fatty plaque-like substances. This disease is called atherosclerosis.
If you think you are having angina, you should follow these steps:
1. STOP what you are doing. SIT DOWN AND REST.
2. If the symptoms are not gone in 2 to 3 minutes, place a nitroglycerin tablet under your tongue and let it dissolve. You may feel a slight sense of stinging or burning under your tongue,this means the nitroglycerin is working to help relieve your angina.
3. Wait 3 to 5 minutes. If your angina is still present, take a second nitroglycerin tablet.
4. Again, wait 3 to 5 minutes. If the symptoms remain, take a third nitroglycerin tablet.
5. If your angina has not subsided after the third nitroglycerin tablet or after 15 minutes since you first began experiencing discomfort, call an ambulance or have someone drive you to the nearest emergency room.
DO NOT IGNORE THESE WARNING SYMPTOMS!!!!
Helpful Hints about Nitroglycerin tablets.
The burning sensation described earlier is not always an indication that the tablet is fresh. The best way to know if your tablets are fresh is to replace them approximately every 6 months.
Another helpful hint is to "check mark" the bottle every time you open it. Once you get to six "check marks" replace the bottle.
All formations of nitroglycerin should be kept at room temperature. The sublingual (under your tongue) tablets are especially susceptible to moisture. They should NOT be kept in bathrooms or kitchens because of higher degrees of moisture there.If carrying nitroglycerin sublingual tablets with you, you may want to check with your pharmacist for devices to aid you in carrying your nitroglycerin bottle (e.g. a metal cylinder on a chain around your neck).
When Should You Contact Your Family Physician?
Call your physician WITHIN 24 HOURS for any of the following:
This is the first time you have ever experienced angina.
You experience angina while resting.
Your angina is occurring more frequently, has changed location, or is more severe than in the past.
The nitroglycerin tablets do not work as quickly as they have in the past.
Your angina has awakened you during the night.
If your angina has reoccurred following a cardiac catheterization, angioplasty, or open heart surgery procedure(s).
What Can You Do to Avoid Angina?
Many people can control their angina by following their medication regimen prescribed by their physician and by making life-style changes that lower the heart's workload and reduce stress. Other things you can do may include:
* Stop smoking (smoking makes the heart work harder)
* Lose excess weight
* Start an exercise program
* Lower your blood cholesterol levels
* Avoid eating heavy meals and rest after eating
* AVOID outside activities on EXTREMELY HOT OR COLD DAYS
* Reduce your stress.
A hernia is the protrusion of an organ through the wall that normally contains it. With a hiatal hernia, part of the stomach protrudes upward through the opening (hiatus) at the esophagus and the diaphragm. The stomach is normally located in the abdomen. The esophagus connects the throat to the stomach, and the diaphragm is a group of muscles used for breathing, located between the abdomen and the lungs.
Hiatal hernias are more likely to occur in females than males, and are very common during middle age. People who are obese or have had abdominal surgery are at higher risk for hernias. The risk also increases with age. Hiatal hernias can occur in children and adults.
Causes of Hiatal Hernia
Hiatal hernias are caused by a weakness in the muscle tissue at the opening in the diaphragm where the esophagus passes through to the stomach. In some people, this weakness is congenital, which means it is present at birth. In others, it develops over time, as a result of excessive weight gain, physical activity that places pressure on the abdomen, pregnancy, heavy lifting, straining during bowel movements because of constipation, severe vomiting, or chronic and intense coughing. Because the muscle is weak, the hernia occurs during abdominal strain.
Symptoms of Hiatal Hernia
A hiatal hernia cannot be seen on the outside of the body, and may not cause any symptoms at all. Patients who do experience symptoms usually feel a burning sensation in the chest and throat a short time after eating. This is called gastroesophageal reflux and is caused by stomach acids being pushed up into the esophagus. Other symptoms include heartburn, an uncomfortably full feeling after eating, and the frequent need to belch. A serious complication of a hiatal hernia can occur if the part of the stomach that is herniated becomes twisted or pinched by the diaphragm. This is called a strangulated hiatal hernia. If this happens, that portion of the stomach can lose its blood supply. Symptoms include severe chest pain, bloating, and difficulty swallowing. Very large hiatal hernias can develop lesions that bleed and cause anemia from the blood loss.Diagnosed of Hiatal Hernia
To diagnose a hiatal hernia, your doctor will rely upon your description of symptoms and a series of diagnostic tests. These may include endoscopy or a barium swallow. With endoscopy, a flexible viewing tube is inserted through the mouth and down to the stomach so the doctor can check for the hiatal hernia between the esophagus and the stomach. You will be given a mild sedative during the procedure so you will feel no discomfort. With a barium swallow, x-rays are taken after you drink a special barium solution. The barium helps reveal the bulge of a hiatal hernia on the x-ray. Both tests can be done on an outpatient basis.
Treatment of Hiatal Hernia
The treatment for hiatal hernias is focused on diet and surgery is rarely necessary. Doctors recommend restricting your intake of spicy and acidic foods and beverages, caffeinated beverages, and chocolate; elevating your head when lying down to prevent gastroesophageal reflux; remaining in an upright position after eating; and using antacids and acid-reducing medications. Patients with hiatal hernias find that symptoms are reduced if they eat frequent small meals throughout the day. Surgery is necessary for a strangulated hiatal hernia and very large hiatal hernias that cause severe gastroesophageal reflux. This procedure may be performed through laparoscopic surgery, in which the surgeon uses a special viewing instrument called a laparoscope, inserted through a small incision in the chest or abdomen. The laparoscope is like a tiny video camera that gives the surgeon a clear view of the abdominal area. Other small incisions are made to insert the surgical instruments used to pull the stomach back down into the abdomen and repair the weak muscle or make a smaller opening between the diaphragm and the esophagus.
Prevented Managment
Although there is no way to prevent hernias due to a congenital weakness, you can help reduce your risk for a hiatal hernia. Follow a healthy diet that is high in fiber and drink plenty of fluids to prevent constipation, maintain a healthy weight through diet and exercise, and avoid cigarette smoking, which can cause chronic coughs. If your job requires heavy lifting, learn the proper way to lift and wear a support garment. Certain medications can aggravate a hiatal hernia. Your doctor can recommend which medications to avoid if you have this condition.
Appendicitis is the inflammation of the appendix. The appendix is a worm-shaped pouch that projects from the cecum, which is the point at which the large intestine joins the small intestine. The appendix is located in the lower right abdomen and is not essential to the body’s function.
Anyone can get appendicitis, and it is the most common reason for emergency abdominal surgery. Appendicitis is most likely to occur between the ages of 10 and 30. It occurs most often in boys between the ages of 10 and 14 and girls 15 to 19. It is less common in the elderly and infants.
Causes of Appendicitis
Researchers are not sure what causes appendicitis, but think it may be a blockage between the large intestine and appendix, or a viral or bacterial infection.
Symptoms of Appendicitis
An inflamed appendix causes mild to severe pain that moves from the navel to the lower right abdomen. The lower right abdomen may be extremely sensitive to touch and the pain is often worse with movement and strain, such as sneezing, coughing, or taking a deep breath. Other symptoms may include nausea, vomiting, loss of appetite, fever, diarrhea, constipation, weight loss, and a swollen abdomen. However, some people may not experience all of these symptoms. An inflamed appendix can become so swollen that it ruptures, spilling its infected contents into the abdominal cavity. This can cause a life-threatening infection called peritonitis. Never treat appendicitis symptoms with laxatives or enemas because they can cause the inflamed appendix to rupture. A ruptured appendix that is not treated immediately can cause death.
Diagnosed of Appendicitis
A diagnosis of appendicitis is based upon a physical examination and the patient’s symptoms. The doctor will ask you about the location of the pain and how long you have felt it. He or she will press gently on your abdomen to check for tenderness and swelling in the area of the appendix. The doctor may order blood tests to check for a high white blood count, which is a sign of infection, and ultrasound or computed tomography (CT) scans to check the condition of the appendix. He or she may order additional tests to rule out other disorders, such as urinary tract infections, tubal pregnancies, and bowel obstructions, that can cause similar symptoms. If you are a woman and your doctor suspects a cause other than appendicitis, he or she might recommend a laparoscopic study. A small, lighted viewing tube, called a laparoscope, is inserted into a small incision in the abdomen to check for disorders of the reproductive system.
Ttreatment of AppendicitisAppendicitis is treated with surgery to remove the appendix, called an appendectomy. This surgery is usually performed as soon as possible after the diagnosis has been made to avoid a rupture. In many cases, appendectomies can be performed with laparoscopic surgery. The surgeon makes a small incision in the abdomen and inserts the laparoscope. The laparoscope is like a tiny video camera that gives the surgeon a clear view of the abdominal area. Other small incisions are made to insert the surgical instruments used to remove the appendix. Because the appendix is not necessary to the body’s function, people who have an appendectomy make a full recovery and are able to continue with life as usual.
Preventive of Appendicitis
There is no known way to prevent appendicitis. However, a healthy lifestyle, including a diet high in fiber and antioxidants, as well as moderate exercise, goes a long way in preventing illness and disease.
WATER
Water is second only to oxygen for human life. It makes up 65–75% of the body and every cell requires water to perform its essential functions. Water maintains system equilibrium, lubricates, flushes, and hydrates the body. It also regulates body temperature and transports needed nutrients to where they are needed throughout the body. When the body has enough water, fluid and sodium retention decrease, hormone function improves and the liver is able to break down and release more fat into the system for energy. At this point, hunger is less and weight loss can occur.
Plain water is the best way to replace lost body fluids. Other good choices are unsweetened fruit juices and vegetable juices without added sodium (salt). Experts use the “eight 8 ounce glasses of water” rule of thumb to let people know how much water a person needs to drink under normal conditions. How much water you actually need depends on your weight, level of activity, the temperature and humidity level, and your food diet. If you eat plenty of water dense foods like fruits and vegetables your need to drink water could be reduced. Fruits and vegetables and their juices contain a lot of water, but also usable nutrients for the body. Many are high in vitamins, minerals, and fiber necessary for good nutrition. Diuretics, such as caffeinated beverages and alcohol cause your body to expel water so you need to drink more water to compensate. When you feel thirsty, you are already starting to dehydrate. Try to avoid this situation by drinking water on a regular basis and before activities begin.
nursing notes
WATER AND WEIGHT LOSS: In a diet/weight loss plan it is important to drink water because
Initial weight loss is largely due to loss of water, and you need to replace lost water to avoid dehydration.
The process of burning calories and temperature regulation requires an adequate supply of water in order to function efficiently; dehydration slows the fat burning process and can lead to heat exhaustion or stroke.
Burning calories creates toxins and water plays the vital role of flushing these toxins from your system.
Dehydration causes a reduction in blood volume which lowers the available oxygen to your muscles which will make you feel tired.
Water helps maintain muscle tone by assisting in their ability to contract and helps lubricate the joints. Proper hydration helps reduce muscle and joint soreness during and after exercising.
Water alone has no calories or nutrients, so water alone is not very filling. But, drinking water with a meal will make you feel full sooner so that you may eat less.
A healthy weight loss program includes a high fiber intake. Fiber is important to certain body functions, but without plenty of water, it can lead to constipation.
nursing notes
Calories
The theory of the human body taking in calories and using them for energy or storing them for future use is pretty simple. If a person takes in fewer calories than are needed to meet energy demands, no storage will take place and weight loss will occur. Vice versa, if a person takes in more calories than are needed to meet energy demands, storage will take place and weight gain will occur. With this in mind, a person only needs to know how many calories are needed to meet their energy demands and they should be able to control their weight. Let us take a look at energy demands.
The demand for fuel fluctuates, but it never falls below a fundamental rate that keeps our body functioning at its most basic level. This is called our basal metabolic rate. This base rate supplies energy for functions such as pumping blood throughout the body and breathing. Energy is also needed to maintain brain function and to supply the trillions of cells in our body with energy to perform their specific functions as well as to generate the heat that we need to stay warm. These are our basic, involuntary, and unstoppable energy demands. The human body also expends energy in digesting and assimilating food. Generally this is about 10% of an average person’s caloric intake each day. There are also energy demands created by voluntary activities that we choose to do each day, like exercise, work, housework, play, etc. Most people think that these activities use a lot more calories for fuel than they actually do. Here are some examples of voluntary activities and the associated calorie burn.
Calories used per minute (approximate)
1 calorie - sitting reading, knitting, talking
3 calories - walking 2 mph, washing dishes
5 calories - swimming leisurely, vacuuming, slow dancing
7 calories - sawing with a handsaw, mowing the lawn with push mower
9 calories - cross country skiing, aggressive basketball, fast dancing
11 calories - playing racquetball, running 7 mph, jumping rope (125 time/min.)
So our total energy needs are basically a combination of basal metabolism, voluntary activities and the digestion and assimilation of food. Together they constitute an unending energy drain. A good rule of thumb is that basal metabolism is about 65% of our calorie burn, voluntary activity is about 25% and food digestion is about 10% of our energy demand.
There are about 3500 calories in a pound of body fat. This means that one must create a 3500 calorie deficit to lose one pound of body fat. Simple math tells us that a 500 calorie per day reduction for 7 days equals 3500 calories or one pound. Good choices for reduced calorie nutrition plans include nutrient dense foods with a high content of water and fiber such as grains, vegetables, and fruits. Their high bulk, relative to their calories, makes them good weight reducing food choices. On the other hand, a person could choose to increase their voluntary activity level (eg. Exercise) by 500 calories per day and in 7 days get the same results. Generally, people are advised to try a combination of reduced calories and increased activity levels to promote weight loss. In that scenario, a healthier outcome can be achieved and success is more likely because positive behavior habits are incorporated into a person’s lifestyle.
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Aids to Weight Control
Because emotions can effect how much and what we eat, influencing the emotions can be an important factor in weight reduction plans. The theory looks good on paper, but sometimes it is not that simple to “eat less and exercise more.” There are many deep rooted psychological, familial, ethnic, and societal roadblocks that cause people to have mixed feelings about their weight and mixed views of themselves. There have been efforts to find practical short term ways to deal with weight loss. These efforts generally fall into three broad categories.
Group Support
This method uses the pressure of the group to help or push members to deal with their weight issues. Principles of dieting and nutrition may be taught to these groups in varying degrees. The approval/disapproval power of a group of like minded peers and the sharing of common problems is an important part of this method. Paying to be in these types of groups is sometimes a motivation to be successful. In a recent Consumer Reports study, ‘Weight Watchers’ with its varied menus and support meetings provided the best chance to lose weight and keep it off in these types of programs. The report said that those who attended meetings and followed the plan were more likely to still be on track after one year or more.
Restricting Choices
This category is designed to restrict a dieter’s choices. It can be severely regimented as to what to eat and when, with strict meal plans and no variety or choices. These plans work fairly well in the short term for most dieters because there is no danger of overeating when there are no decisions to make about what to eat and how much to eat. Most of us will tend to overeat when given a lot of choices. Many people who are overweight are more prone to external cues. The message to these types of dieters is that the key to weight control is a matter of controlling the number and kind of food choices. In the Consumer Reports study mentioned earlier, “Slim Fast” products received high marks based on ease of preparation and nutritional balance. For people who need to control their food choices, users of these products were more likely to stick with the program and lose weight.
Behavior Modification
The focus of this type of approach to dieting is to increase awareness of the act of eating. Eating behavior modification refers to a special kind of training using various techniques to alter eating habits – to make eating a more conscious act not a blind unthinking behavior. A basic feature of these types of programs is journaling or keeping food diaries with times and food amounts written down for analysis. The aim is to teach awareness of a person’s eating habits so that adjustments can be made based on eating times and situations or locations that cause poor eating behavior. In terms of long term success, some programs that use behavior modification techniques have achieved better results than other methods.
The Bottom Line
People who want to lose weight in a nutritionally and medically sound way must accept the truth that they have to eat fewer calories and/or exercise more. Weight loss of about one pound per week is reasonable, considering the fact that the aim is to lose excess body fat, which requires a calorie deficit of 3500 calories per week. The best reducing plan is one that includes at least moderate physical activity, a food plan that is nutritionally adequate, and behavior modification techniques to change eating and exercise habits so that long term weight control is possible.
Mouth care
Daily care
Children should brush their teeth and gums with fluoride toothpaste and a soft bristle toothbrush every morning and night. You may need to help your child do this. When the toothbrush bristles get stiff or bent, you should replace your child’s toothbrush about every three months.
Use dental floss only if you are familiar with the procedure. Check with your doctor or nurse for the times when it is OK to floss.
If your child’s mouth feels dry, he or she can rinse with salt water solution of ¼ teaspoon salt mixed in one glass of lukewarm water. Do not use drugstore mouthwash. Avoid all mouthwash with alcohol, since it dries the mouth.
For dry lips, use a lanolin ointment or Nature’s Second Skin® to moisten, not Vaseline.
To lessen the mouth sores, which may occur during chemotherapy or radiation therapy, have your child rinse with Peridex® after each morning and evening brushing. One to two teaspoons are swished in the mouth for 30 seconds then spit out. Peridex® can change the way food tastes. Ask you doctor or dentist about Peridex®.
After your child brushes his or her teeth, examine the mouth area. Your hands should be clean when you do this. Look for these things:
• Lips should be smooth and moist.
• Tongue should be moist, smooth and pink with no coating.
• Floor of the mouth should be moist and pink.
• Open the mouth as wide as possible. Check the roof of the mouth and sides of the cheeks; they should be moist, pink and free of spots or patches.
• Teeth should be white and free of film, soft debris or crusts.
This exam is an important part of daily care. If you see red or white spots or patches, sores, or if your child’s tongue looks furry or coated, call your doctor or nurse coordinator.
Your child needs to brush his or her teeth after eating sweets. If a brush is not available, help your child swish and swallow with lukewarm water three to four times. Try to avoid frequent sweet snacks, especially sticky or chewy candy, raisins, fruit rolls and hard candies. Snacks that are less likely to cause cavities include cheese, carrots, fresh fruit, popcorn, crackers, pretzels, chips, and artificially sweetened candy, gum and sodas.
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Toddlers and preschoolers
When the first tooth is visible, begin cleaning your child’s teeth and gums after each feeding. Clean using a water-moistened gauze wrapped around your finger. Examine your child’s mouth at this time. As soon as your child has several baby teeth, you should brush your child’s teeth two times a day.
If your child tends to swallow toothpaste, do not use it. Use plain water instead.
After your child takes sweetened medicine (liquid or pill), help your child rinse his or her mouth with water.
If your child takes a bottle to bed, fill it only with water. Do not send your child to bed with formula, juice or milk, since this can cause tooth decay. If your child cries, try giving him or her a clean pacifier instead of a bottle.
nursing notes
Mild mouth irritation
The dentist or doctor needs to examine your child’s mouth. The following are signs of a mild mouth irritation:
• Red, shiny gums and mouth lining that can include white patches
• Gums look swollen
• A burning feeling or tenderness in the mouth, but no sores can be seen
• Tongue may be coated, red, dry or swollen
The dentist or doctor will ask you to help your child:
• Eat bland foods, such as mashed potatoes or fruit-flavored gelatin. Avoid acidic, fried or hard crusty foods that may irritate your child’s mouth.
• Rinse with salt-soda solution as often as every two hours when awake. You can make your own solution, using this recipe:
~ 1/2 teaspoon salt
~ 1/4 teaspoon soda
~ 8 ounces water
• Twice a day: If dried mucus or food is present, rinse the mouth first with 1 tablespoon of Peroxyl® mixed with 1 tablespoon lukewarm water, or use a soft toothbrush dipped in Peroxyl®. Then rinse the mouth well with the salt-soda solution or plain water.
*DO NOT use Peroxyl® as a mouth rinse more than three days in a row.
• Remove a coating on the tongue by brushing or scraping this area twice a day. Scraping may be done with a tongue blade, plastic spoon or special “scraper.” Then rinse mouth well with the salt-soda solution or plain water.
Nursing Notes
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• Relieve mouth pain by swishing 1 teaspoon ST-37 solution mixed with 1 teaspoon plain water for 1 minute, then spit it out. Your child should do this 15 minutes before eating and as needed.
Moderate mouth sores
The dentist or doctor needs to examine your child’s mouth. With moderate mouth sores your child will have pain in these areas during eating and swallowing.
The dentist or your doctor will ask you to help your child:
• Eat bland foods, such as mashed potatoes or fruit-flavored gelatin.
• Clean teeth and gums using a soft toothbrush. Dip the toothbrush in a mixture of 1 tablespoon Peroxyl® mixed with 1 tablespoon of plain water. Then your child can rinse with a large mouthful of salt-soda solution. If the Peroxyl® causes a burning feeling in the mouth, increase the amount of lukewarm water.
You can decrease your child’s mouth pain, depending on the amount of sores, by doing the following:
• For a few tiny sores, place KANKA® solution on a cotton swab and touch the sore mouth areas. Your child may complain of a burning feeling for a few seconds, but then the pain should get better. Help your child with this treatment three times a day.
• For many or large mouth sores, help your child swish and spit 1 to 2 teaspoons of Ulcer-Ease® solution in the mouth. Your child should hold the solution in his or her mouth for 30 seconds or longer before spitting it out. Help your child with this treatment four times a day.
nursing notes
Dry mouth
• Rinse with salt-soda solution every two hours or as needed. You can find a recipe for making your own solution under “Mild mouth irritation.”
• Moist foods like fruit-flavored gelatin, gravy or a sauce will help swallowing.
• Artificial saliva may be ordered by the dentist or doctor or Moi-Stir® swabsticks may be used several times a day.
• Moisten lips with lanolin ointment. One brand name for this ointment is Nature’s Second Skin®.
• Chew sugar-free gum.
Nursing notes
Dry, cracked, crusty lips
Clean every two hours with a clean washcloth soaked with salt-soda solution. Pat dry with another clean cloth and apply lanolin ointment. Do not use petroleum jelly or lip balms, because they can dry out the lips even more.
Nursing notes
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Low platelet count
• Gently brush teeth and gums with a soft toothbrush. Dip the toothbrush in a solution of 1 tablespoon Peroxyl® mixed with 5 tablespoons of water. You may also use a moist washcloth wrapped around a finger.
• Rinse with the salt-soda solution.
• If your child has cracking at the corners of his or her mouth, it could mean that your child has a yeast infection. Ask your doctor or nurse coordinator about a special ointment you can use.
If you have any questions or concerns, please speak with your child’s doctor or nurse coordinator.
nursing notes
Adapted with permission from St. Jude Children’s Research Hospital. Revised 9/03
UC Davis Cancer Center 12/06
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Tired of spending hundreds of dollars on skin creams and other skin products? Well, believe it or not, if you really want to have beautiful, luminous skin, you may need to change your diet. Nutrition is an important aspect of making skin look great. Eating the right vitamins and minerals can make a huge difference. So ladies, if you are ready to get great skin, don’t shop in the beauty isle, start looking in the grocery section.
Important Vitamins and Minerals for Lovely Skin
If you want beautiful and youthful looking skin, then it’s important that you get the appropriate vitamins and minerals in your diet. Antioxidants are especially important, since they fight off free radicals that can make skin age and cause impurities. Here are some of the most important vitamins and minerals you need to have lovely skin.
- Vitamin E - Vitamin E is an important mineral that you should be getting for beautiful skin. It helps to keep your skin protected from damage from the sun and also keep the cell membranes protected. Some studies suggest it even works together with vitamin C to avoid aging.
- Vitamin C - Speaking of vitamin C, it’s also a very important vitamin for skin health. It is important for the production of collagen and also fights off free radicals. You definitely need to get plenty of this vitamin in your diet on a regular basis.
- Selenium - Selenium is also important for your skin. It also works to keep the skin safe from the sun and also works to delay aging. It protects both the elasticity and the quality of your skin. In tests that have been done on animals, it can help to prevent certain skin cancers and can even reduce sun damage that has already been done.
- Beta Carotene - Beta carotene, which is a form of Vitamin A, is a must if you want healthy skin. This vitamin is used to help repair and grow tissue in the body. While it’s important that you avoid overdoing it, since high doses can be toxic, you do need a certain amount of beta carotene in your diet for skin that looks beautiful.
- Omega 3’s - Omega 3’s, which are fatty acids, should also be included in your diet. They keep cell membranes healthy and they keep out toxins as well. Studies show that they help to keep skin protected from the sun as well.
Best Foods to Eat to Improve Your Skin
Now that you know a bit about some of the important vitamins and minerals needed for skin health, here’s a look at specific foods that you can eat to improve your skin.
- Salmon for Your Skin - Wild salmon is a great food choice for our skin, since it is filled with healthy omega 3’s. Vitamin D is included, which is great for the rest of your body. Selenium is found in salmon too, protecting your skin from the sun. So, this makes a great all around choice if you want to eat to keep your skin looking great.
- Blueberries for Beauty - Blueberries are one of the best fruits out there because of the high amount of antioxidants that are found in them. Antioxidants are known to help prevent aging of the skin. So, add some of these berries to your diet on a daily basis.
- Eat Your Greens - Spinach, one of the best greens out there, is another food you should eat for your skin. It’s loaded up with antioxidants and includes vitamin E, vitamin B, and a lot of vitamin C. You’ll even find omega 3’s in spinach. All of these vitamins and the fatty acids are great for your skin.
- Slice Up Some Tomatoes - Tomatoes are on the list because of the high amounts of lycopene found in them. Lycopene is a great antioxidant for anti aging, which will help keep your skin looking young.
These are just a few of the great foods that can help you eat your way to skin that is healthy and beautiful. Some of the other options for great skin include walnuts, oysters, oranges, kiwi, carrots, nuts, and even dark chocolate. So, it’s time to start spending so much on those lotions for your skin. Spend a bit of money in the grocery isle and take home foods that will help prevent aging and promote beautiful skin.
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Every woman wants to look beautiful, healthy and youthful. A daily and consistent skin care and hair care regimen will help every woman do just that. A woman’s self-esteem is often wrapped up in how young or healthy she perceives her skin and hair to look every day. Here are a few simple things you can do to ensure you’ll look your very best now and for years down the road.
1. Cleansing your skin is really the foundation of a healthy skin care routine. Surprisingly, most people go overboard in this area. Whether you have oily, normal or combination skin, it is important to clean your facial skin without stripping it of naturally occurring oils that are important for younger looking skin.
2. Wash at night to remove makeup and debris with a cleanser for your skin type. Cleanse by using a dime-size amount of cleanser and rinsing your skin with lukewarm water. Pat dry. In the morning, simply splash a bit of lukewarm water on your face to remove any excess oils from the night’s moisturizer. Remember: never use hot or cold water to wash your face, as either one can cause broken capillaries and make your skin appear blotchy.
3. Exfoliation is often overlooked when it comes to skin care, but it is an essential step to keep you looking young. Microdermabrasion, retinoids, and chemical peels are all great methods by which to exfoliate your skin by removing the dead skin cells on the surface of the skin. Each is also available for in-home use if you are unable to afford treatments at a spa, so try one of these at home and you’ll notice that your skin is not only clean, but also glowing. Beauty experts do not recommend toners, but others say they are the key to their facial skin routine. Stick with what makes your skin look the best for you.
4.
Moisturizing your skin is a wonderful way to remain looking young and have soft skin as well. Even if you have oily facial skin, be sure to use a moisturizer, even if it’s only a little each time. Make sure to apply a moisturizer all over after you’re out of the bath or shower.
5. Apply your makeup with clean sponges each time.
6. Give yourself a facial at home once a week or so. There are several facial "recipes" out there.
7. Puffy eyes in the morning can be tamed by placing slices of potatoes or cucumbers over them for a few minutes. For some reason, the puffiness is eased.
8. Bathe only once a day to minimize the possibility of depleting your skin’s moisture. Use lukewarm water (instead of extremely hot or cold water), a soap less cleanser, and limit your bathing or showering times to under 15 minutes to keep your skin from drying out.
9. Sunscreen is a must and probably the most important step when it comes to protecting our skin from harmful environmental factors. Make certain to use a sunscreen or moisturizer containing at least 15 SPF and apply it daily to every area that is exposed to the sun.10. Hair care is essential for good health as well. If your hair appears healthy, you look younger. Shampoo your scalp at least two or three times a day in order to avoid developing dandruff.
11. When you shampoo your scalp and hair, use your fingertips to scrub your scalp thoroughly to loosen up dirt, oils, and debris. Rinse your hair with cool water and you’ll notice it has more body as opposed to rinsing with hot water.
12. Before going to bed each night, be sure to brush your hair to remove tangles and redistribute natural oils in the hair.
13. If possible, allow your hair to air dry rather than subjecting it to blow-drying which can rob your locks of essential moisture.
14. Use a wide-toothed comb to comb out hair when it is wet to avoid breakage.
15. Regular trims will prevent split ends and give you a new, polished look.
16. Believe it or not, proper nutrition and ample amounts of rest contribute to healthy skin and hair, so make sure to get the proper amounts of vitamins, minerals and nutrients in your food or via supplements.
17. Go to bed at the same time each night and get up the same time each morning.
Ulcerative Colitis
What is it?Ulcerative colitis is an inflammatory bowel disease (IBD), which is a general name for diseases that cause the intestine to become inflamed. Ulcerative colitis is a form of IBD in which the inner lining of the large intestine becomes inflamed, swollen, and ulcerated. The inflammation usually begins in the lower end of the large intestine, called the sigmoid colon, which empties into the rectum. (Inflammation of the rectum only is called proctitis.) When the rectum and large intestine become inflamed, water can’t be absorbed into the blood stream, which causes diarrhea. Eventually, the inflammation spreads throughout the large intestine, with the exception of the last section called the ileum. The small intestine is not affected.
Who gets it?
Ulcerative colitis can affect all age groups, but occurs most commonly in people between the ages of 15 and 40. It has been found that people of the Jewish faith are three to six times likelier to have a form of IBD. It is also more common in whites than other racial groups. If someone in your family suffers from an IBD, you have a 20% chance of also having the disease.
What causes it?
The cause of ulcerative colitis isn’t known. While stress can increase symptoms, stress is not a direct cause. Evidence supports the belief that heredity and overactive immune responses could be causes. Some researchers believe some type of viral, bacterial, or fungal organism sets off the cycle of the disease.
What are the symptoms?
Often the symptoms of ulcerative colitis attack suddenly. The most common symptoms are severe abdominal pain, intense diarrhea, and high fever. There may be blood and pus in the bowel movements. Continued diarrhea can cause dehydration, increased heart rate, dizziness, and weight loss. If the inflammation is limited the sigmoid colon and rectum, the stools may be normal or hard and dry. However, there is a discharge of mucus containing red and white blood cells either during or between bowel movements. People with ulcerative colitis may also experience arthritis, liver and gallbladder disorders, eye inflammation, mouth and skin ulcers, and inflammation of the vertebrae (spondylitis). Symptoms of ulcerative colitis may flare up and then go away for a period of time (remission). Patients with ulcerative colitis mostly on the left side of the large intestine are most likely to have longer periods of remission. Some people never have anything more than mild symptoms. In severe cases, however, there is a risk of a number of complications. These include anemia from frequent bleeding, an increased risk of colon cancer, and holes (perforations) in the wall of the intestine. These are extremely dangerous because the contents of the intestine can spill into the abdomen and cause serious infection. Another complication is toxic colitis, in which the colon becomes extremely swollen. When the colon swells to extreme proportions and infection sets in, it is called toxic megacolon.
How is it diagnosed?
Your doctor will question you about your symptoms and examine a stool sample for blood and pus. Because the inflammation of the large intestine can be caused by disorders other than ulcerative colitis, stool and blood samples are important methods to determine whether the symptoms are caused by a bacterial or parasitic infection. Blood tests may also reveal anemia in cases of severe blood loss. The best way to confirm a diagnosis and locate the area of infection is through a procedure called endoscopy. A tiny, flexible viewing tube inserted through the rectum and into the colon lets the doctor examine the lining of the intestine. He or she can also take a small sample (biopsy) of the intestine to examine under a microscope for inflammation. If you have been diagnosed with ulcerative colitis, your doctor will recommend regular endoscopic exams and biopsies because of the increased risk of colon cancer. X-rays of the abdomen are also helpful to diagnose the severity and amount of intestine affected by the disease. Once treatment has begun, your doctor may order a barium x-ray, in which you drink a chalky solution that reveals more detail in an x-ray. He may also order a colonoscopy, in which the entire large intestine is examined with a flexible viewing tube. Because these procedures add stress to the intestinal wall, your doctor will not perform these tests if there is any risk of intestinal perforation from ulcerative colitis.
What is the treatment?
The goal of treatment for ulcerative colitis is to control the inflammation, reduce symptoms, and replace lost fluids and nutrients caused by diarrhea and blood loss. Doctors only recommend medications that can slow diarrhea, such as loperamide or diphenoxylate, in cases of mild diarrhea. Antidiarrheal drugs can actually cause toxic megacolon if not monitored carefully. Inflammation is treated with drugs such as sulfasalazine or mesalamine, which reduce inflammation and help stop flare-ups. Patients who don’t respond to these drugs may be given steroid medications, such as prednisone. If prednisone is used, the goal is to slowly reduce and then stop the steroid and continue the sulfasalazine or mesalamine. When symptoms of ulcerative colitis are severe, the patient is hospitalized. Treatment may include antibiotics, blood transfusions, intravenous fluid replacement, intravenous steroid medications, and nasogastric suction to remove stomach juices through a tube passed through
the nose. If there is a risk of perforation with toxic megacolon, surgery to remove the colon is recommended. This is called a colectomy. Patients who show signs of colon cancer may also need to have a colectomy. In this procedure, a small opening is made in the front of the abdominal wall, and the tip of the ileum is brought to the skin's surface. The opening is called a stoma. A pouch is worn over the opening to collect waste, and the patient empties the pouch as needed. An alternative treatment is called the ileal pouch anal anastomosis (IPAA). With this procedure, the colon and rectum are removed, but the anal sphincters are preserved. A small pouch-like reservoir is created from the small intestine and connected to the remaining rectum, just above the anus. The patient has a stoma with a bag for a short period of time while the intestine heals. The pouch can store waste materials, which are expelled through the anus after the temporary stoma is closed. Surgery to remove the large intestine and colon provides a complete cure for severe ulcerative colitis. About 20 to 25% of all ulcerative colitis patients will require some type of surgery. Your doctor will also make dietary recommendations to help reduce and control symptoms.
Self-care tips
If you have been diagnosed with ulcerative colitis, follow the treatment plan your doctor has recommended. Avoid any foods or beverages that cause indigestion. If you have diarrhea, drink only clear liquids. Get plenty of rest and continue to have regular checkups.
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Urinary Tract Infections (UTI)See also: Bladder Infection
What is it?
The term urinary tract infection (UTI) is used to describe an infection that begins in the urinary system. UTIs can be painful and annoying. They can also become a serious health problem if the infection spreads to the kidneys.
Urinary tract infection (UTI) refers to a group of inflammations of the urethra, bladder, or kidneys. The urinary tract consists of the kidneys, ureters, bladder, and urethra. The kidneys filter waste materials from the blood, and these waste materials become urine. The ureters carry the urine from the kidneys to the bladder, where it is held until you go to the bathroom. The tube that carries the urine from the bladder and outside of your body is called the urethra. Urine is usually sterile, which means it doesn’t contain any bacteria or infectious organisms. However, these types of organisms sometimes get into the urinary tract and cause an infection.
Who gets it?
Urinary tract infections are more common in women than in men. In fact, 1 in 5 women will develop one during her lifetime, and many will have more than one. The male urethra is long, so it is harder for bacteria to get to the bladder. Men are more likely to get a UTI once past the age of 50. People with kidney stones, urinary tract abnormalities, weakened immune systems, spinal cord injuries, and diabetes are more likely to get UTIs, as are patients who have been catheterized to drain urine directly from the bladder.
What causes it?
Urinary tract infections can be caused by bacteria, viruses, fungi, or some types of parasites. The most common types of urinary tract infections are bladder infections, called cystitis; kidney infections, called pyelonephritis; and infections of the urethra, called urethritis. They are caused by bacteria that are normally present in your digestive system and on the skin around the rectum and vagina. This bacteria can pass through the urethra and up into the bladder. Urinary tract infections are not contagious. However, bacteria in the area of the vagina can get pushed into the urethra during sexual intercourse. Infections can also be caused by irritation to your genital area, such as using a diaphragm or spermicides as contraception, wearing tight pants, and using perfumed soaps. Children, especially girls, are more likely to get UTIs from bubble baths and other irritants. Men are more likely to get UTIs when an enlarged prostate gland presses on the bladder and prevents it from emptying completely, or because of kidney stones.
Cystitis commonly occurs in women as a result of sexual intercourse. But even sexually inactive girls and women are susceptible to lower urinary tract infections because the anus, a constant source of bacteria, is so close to the female urethra. More than 90 percent of cystitis cases are caused by Escherichia coli (E. coli) , a species of bacteria commonly found in the rectal area.
Risk Factors
Some people appear to be more likely than others to develop UTIs. Women are one such group. Up to 20 percent will develop a bladder infection over a lifetime. A key reason is their anatomy. Women have a shorter urethra than men have, which cuts down on the distance bacteria must travel to reach the bladder.
Women who are sexually active tend to have more UTIs because sexual intercourse can result in bacteria being pushed into the urethra. Studies have also shown that women who use diaphragms for birth control may be at higher risk. After menopause UTIs may become more common because tissues of the vagina, urethra and the base of the bladder become thinner and more fragile due to loss of estrogen.
Other risk factors include anything that impedes the flow of urine, such as an enlarged prostate or a kidney stone . Changes in the immune system, which can occur with conditions like diabetes , also can increase the risk of UTIs. So can the prolonged use of bladder catheters, which may be needed by the chronically ill or older adults.
New research funded by the National Institutes of Health suggests that a woman's blood type may play a role in her risk of recurrent UTIs. Bacteria may be able to attach to cells in the urinary tract more easily in those with certain blood factors. But more research is needed to determine whether an association exists and whether it could be useful in identifying people at risk of recurrent UTIs.
What are the symptoms?
Not everyone with a UTI will develop symptoms, but most people have some. They can include:
A strong persistent urge to urinate
A burning sensation when urinating
Passing frequent, small amounts of urine
Pain in the lower part of your abdomen or lower back
Blood in the urine (hematuria) or cloudy, strong-smelling urine
A man with a urinary tract infection may have a discharge from his penis. A kidney infection is more serious. Its symptoms include a burning sensation when you urinate, abdominal and lower back pain, fever, chills, nausea, the frequent need to urinate, and cloudy or bloody urine. Some sexually transmitted diseases can cause symptoms that look like a UTI. For example, the chlamydia organism can cause urethritis. For this reason, it is important to see a doctor for diagnosis if you have any symptoms of a urinary tract infection. Symptoms will also get worse if not treated. Untreated UTIs can spread to the blood and cause a serious infection that can be fatal.
There are more specific signs and symptoms for each type of UTI. In addition to the symptoms listed above you may experience the following:
Acute pyelonephritis may cause flank pain, high fever, shaking chills and nausea or vomiting.
Cystitis may result in pressure in the lower abdomen and strong-smelling urine.
Urethritis may lead to pus in the urine. In men, urethritis may cause penile discharge.
How is it diagnosed?
If you have any symptoms of a urinary infection, contact your physician as soon as possible. To diagnose a UTI, your doctor will look at your medical history, ask about your symptoms, and perform a physical exam that includes pressing on your abdomen to check for tenderness. If a UTI is suspected, your physician will most likely ask for a urine sample to determine if bacteria are present in your urine. You will wash your genital area with a disposable wipe, then urinate into a sterile cup. Your doctor will ask you to begin urinating in the toilet, then stop and continue urinating into the cup. This is so any bacteria outside the vagina or on the end of the penis is washed away and not included in the sample. This sample will be tested for bacteria and other causes of UTIs. Although no simple test can differentiate between an upper and lower urinary tract infection, the presence of fever and flank pain may indicate that the infection involves the kidneys. If you have repeated infections, your doctor may order additional tests such as an ultrasound study of your abdomen; intravenous pyelography (IVP), which is an x-ray of the urinary tract; or a cystoscopy, which involves inserting a tube into the urethra for a close view of the urethra and bladder. If you are a man, your doctor will also perform a prostate exam to check for any tenderness or enlargement. He or she will also check for and take a sample of any discharge from the penis.
When treated promptly and properly, UTIs rarely lead to complications. But if they are left untreated, a lower urinary tract infection can become something more serious than a set of uncomfortable symptoms.
Untreated UTIs can lead to potentially life-threatening complications, such as acute or chronic pyelonephritis, which could permanently damage your kidneys. Young children and older adults are at the greatest risk of kidney damage due to UTIs because their symptoms are often overlooked or mistaken for other conditions. Women who have UTIs while pregnant may also have an increased risk of delivering low birth weight or premature infants.
What is the treatment?
Urinary tract infections are usually easy to treat, but it’s important to begin treatment right away. If you have a mild bladder infection, drinking plenty of fluids may be enough to wash away the bacteria and let your body do the rest. In most cases, your doctor will prescribe antibiotics to fight the infection. If you have a lot of pain in the abdominal area, your doctor may give you a different medication for that. Medications for UTIs usually make your urine bright orange. Follow your doctor’s instructions and take all medications until they are gone. If you do not, all the bacteria may not be killed and you may get the infection again. Make sure you drink plenty of fluids everyday. Research has shown that cranberry juice is also effective in treating urinary tract infections and even in preventing them. If you are sexually active, you should avoid sexual intercourse until your symptoms have been gone for at least two weeks.
Usually, UTI symptoms clear up within a few days of treatment. But you'll likely need to stay on antibiotics for a week or more. Indeed, it's important to take the entire course of antibiotics recommended by your doctor to ensure that the infection is completely eradicated. For an uncomplicated UTI that occurs when you're otherwise healthy, your doctor may recommend a shorter treatment with a double-strength version of a prescription drug. But this will depend on your particular symptoms and history.
If you have recurrent UTIs, your doctor may recommend longer antibiotic treatment or refer you to a urologist or nephrologist for an evaluation to see if urologic abnormalities may be causing the infections. If abnormalities of the urinary tract are not to blame, taking a single dose of antibiotic each time after sexual intercourse may be helpful.
For severe UTIs hospitalization and treatment with intravenous antibiotics may be required. When recurrences are frequent or a kidney infection becomes chronic, it's important to have a urologic evaluation because an underlying physical problem may require treatment.
Self-care tips
You can prevent urinary tract infections by making sure you always empty your bladder completely when you go to the bathroom. Women, in particular, may benefit from the following:
Drink plenty of liquids, especially water. Cranberry juice may have infection-fighting properties.
Urinate frequently, and avoid retaining your urine for a long time after you feel the urge to void.
Wipe from front to back after a bowel movement to prevent bacteria in the anal region from spreading to the vagina and urethra.
Take showers rather than bubble baths.
Wash the skin around the vagina and anus daily.
Empty your bladder as soon as possible after intercourse, and drink a full glass of water to help flush bacteria.
Avoid using deodorant sprays or feminine products such as douches in the genital area that could irritate the urethra.
Wear cotton underwear
If you are sexually active, make sure you wash your genital area and urinate after intercourse. This will help to remove any bacteria that could travel up the urethra.
Men can prevent UTIs by wearing condoms during intercourse. If you are uncircumcised, make sure you wash carefully under your foreskin each time you bathe.
UTIs can be painful, but you can take steps to ease your discomfort until antibiotics clear the infection. Sometimes a heating pad placed over the abdomen can help minimize feelings of stomach pressure or pain. It's also a good idea to avoid coffee, alcohol, soft drinks with caffeine, citrus juices and spicy foods until you have finished a course of antibiotics. These items can irritate the bladder and aggravate the frequent or urgent need to urinate.
If recurrent bladder infections are a problem, make sure your physician is aware of this. Together, you can develop a strategy to reduce recurrences and the discomfort they can bring into your life. Call your doctor if symptoms return after treatment, or do not get better after a few days of treatment.
References from Medline Plus