By T. Einar. Bradford College.

This recombines with scotopsin and rhodopsin to generate another cycle of action on exposure to light order trandate 100mg without prescription ulterior motive. Vit A deficiency Vit A affects growth and differentiation of epithelial cells leading to defective epitheliazation cheap trandate 100 mg mastercard heart attack warning signs, a condition affecting the cornea of the eye. Severe Vit A deficiency leads to progressive keratinization of the cornea and possibly permanent blindness. Plasma [Vitamin A] may be decreased in states of severe protein deficiency,due to lack of its carrier protein. Effect on Skin The deficeiency causes dryness and roughness of skin developing keratosis of hair folliciles with concomitant deficiency of Vit-B complex. Osteoclastic activity is also hampered, causing defective bone formation Effect on general Metabolism Zinc is necessary to maintain normal plasma concentration of Vit A. This vitamin is also necessary for the conversion of trioses to glucose perhaps indirectly through adrenal cortex that synthesizes hormones concerned with Gluconeogenesis. It is a photolytic process involving no enzyme and slows down with aging because of the decrease of 7- dehydrocholesterol. Hydroxylation at C21 takes place in the endoplasmic reticulum of hepatocytes in a non-regulating process. It crosses cell membrane bind to cytoplasmic receptor to form a complex, which is translocated to the nucleus. Ricketes is characterized by the production of soft pliable bones due to defective mineralization secondary to calcium deficiency. Vit D deficiency is also characterized by low concentration of calcium in blood in association with increased serum alkaline phosphatase. In adults the deficiency produce Osteomalacia due to decreased absorption of calcium and phosphorous, maintains a low plasma level resulting in weak mineralization of bones. Functions The main function of Vit E is as an antioxidant, in particular a membrane antioxidant associated with lipid membrane structure. It provides protection from the action of peroxides by converting them to a product that is conjugating with glucuronic acid and excreted in bile. Source: The richest source is vegetable oil, and nuts 180 Deficiency Vit E deficiency is a rare but found in complication of prolonged and severe steatorrhoea, and of prolonged parenteral nutrition. Deficiency of Vit E causes anemia in children with cystic fibrosis of pancreas are found to be tocopherol deficient as a result of stetorrhoea. It is required for post translational modifications of several proteins required in the coagulation cascade. Activation is carried out by the carboxylation of specific glutamate residues on the prothrombin by Vit K dependent enzyme. The presence of a second carboxyl group on the glutamate (γ- 181 carboxy glutamate) side chain confers phospholipids binding properties on the Prothrombin in 2+ the presence of Ca. However, it is found in patients suffering from Liver diseases (obstructive jaundice), in new born infants and in patients with malabsorption. The placenta is inefficient at passing maternal Vit K to the fetus and immediately after birth the circulation concentration drops, but recovers on absorption of foods. In addition the gut of the new born is sterile, so that the intestinal micro flora does not provide a source of vit K for several days after birth. This is the reason why adults who are on prolonged antibiotic treatment require supplementation of Vit. Warfarin, which inhibit the action of Vit K - probably via the mechanisms involved in the regeneration of the active hydroquinone. Tests to asses Vitamin K status include the prothrombin time-an important test in the investigation and management of jaundiced patients and of those on anticoagulant treatment. Sodium and Potassium: They are important in cell, muscle physiology, transmission of messages and other biological processes. Hyponatremia: It is common in patients who are in diuretics or excessive sweating, kidney disease, diarrhea and congestive heart failure. Other causes are decreased excretion by the kidney, diseases like Anuria, tissue damage or Diabetes Mellitus. Hypokalemia: Low potassium is not due to dietary deficiency but due to conditions like vomiting, diarrhea. Calcium and Phosphate: Major parts (90%) of them are found in the form of crystal lattice in the bone.

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The prophylactic and prognostic stakes clearly underscore the importance of correctly identifying carditis 100mg trandate for sale blood pressure chart exercise. A diagnosis of recurring carditis requires the demonstration of valvular damage or involvement buy trandate 100 mg without a prescription blood pressure 40 over 0, with or without pericardial or myocardial involvement (11). Such clinical findings include a documented change in a previous murmur to a new murmur or pericardial rub, or an obvious radiographic increase in cardiac size, respectively. Further, recurrences of the disease are common in developing coun- tries, owing to gaps in the detection and secondary prevention of disease caused by a lack of health-care facilities. It is prudent to consider them as cases of “probable rheumatic fever” (once other diagnoses are excluded) and advise regular secondary prophylaxis. This cautious approach is particularly suitable for patients in vulnerable age groups in high incidence settings. However, an echo-Doppler examination should be per- formed if the facilities are available. Subcutaneous nodules are almost always associated with cardiac involvement and are found more commonly in patients with severe carditis. The major noncarditic manifestations occur in varying combinations, with or without carditis, during the evolution of the disease. The presence of noncarditic manifestations facilitates the detec- tion of rheumatic carditis and their identification is particularly important in recurrences of disease, when the diagnosis of carditis is difficult. Diagnosis of rheumatic carditis Although the endocardium, myocardium and pericardium are all affected to varying degrees, rheumatic carditis is almost always asso- ciated with a murmur of valvulitis (Table 4. Accordingly, myocardi- tis and pericarditis, by themselves, should not be labeled rheumatic in origin, when not associated with a murmur and other etiologies must be considered. Simultaneous demonstration of valvular involvement generally considered essential. The strict application of diagnostic criteria is mandatory to demonstrate pathological valvular regurgitation. Currently, data do not allow subclinical valvular regurgitation detected by echocardiography to be included in the Jones criteria, as evidence of a major manifestation of carditis. Myocarditis Myocarditis (alone) in the absence of valvulitis is unlikely to be of rheumatic origin and by itself should not be used as a basis for such a diagnosis. If previous clinical findings are known, they can be compared with current data — myocardial involvement is likely to result in a sudden cardiac enlargement that will be detectable radiographically. At times, however, the friction rub can mask the mitral regurgitation murmur, which becomes evident only after the pericarditis subsides. Since isolated pericarditis is not good evidence of rheumatic carditis without supporting evidence of a valvular regurgitant murmur, it may be helpful to have Doppler echocardiography available in such circumstances to look for signs of mitral regurgitation. Echocardiography could also corroborate the mild-to-moderate pericardial effusion likely to be associated with pericarditis; large effusions and tamponade are rare (18). Patients with this form of pericarditis are usually treated as cases of severe carditis. Noncardiac manifes- tations may be the best guide for a diagnosis of rheumatic carditis. Arthritis is often the only major manifestation in adolescents, as well as in adults, where carditis and chorea become less common in older age groups. Joint pain without objective findings does not qualify as a major disease manifestation because of its nonspecificity. Inflamed joints are characteristically warm, red and swollen, and an aspirated sample of synovial fluid may reveal a high -3 -3 average leukocyte count (29000mm , range 2000–96000mm ) (21). Tenderness in rheumatic arthritis may be out of proportion to the objective findings and severe enough to result in excruciating pain on touch. The term “migratory” reflects the sequential involvement of joints, with each completing a cycle of inflammation and resolution, so that some joint inflammation may be resolving while others are beginning. Frequently, several joints may be affected simulta- neously, or the arthritis may be additive rather than migratory. In- flammation in a particular joint usually resolves within two weeks and the entire bout of polyarthritis in about a month if untreated.

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Stages of labor • First stage labor This is labor which lasts from the beginning of a strong contraction of the uterus until the baby drops into the birth canal order trandate 100mg on-line pre hypertension nursing diagnosis. First stage labor lasts 10 - 20 hours for women with first birth buy 100 mg trandate with mastercard prehypertension and hypertension, 7 - 10 hours for mothers with more than one births. Therefore, the health extension worker should take into account these stages of labor and if the labor at each stage is more than the expected time, she should take her to the next health facility with supervision and assistance. Preparations of the woman for delivery To keep personal hygiene of pregnant women: water, soap and clean cloth should be prepared for washing the legs, the pelvic and genital areas. Care during intense labor • Since labor entails tiredness, the woman on labor should be made to get simple food on occasional basis. As traditionally done, painting it with cow dung, mud, butter or 24 Family Health another thing is dangerous to the baby. The health extension workers should make follow up and a feedback should be received from the health facility. If there is tear, put cotton pad or clean cloth and advice for urgent referral to the next health facility. Postpartum Care Definition: postpartum care is the period from completion of third stage of labor to the return to the normal non-pregnant, or pre- pregnant state, usually six weeks later. Lactation may continue after this period, menstruation may not recommence yet, or sexual activity is resumed. Overall it is a care given within the first 24 hours of delivery up to six weeks to: ♦ Prevent complications ♦ Restore to normal health ♦ Check to adequacy of breast-feeding ♦ Provide Family Planning service ♦ Give basic health information Complications during Postnatal period ♦ Puerperal sepsis/general infection ♦ Thrombo-phlebitis ♦ Secondary Haemorrhage ♦ Breast problems – engorgement, infection ♦ Incontinence – stool or urine 27 Family Health Care to the mother during postnatal period. Breastfeeding Breast milk is: a perfect nutrient, easily digested, can be efficiently used and protects against infection. Disadvantages of Bottle Feeding Formula milk is expensive Formula needs to be accurately mixed for adequate nutrition Takes time for preparation Baby more susceptible to diseases and infection 30 Family Health Fuel is needed for heating water to mix the formula More than one bottle is needed Demonstration on getting sunlight for the baby. Supplementary Feeding • Wash hands before the preparation of child’s food • Start supplementary feeding when the baby reaches 6 months of age. It is a means of promoting the health of the women and families and part of a strategy to reduce the high maternal, infant and child morbidity and mortality. Objectives: General: Is to reduce morbidity and mortality of mothers and children by spacing child bearing, preventing unplanned and unwanted pregnancy. Specific: • To increase awareness, knowledge and skills of the community to utilize family planning services, • To increase utilisation of family planning services by households, • To prevent mothers from having too many pregnancies and children • To avert population growth rate, 33 Family Health • Prevent unwanted pregnancies and high risk abortions, • Promote active participation of males in family planning activities. Traditional family planning methods Breast-feeding method: When a mother breast-feeds her baby, the message concerning the feeding goes from the nipple to the vagus nerve and proceeds to the front-part of the pituitary gland in the brain. Then the pituitary gland 35 Family Health initiates the production of prolactin hormone to activate the milk producing glands in the breasts. The prolactin hormone again reduces the secretion of luteinizing hormone which initiates the normal menstrual cycle. The calendar method: If a woman has a regular cycle of 27 days, it is possible to know by subtracting from 27-18 and 27-11 the first and last days of ovulation respectively. Based on this calculation , the woman should avoid sexual intercourse between day 9 and day 19 of the menstrual cycle in order to prevent pregnancy. By the same token, women who have regular menstrual cycles of 28 days, to 30 days should avoid sexual intercourse between 10-17 days and 12-19 days respectively; this time they are safe to do sexual intercourse during the remaining 36 Family Health respective days. Using this natural / traditional method requires a strong discipline, thrust and good understanding between husband and wife or sexual partners. Withdrawal Method: This method uses the withdrawal or the pulling out of the male genital (penis) from the vagina, interrupting sexual intercourse just before ejaculation so that sperm does not enter the vagina. Modern Contraceptive Methods Combined oral contraceptive pills: Combined oral contraceptive is prepared from two hormones, estrogen and progestin. Mechanisms of action • Prevents ovulation; • Thicken cervical mucus making it difficult for the sperm to pass through; • Makes the lining of the uterus too thin for the fertilized egg to implant itself making it difficult for further development. In the first three rows are the combined oral 38 Family Health contraceptive pills, while the seven pills in the last row are body supportive pills made of minerals. Effectiveness • It is highly effective; • Avoids the fear of unwanted pregnancy during sexual intercourse; • Can be taken by any female that has reached puberty-age; • Pregnancy resumes immediately after interrupting the pills; • Prevents extra-uterine pregnancy; • Prevents unwanted pregnancy resulting from casual or unexpected sexual intercourse. Adverse effects • Nausea (the first three months); • Irregular menstruation or missed menses, • Headache; • Tenderness of the breast; • Weight increase; and • It is not the choice for breast-feeding mothers. Emergency contraception: Emergency contraception is a combined oral contraceptive pills method that women can use to prevent pregnancy expected from unprotected sexual intercourse /violence, rape/.

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