nurse's notes

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THROMBOANGITIS OBLITERANS OR BUERGER'S DISEASE-

• inflammation of the arteries, veins, adjacent nerves of the extremities and result in thrombus formation and occlusion of the vessels
• unknown cause
• maybe a bacterial origin
• had consider that maybe due to smoking

SIGNS AND SYMPTOMS:

• leg cramps
• burning pain
• painful red lumps under the skin
• cyanosis later- ( cyanosis bluish discoloration of the skin and mucous membrane due to lack of oxygen in the blood)
  
• ulceration and gangrene if progresses

NURSING MANAGEMENT:

• improved circulation
• protect from trauma to avoid source of infection
• avoid smoking
• enough rest
• increase fluid intake
• proper foot hygiene
• socks or stocking must always clean
• slight massage of the foot with moisturizer
• avoid circular or rolled stocking
  

ATHEROSCLEROSIS- characterized by the formation of deposits containing cholesterol or fatty acids

ARTERIOSCLEROSIS - loss of elasticity and a hardening of the wall of arterial vessels

FACTORS THAT CAUSED ARTERIOSCLEROSIS:

• hereditary
• metabolic disturbance
• factors related to arterial hypertension, platelet capabitlity, of initiating formation of atherosclerotic lesion

RISK FACTORS:

• hypertension
• stress
• cigarette smoking
• hereditary
• diabetes obesity elevated blood cholesterol
• tiring activity

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VARICOSE VEINS -

• abnormally dilated veins most commonly occur in the lower extremities or the lower trunk.
• it can also occur to any part of the body like esophageal varices and hemorrhoidal veins

PREDISPOSING FACTOR:

• long standing distension due to back pressure on the veins, on pregnancy, obecity, prolonged standing
• hereditary weakness of the veins
• occupation factor which require long standing like barbers, nurses, beauticians ,elevator assistant

POSSIBLE COMPLICATION:

• edema of the legs
• trauma and infection

SIGNS AND SYMPTOMS:

• disfigurement of the legs
• easy fatigue of the part affected area
• feeling of heavyness
• painful cramps of the legs at night
• pain during menstrual period
• darkened tortuous swollen veins

PREVENTION:

• avoid wearing tight garters, constricting girdle that obstruct venous flow
• avoid cross legs
• avoid sitting and standing for a long period

NURSING CARE AFTER THE STRIPPING PROCEDURE:

• encourage to walk
• carried out prescribed analgesic for pain observed for any signs of hemorrhage at affected site
  
• circulation is observed that dressing must not too constricting
  

THALASSEMIA Major ( Cooley's Anemia) -

• beochemical abnormality affecting either alpha or beta polypeptide chains of globin
• beta thalassemia refers to inherited hemolytic anemiacharacterized by absence of the beta globulin chain of hemoglobin synthesis
• very common in middle east
• this inherited from both parents

SIGNS AND SYMPTOMS:

• severe chronic hemolytic anemia
• mark enlargement of the liver and spleen
• jaundice

THALASSEMIA MINOR (Cooley's trait)-

• characterized by a defective red cell as seen in laboratory finding

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FIBRO ADENOMATA

• are benign tumor of the breast which are firm, round, movable and usually appearing in breast of young woman
• painless and not tender
• no malignant potential

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CARCINOMA -

• BREAST- is common sites of carcinoma in females
• unknown cause but common in woman who have family history
  
• most tumors of the breast in women who are at age of 40 and above
• those who had late menopause are carcinomatous
  
• those who are in higher economic level

Usually tumor grows at the upper outer quadrant of the breast. When it grows, it attaches to the chest wall on the overlying skin then tumor extends to the lymph gland of the adjacent axilla. If not treated, tendency to reach the medial half of the breast, it extends to the lymp nodes within the chest along the internal mammary artery until possibility to metastasize to other organs like lungs, bone, brain or liver

SIGNS AND SYMPTOMS:

• non tender lump, movable at the upper outer quadrant of the breast
  
• painless except in late stage
• dimpling or "orange peel" skin
• retracted nipple is evident
• assymmetry- that the breast affected is more elevated
• pain, ulceration and edema at later stage

DIAGNOSTIC EXAMINATION:

• physical examination
• mammography- most common to detect non-palpable lesion
• biopsy or aspiration
• metastatic work may include bone scan, liver scan, liver function test, chest x'ray brain scan and other laboratory works

Nursing Management:

• Psychosocial Preparation- listen and support the patient and alleviate patient's feels of disfigurement and her cancer disease
• explanation to patient and family about the purpose of surgery and sought to determine that the husband's genuine understanding and love
• carried out pre-operative skin preparation by shaving the areas for a possible maximal surge

Surgery

• Simple Mastectomy- removal of breast without lymph node dissection
• Radical Mastectomy-removal of the breast and the underlying muscles down to the chest wall after removal of the nodules and the lymphatic of the axilla

POST OPERATIVE CARE:

• Monitor vital signs every 30 minutes for first hour and record for doctors evaluation
• observe dressing for any signs of bleeding
• if recovered from anesthesia sedatives- must give pain reliever as ordered by physician
• turned head to one side
  
• encourage to have a deep breath to prevent pulmonary complication
• proper care of drainage catheter if there is any
• positioning of patient depends on the dressing and semi- fowlers is desirable
• encourage to stand from bed on the second or third day
  
• arms on the affected area must hold by a sling
• normal diet is to be given unless if patient is nauseated
• drainage tube removed on the second or third day