nurse's notes

Heart disease like heart attack is now the number one killer in my country (Philippines). Most of those wealthy Filipinos going abroad like in the United States prefer to seek medical treatment or surgery such as Heart bypass surgery. Most of the patient having this disease are from middle class to higher class especially executives whose works are emotionally stressful and no physical exertion and those also the people who can afford to buy and used to eat delicious food but fatty and mostly rich in cholesterol.These are the foods that highly prone to form plaque-like deposits containing fatty substance, mostly cholesterol, fatty acids, and often calcium which form in the inner wall of an artery. Once the plaque build up, plaques clogged the arteries and blocks the nutrients and oxygen supply of the heart . Through the blood investigation result- the increasing of normal level of cholesterol in the blood stream and there are certain oral drug medications to lower down the increase of normal level of cholesterol of our body but when arteries clogged there is no other treatment than to create a coronary bypass continuos blood flow to supply heart' muscle with nutrients and oxygen. Once the heart failed to received blood supply , patient suffer of chest pain called angina.

Coronary Artery bypass Surgery is a surgical procedure to relieved angina and reduce the risk of death from coronary artery disease. Performed to route blood flow around clogged arteries. Arteries and veins in the patient's body are grafted to the coronary arteries to bypass the clogged arteries and improve the blood supply to the hearts blood circulation which is supplying the heart muscles.
I know many of you are suffering coronary disease that needs surgery, you may search www.umm.edu/ency/article/002946.htm for further information about coronary bypass surgery.

atherosclerosis which needs bypass operation

heart bypass surgery - series

LYMPHANGITIS AND LYMPHADENITIS-

• inflammation of the lymphatic channels
• commonly caused from infected wound in an extremity

SIGNS AND SYMPTOMS:

• red streaks that extends up -from an arm or legs,
  
• an infection that is not localized and that can lead to septicemia.

• Infection's symptoms: fever, chills, localized pain, tenderness of the affected area,
  
• swelling of the involved lymphatic channels
• necrotic to form abscess

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Christmas is past approaching, kids like nephews , niece, god children and many more are expecting to Christmas gifts as usual. Last year I only choosed the simple one which small cake in box which Santa clause printed on the cover and wrapped with pink ribbon. I found it very common

ABDOMINAL HERNIA- is the protrusion of a viscus through the wall of the cavity in which it is naturally contained and may result from congenital or acquired weakness of the abdominal wall
TYPES:
1. Inguinal hernia

• indirect inguinal hernia-due to weakness of the abdominal wall at the point through which the spermatic cord emerges (in the male) and the round ligament (in the female). Extends to inguinal canal and often to the scrotum ( for male) and labia ( for female)
• direct inguinal hernia-passes through the posterior inguinal wall and this is more difficult to repair than indirect

2. Femoral hernia- appears below the groin and frequent in women

3. Umbilical hernia- when umbilical orifice failed to closed . Common also to obese person and children when there is a protrusion of the umbilicus

4. Ventral or incisional hernia due to weakness of the abdominal wall usually occur to an infected previous abdominal operation with drainage.

Complication:

• irreducible- adhesion form between sac and its contents
• incarcerated - intestinal flow is completely obstructed
• strangulated - blood and intestinal flow is completely obstructed
  

Sign and Symptoms:

• abdominal pain
• vomiting
• swelling of hernial sac

ABDOMINAL ANEURYSMS ;
Clinical Manifestation:

• with pulsating palpable mass, produced a constant severe and boring pain

Untreated is eventually outcome is rupture and sudden death
Only surgery is the treatment and no medical treatment

Types of Surgical Intervention

• Excision of area affected
• replacement of excised segment by a bypass (Synthetic ) graft

Dissecting Aneurysm of the aorta

• an aneurysm with a tear in the intima of the aorta this permits blood flow to dissect its way into the substance of the aortic wall, resulting a formation of hematoma
• symptoms may resemble coronary occlusion
  

• this may involve renal artey, subclavian artery, popliteal artery or any major artery
• this cause pulsating mass and pain or pressure on the surrounding structure
• replacement graft are used to repair this aneurysms
  

URINARY TRACK INFECTION- caused by the invasion of pathogenic microorganism in the urinary track.

Sites of the urinary tract where microorganisms usually invade are the following:
Bladder- infection of the bladder called Cystitis
Urethra- infection of the urethra is called urethritis
Prostate- infection of the prostate is called prostatitis

Bacteriurea - presence of bacteria in the urine upon urine laboratory examination which indicates infection

PREDISPOSING FACTORS THAT CAUSES INFECTION:

• urinary obstruction or stasis due to possible urethral stenosis or stone or tumor
• increasing intraluminal pressure or over distended bladder
• fecal soiling of urethral meatus
• due to pressure or injury during catheterazation or cystoscopy
  
• old age or pregnancy
• patient with diabetis mellitus or arteriosclerosis are prone to infection due to lack of blood supply.

FEMALE PATIENT WITH URINARY TRACT INFECTION

• In female urethra is prone to bacterial invasion, unless personal hygiene is stringently. Organisms migrated from intestinal content (fecal). May sometimes sometimes accidentally enters the bladder and infect the urethra. If infection remained in the bladder it is termed Cystitis
• in women seem to be more prone to develop cystitis because has a shorter length of urethra, anatomic proximity to vagina so infection apt to develop after mechanical coitus
• anatomic proximity to rectum so infection apt to develop infection due to fecal contamination

Signs and Symptoms:

• difficulty of urination
• urinary frequency
• urgency
• pain
  
• back pain if there is involvement of the kidney
• fever - if temperature rises , patient has to submit urine investigation for pus in the urine
  

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Medical assistant program are offering courses to help students to be a medical assistant. This online programs are design to prepare to students to assist medical professionals by performing and assisting basic medical duties and responsibilities in medical office or medical clinics / centers. This curriculum includes the subjects on medical practice , jurisprudence medical ethics and other clerical jobs like keeping patients records and handling patients medical benefits like health services discounts or health insurance.

Medical assistant is one in demand job, so many students wishes to take this course aside from easy seeking job but also an wonderful job. You work as an assistant of medical professionals which deals with the care of sick people. As a nurse, I am advising my nephew to study medical assistant but be sure that he enter a medical assistant which is accredited, well facilitated and can provide the best education and training on medical assistant course.

When I was a staff nurse in a hospital I saw them and be with them working together and their were assisting the physicians in their clinical tasks to keep the offices and clinics of physicians in running smoothly. I also came across some medical assistant students who are required to complete a supervised clinical experiences that includes competencies, and evaluations should be all completed by them before they graduate . At the completion of the program, graduates who have diligently attended class and their actual clinical practice he will become a capable medical assistant and he could be joining medical assistant organizations which update his knowledge and the trends on medical assistant practice.

AORTITIS- inflammation of the aorta

TYPES:
Arteriosclerotic aortitis- characterized by dilatation or aneurysm of the vessel which cause pain. Usually manifest at the age of 60.. entire surface of the intima degenerates and becomes sclerosed.
Luetic Aortitis - usually age 50 are affected of the disease. Start at the roots of the aorta then scattered in the other parts of the aorta

Signs and Symptoms:

• feeling of constriction of the chest
• sudden attacks of dyspnea
• rapid pulse
• high blood pressure
• deep cyanotic and profound sweating