Nursing Process

Hypothyroidism

Definition

Hypothyroidism is a disease caused by the lack of thyroid hormones in the body. This usually happens with the reduction or the complete loss of the thyroid function. There are primary and secondary types of hypothyroidism. Primary hypothyroidism is caused by the disorders of the thyroid gland, due to which hormone production decreases. Secondary hypothyroidism is associated with the disruption of the pituitary or the hypothalamus that regulates the production of the thyroid hormones.

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It is a well-known fact that hypothyroidism is one of the most common diseases of the endocrine system. Often, the disease is diagnosed in women older than 65 years, but other groups of people may have hyperthyroidism as well. By reducing the number of thyroid hormones, the body's metabolism is disrupted, and the work of the cardiovascular system deteriorates. Furthermore, gastrointestinal tract, mental, and sexual activity also experience problems. The symptoms of hypothyroidism develop slowly, imperceptibly, and the patients do not go to the doctor for a long time due to the lack of symptoms.

Symptoms of Hypothyroidism

The clinical picture of hypothyroidism can be represented by the main symptoms that signify the dysfunction of thyroid. Therefore, the main symptoms of hypothyroidism are menstrual disruptions for women and sudden weight gain, albeit slight. Hyperthyroidism decreases the appetite, which does not allow preventing a substantial increase in body weight. The other symptoms are the feeling of nausea, bloating, and constipation. Face and the limb may swell. If a person suffers from hyperthyroidism, the hair becomes dry and brittle and begins to fall heavily.

The scalp may acquire a yellowish tinge. There is an infringement of the hearing and voice changes. It should be noted that this symptom is characteristic of a particularly acute form and it occurs because of the swelling tongue, larynx, and middle ear. In addition, the person experiences constant fatigue and weakness, and one’s thinking processes and speech are slowed down. Moreover, fever caused by slow metabolism is another symptom of the disease.

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One of the most common symptoms of hypothyroidism is depression, because of which patients are often referred to the psychologist or psychiatrist. It was found that hypothyroidism is diagnosed in 8-14% of people who are referred to the specialists because of their complaints about depression. Quite often, these two diseases are difficult to distinguish, especially at the beginning of hypothyroidism when depression may be the only symptom. Sometimes, there are persistent symptoms of hypothyroidism with the normal or even elevated levels of the thyroid hormones. The reasons for this state of intoxication can be metals as well as the destruction of the normal tissue tumors of the thyroid gland as the result of surgery or treatment with radioactive iodine thyroid. Hypothyroidism can occur in response to antiarrhythmic kinds of drugs and antiepileptic drugs.

Diagnosis and Treatment

An endocrinologist sets the diagnosis of hypothyroidism based on the complaints and the examination of the patient as well as research data. The mainstay of treatment is replacement therapy with thyroid hormones. An endocrinologist selects the desired dose depending on the severity and duration of the disease, the age of the patient, and the presence of concomitant diseases. Medications are well tolerated and easy to use. Typically, the drugs must be taken once a day. In most cases, treatment is lifelong. To monitor the treatment, it is necessary to visit an endocrinologist regularly (once a year) to check the level of thyroid hormone and thyroid-stimulating hormone. If the cause of the disease is a decrease in iodine intake from the food, the patient is prescribed iodine-containing drugs, recommended eating more seafood and iodized salt.

The main compliance with the doctor's recommendations and the correct administration of the drugs eliminate the symptoms of hypothyroidism. If hypothyroidism is not treated, the patient's condition deteriorates. Untreated hypothyroidism in childhood leads to irreversible stunted growth, physical and mental development. The elderly can develop severe, often fatal complication - hypothyroid coma.

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Pneumonia

Definition

Pneumonia, or an inflammation of the lungs, is the disease affecting one or both lungs, and it is usually caused by bacteria, fungi, and viruses. Until the discovery of penicillin, every third sick person died because of the infection. Currently, in the United States, about three million people fall ill with pneumonia every year. Despite all the advances of modern medicine, pneumonia remains a serious and dangerous disease as about 5% of the patients with pneumonia die.

Medical science distinguishes several types of pneumonia. Community-acquired pneumonia is the most common form of the disease. Nosocomial pneumonia or hospital pneumonia is the next type. Aspiration pneumonia results from the inhalation of food, water, and foreign objects. SARS is a variety of diseases caused by atypical microflora (Chlamydia, Mycoplasma, Legionella, etc.).

Symptoms

Symptoms of pneumonia are varied. However, the main symptoms include fever, ranging from 37 to 39.5 degrees, shortness of breath and phlegm, chills, and cough. Sometimes, there are bloody discharges that extend in the form of streaks of the blood in the sputum structured. Pain in the chest when the person tries to take a deep breath is also a quite characteristic symptom of the disease. Usually, pain develops in a place where the main point of inflammation sets. Very often, painful sensations occur during the pleural form of pneumonia.

Coughing is not a characteristic symptom because the infection can be away from the main airway. Sometimes, pneumonia can change the skin color of the patient (cyanosis during development). In addition, the disease may be accompanied by headache, loss of consciousness, and fever. Symptoms vary in the extreme age groups - infant infections may manifest as vague irritability and restlessness. In the elderly, the disease may present itself as a loss of orientation and consciousness. Therefore, symptoms of pneumonia include malaise, cough, shortness of breath, and chest pain.

In children, the most common characteristic symptoms of pneumonia are not observed with the exception of weakness, loss of appetite, and fever. Cough is usually wet for older children and adults, and it is dry in infants, young children, and the elderly. Manifestations include fever, tachypnea, tachycardia, wheezing, bronchial breathing, and dullness to percussion.

Treatment

Antibiotics are used in treating all types of pneumonia regardless of the nature of their origin. Unfortunately, currently, for infectious pneumonia, penicillin is no longer viable as a cure because viruses and bacteria have become resistant to the drug. In the treatment of pneumonia caused by adenoviruses, rhinoviruses, parainfluenza, and influenza viruses, antibiotics do not give adequate therapeutic effect quite often. In such cases, it is required to add antiviral drugs.

In addition to the treatment, one should observe a special diet that must be controlled by the doctor. The patients are not able to self-medicate in any case, and this is the main recommendation. Everything should be checked by the doctor because the treatment is rather complicated.

In should be noted that many drug-resistant bacteria make almost all existing antibiotics ineffective. That is why it is necessary to screen and understand the true cause of the disease. Virulent bacteria and viruses can be defeated only by using a complex therapy that combines two or three antibiotics and additional drugs depending on the type of inflammation - antifungal, antiviral, etc. Only the correct diagnosis ensures the rapid recovery and the protection from the possible complications of the disease.

Arthritis

Definition

Arthritis is an inflammatory disease of a joint. Patients with arthritis feel the pain in the joints, especially while walking. Sometimes, the skin located on the painful joints begins to turn red and feverish. Several types of arthritis are distinguished. If one joint is inflamed, the disease is called monoarthritis, and if the several joints are involved in the process, then it is the polyarthritis.

It should be noted that the risk group includes everyone 65 years of age and older. Among seniors, the number of people suffering from this disease is about 60%. It can also affect people at a younger age and even children. Everything depends on the causes of pathological changes in the joints. It is estimated that around the world millions of people suffer from the symptoms of arthritis, and according to recent research, this number increases every year. Some experts say that those or other symptoms of the disease will face every third inhabitant of the planet.

Symptoms

Pain is one of the main signs of arthritis, but the nature of pain is different. For example, in osteoarthritis, pain manifests itself mainly when driving only and carrying the additional strong load. In this case, pain may not be very strong, especially in the first stages of the disease. That is why, often, people do not pay attention to the pain, which triggers the disease. In the second stage, pain is manifested even at low load, and the third stage is full of pain even when one rests. A special characteristic of arthritis pain is that it becomes worse at night, between three and five o'clock in the morning.

Crunch with osteoarthritis arises from the fact that the layer of cartilage breaks down and there is bone friction. However, if the person occasionally crackles joints, it is not a reason for panic. Crunch with osteoarthritis has a specific sound: it is not an easy clicking of joint rather rough and dry. The higher the stage of arthritis is, the stronger the joint in a crunch is.

The next symptom is the reduction of mobility and stiffness throughout the body or in the joint. In addition, arthritis can cause some kind of deformations. It changes the appearance of the joint, but in this case, there is no swelling. The symptoms of arthritis may be inflammation, swelling, the appearance of dense knots, increasing the temperature at the site of inflammation that may become hot to the touch. Arthritis Inflammation of the joints may also be accompanied by the increase of temperature, psoriasis, inflammation of the eye (the feeling of sand in the eyes), chills or excessive sweating, weakness, and discharge from the genitals.

Diagnosis and Treatment

In order to diagnose and identify the kind of disease accurately, there must be a comprehensive approach to it, including inspection, obtaining laboratory data, and using instrumental diagnostic methods. The diagnosis is required to visit such doctors as trauma, rheumatology, infectious diseases, TB doctor, and dermatologist.

To support the diseased joints, one should include in the diet the following groups of products - vegetables, edible roots and fruits, all foods rich in crude fiber and vitamins. Heat treatment in this case must be minimized. One should also consume milk and all its derivatives such as sour cream, cottage cheese, yogurt, fermented baked milk as well as a wide variety of cereals, fish, poultry, and occasionally lean meat. In fact, the diet for arthritis does not cause any difficulties. For successful treatment, it is important to control body weight. If the patient has extra weight, then he needs to get rid of it first.

Appropriate treatment of arthritis is always a complex, long-term, and systematic procedure. It should be aimed at eliminating the causes of arthritis as well as the removal of the pain syndrome and inflammatory process. Thus, depending on the form, type, and extent of arthritis, prediction for a cure is made but in some cases, it may be disappointing. The foregoing principles of the treatment of various types of arthritis can be successfully complemented and, in some cases, replaced by modern techniques and homeopathic drugs.

Hypertension Aspects

Definition

Hypertension is a disease with high blood pressure as its main symptom. High blood pressure is considered the cause of the neuro-functional disorder of vascular tone. Most often, the disease occurs in the people aged 40 and more; but in recent years, people of different ages have faced this kind of disease as well. For decades, scientists from around the world have been engaged in the study of hypertension.

According to various researches, the results of which are published in specialized media, hypertension is a major cause of disability of many people in the world. Today, hypertension is the most common disease of the cardiovascular system. Hypertension has several stages - a slowly progressive (benign), rapidly progressive (malignant) within, and the third stage (severe).

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Symptoms

The main symptoms of hypertension include the following ones - weak, but palpitations heartbeat, feeling of a strong pulsation in the head and unusual inner tension, often sweating and anxiety, strange flies in front of the eyes, flushing, and chills, swelling of the eyelids and puffiness of the face in the morning, the swelling of the hands and numbness of fingers. However, it is extremely important not to confuse the symptoms of hypertension with the usual signs of fatigue.

Most of the patients noting the deterioration of their health try to deal with it in different ways unsuccessfully and do not even think about measuring their blood pressure. Furthermore, they do not realize the real dangers of the disease - the numerous complications of hypertension.

One should mention that hypertension is also called the ‘invisible killer’. Sometimes, the presence of hypertension in humans becomes clear in the emergency room or even during the autopsy in the morgue. Therefore, every person should measure blood pressure from time to time. It is important to purchase special instrument-tonometer. Moreover, even a moderate rise in blood pressure greatly increases the risk of a stroke (bleeding) and myocardial infarction. Therefore, not to expose one’s health and live to the unnecessary risk, if there are at least a few symptoms and, especially the risk factors causing of hypertension, an individual should regularly measure his blood pressure and, in case of its increase, attend a doctor as soon as possible.

Treatment

Hypertension treatment is carried out on a regular basis during one’s lifetime. Increased blood pressure influences one’s heart, brain, kidneys, etc. Hence, this disease needs to be treated firstly, which would completely relieve the person of exacerbations. Approximately half of the patients with mild hypertension can maintain normal pressure without resorting to drugs. For this, one should only give up some bad habits. The experience of the different countries of the world shows that only the promotion of a healthy lifestyle provides a greater reduction in mortality from hypertension than any new kind of drug.

However, only a doctor can diagnose and treat hypertension. The main rule of medical treatment is its continuity. One should never abruptly stop taking the drug because, for some patients, even temporary interruptions in therapy are fraught with severe complications such as myocardial infarction and cerebral stroke. Patients with malignant hypertension or suspected secondary hypertension are sent to a specialist in internal medicine or nephrologist for a more thorough inspection.

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Dementia

Definition

Dementia is a syndrome leading to the degradation of memory, thinking, behavior, and the ability to perform daily activities. Dementia mainly affects the elderly, but it is not a normal condition of aging. It is known that there are about 47.5 million people with dementia, and every year, 7.7 million new cases are registered in the world. Alzheimer's disease is the most common cause of dementia. It accounts for 60-70% of all cases.

Dementia has no effect on consciousness. Cognitive impairment is often accompanied and sometimes preceded by a deterioration of the control over the emotional state as well as the degradation of social behavior or motivation. Dementia is one of the main causes of disability and dependence among the elderly worldwide. It has a profound impact not only on the people affected by it but also on their families and the caregivers. Often, there is a lack of awareness of dementia and a lack of understanding of this condition, which leads to the emergence of stigma and barriers to diagnosis and care. The impact of dementia on caregivers, family, and society can be physical, psychological, social, and economic.

Symptoms

Signs and symptoms associated with dementia are connected with the three stages of the development. The early stage of dementia often goes unnoticed as it develops gradually. Common symptoms include forgetfulness, time loss account, and disorientation in familiar surroundings. As dementia progresses to the middle stage, the signs and symptoms become more pronounced, increasingly narrowing one’s abilities. These signs include forgetfulness in relation to recent events and the names of the people, disorientation at home, increasing difficulty in communicating, the inability to take care of one’s basic needs, and behavioral difficulties, including an aimless walk and asking the same questions.

The late stage of dementia develops almost complete dependence and passivity in patients. Memory deficits become significant and physical signs and symptoms more apparent. The symptoms include disorientation in time and space, difficulty in recognizing family and friends, the increasing need for assistance in basic activities, difficulty in walking, behavioral changes, which may be exacerbated, and aggression.

Diagnosis and Treatment

Although currently there is no treatment that could slow or stop the impact of Alzheimer's on the brain, there are medications that can temporarily alleviate the symptoms of dementia for some patients. The action of these drugs is based on the increase in the number of neurotransmitters in the brain. Researchers continue to look for ways to improve the treatment of Alzheimer's disease and other types of dementia. Currently under development are dozens of therapies and pharmacological studies aimed at preventing the destruction of brain cells under the influence of Alzheimer's disease.

It should be emphasized that formulations that improve cerebral blood flow and neuronal metabolism are more effective if they are assigned in the early stages of cerebral vascular insufficiency, where the severity of cognitive impairment has not yet reached the degree of dementia. Separate treatment may require the appearance of patients with depression, anxiety, hallucinations, and agitation. The reaction to the treatment should be carefully evaluated for each patient, taking into account the relatively frequent occurrence of the paradoxical reactions and side effects of therapy.

It is necessary to review the treatment periodically, avoiding long-term use of the drugs that can impair cognitive abilities without proper reason for it. Adequate treatment of concomitant somatic diseases, which significantly affect the neuro-psychological condition of the patients, should be carried out jointly with other professionals. However, the most important is the psychological support of the patient by the relatives.

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