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Anxiety:  a feeling of apprehension, uncertainty, and fear without apparent stimululi, associated with physiological changes.

Anxiety related to situational crisis; this diagnosis can apply to any hospitalized patient, or a traumatic change in one’s life.  It’s used most commonly in a patients with conditions requiring surgery or use of sophisticated technologic devices or techniques.  The diagnosis also applies to patients with newly diagnosed chronic or terminal cardiovascular disorders. Also related to unmet expectations or threats to safety or security, this diagnosis may be associated with such conditions as anorexia nervosa and schizophrenia.  Because anxiety can increase myocardial oxygen consumption and exacerbate cardiac stress, helping the patient improve his coping skills is vital.

Symptoms:

• Tachycardia (increase pulse rate)

• Sweating

• Tremor

• Restlessness

• Apprehensiveness

• Worry

• Extreme silence or extreme talkativeness

Treatment:

• Allowing patient to express self

• Require no demands/ giving patient facts

• Relax therapy/meditation

• Antidepressant’s/Antianxiety medications

• Have a love one stay with the patient if in a hospital 

Anxiety disorders:   Everyone at some point in their lives, experience worry, insecurity, apprehension and foreboding.  When anxiety and inner conflict become overwhelming, a psychiatric disorder may develop.  Types of anxiety disorders include obsessive – compulsive disorder and postraumatic stress disorder (PTSD).

Obsessive-compulsive disorder: Obsessive thoughts and compulsive behaviors represent recurring efforts to control overwhelming anxiety, guilt, an or unacceptable impulses that persistently and involuntarily enter the  consciousness.

Obsession :  an persistent unwanted idea or impulse that cannot be eliminated by reasoning.

Compulsion:  an overwhelming urge to perform an irrational act or ritual, or an involuntary defensive behavior as an expression of anxiety.

Obssive-compulsive is marked by compulsion to repetitively perform certain acts, or carry out certain rituals.  Compulsive behaviors are repeated because they reduce the anxiety associated with the obsession.  This disorder occurs in both sexes, with typical onset in adolescents or young adults.  Recent studies indicate a higher incidence in upper-class people with higher intelligence.

Researchers have not uncovered a single cause for obsessive-compulsive disorder.  Some studies suggest the possibility of brain lesions, but the most useful research and clinical studies point to and explanation based on psychological theories.  Major depression, organic brain syndrome, and schizophrenia may contribute to the onset of this disorder.

Symptoms: 

Compulsive actions may be simple, mild, and uncomplicated or dramatic, elaborately complex, and ritualized.  Their meanings may be obvious or may reflect inner psychological distortions that are unraveled only through intensive psychotherapy.

Often the patient’s anxiety is so strong that he will avoid the situation or the object that evokes his compulsion.  For example:  a patient who has a recurring urge to push people down long flights of stairs may avoid going up or down any stairs in buildings.

Has a tendency to repeat acts over and over, such as; repetitive touching, repetitive hand washing, repetitive doing and undoing (opening and closing doors, drawers), repetitive checking of a certain thing.

When the obsessive-compsive phenomena are mental, no one knows that anything unusual is happening unless the patient talks about these private experiences. Commonly, the obsessive patient has repeated thoughts of violence or contamination, or constant worry about a tragic event.

Treatment:

• Treatment aims to reduce anxiety, and depression

• Tranquilizer and or antidepressants therapy

• Psychotherapy (may be long-term)

• Brief supportive psychotherapy 

• Behavior therapy

• Group therapy

Posttraumatic stress disorder:  or PTSD, involves the psychological consequences of a traumatic event that occurs outside the range of usual human experience.  PTSD can be acute, chronic, or delayed and can follow a natural disaster such as; a flood, or man-made disaster such as; war, torture, incest or car accidents, an assault, or a rape.

In most people with posttraumatic stress disorder, the stressor is a necessary but insufficient cause of the persisting symptoms.  Even the severest stressors do not produce PTSD in everyone, so psychological, physical, genetic, and social factors may  also contribute to it.

Symptoms:

• Patient may have a recurrent, intrusive recollections or nightmares

• Psychological distress at exposure to events that symbolize trauma.

• Sleep disturbance

• Chronic anxiety

• Panic attacks

• Memory impairment

• Difficulty concentrating

• Feeling of detachment or estrangement that destroy interpersonal relationships

• Headaches

• Depression

• Rage

• Use of violence to solve problems

• Suicidal thoughts

• Persistent avoidance of stimuli associated with trauma

• Diminished general responsiveness

Treatments:

Goal of treatment include reducing the target symptoms, preventing chronic disability, and promoting occupational and social rehabilitation.

• Behavioral techniques/relaxation therapy

• Antianxiety medication

• Antidepressants medications

• Psychotherapy

• Support groups

Many patients need treatment for depression, alcohol and drug abuse or medical conditions before psychological healing can take place.

Appendicitis:  One of the most common major
surgical disease, appendicitis is obstruction and inflammation of the vermiform
appendix, which may lead to infection, thrombosis, necrosis, and perforation.

Appendicitis may result from an obstruction of the intestinal lumen
caused by a fecal mass, stricture, barium ingestion, or a viral infection.

Symptoms:

Abdomen pain – generalized or localized in the right upper abdominal,
eventually localizing in the right lower abdomen

Nausea

Anorexia

Vomiting

Boardlike abdominal rigidity

Retractive respirations

Increasingly severe abdominal spasms and rebound spasms

Constipation

Fever

Tachycardia

Indication of perforation or infarction of the appendix–Sudden cessation
of abdominal pain

Treatment:

Only effective treatment:  Appendectomy

If peritonitis develops, treatment involves gastrointestinal intubation,
parenteral replacement of fluids and electrolytes, and antibiotics.

Arthritis: Inflammation
of a joint, marked by pain, heat, redness, and swelling. Arthritic
disorders are among the most common chronic conditions that is painful
and disabling. There are different types of arthritic disorders they
include: Rheumatoid arthritis, Osteoarthritis, Septic arthritis, Gout, Intermittent hydrarthrosis, Traumatic arthritis, Schonlein-Henoch purpura, and Hemophilic arthrosis.

Rheumatoid arthritis or RA:
This chronic, systemic inflammatory disease mainly attacks peripheral
joints and surrounding muscles, tendons, ligaments, and blood vessels.
Spontaneous remissions and unpredictable exacerbation’s mark the course
of rheumatoid arthritis. This disorder has the potential to cripple and
in some cases patient becomes totally disable from severe articular
deformity or associated extra articular symptoms, or both. In most
patients, the disease follows an intermittent course and allows normal
activity.

Cause: Rheumatoid Arthritis is believed to have an autoimmune basis, though the exact cause remains unknown.

Symptoms:

Early stage – may experience:
Fatigue
Malaise
Anorexia
Persistent low-grade fever
Weight loss
Lymphadenopathy
May experience vague articular symptoms

Later stage:
Joint pain – joint symptoms occur bilaterally and symmetrically
Tenderness
Warmth and swelling
Stiffness
Paresthesias in hands and feet
Stiff , weak, and painful muscles
May develop rheumatoid nodules ( subcutaneous, round or oval, non
tender masses, usually on pressure areas, such as the elbow)

Advance signs:
Joint deformities and diminished joint function

Treatment:

Salicylates – such as aspirin to decrease inflammation and relieve joint pain

Nonsteroidal anti inflammatory agents – such as ibuprofen

Antimalarials

Corticosteroids – such as prednisone

Immunosuppressives – such as cyclophosphamide and azathioprine, are also therapeutic

Supportive measures include: Adequate sleep and frequent rest period.

Physical
therapy program – Range of motion exercises and carefully
individualized therapeutic exercises, forestalls loss of joint function.

Application of heat relaxes muscles and relieves pain. Ice packs are effective during acute episodes.

Advanced disease may require synovectomy, joint reconstruction, or total joint arthroplasty.

Osteoarthritis: The most common form of arthritis,
this chronic condition causes deterioration of the joint cartilage and
formation of reactive new bone at the margins and subchondral areas of
the joints. Degeneration results from a breakdown of chondrocytes, most
often in the hips and knees.

Disability depends on the site and severity of involvement and can
range from minor limitation to severe disability in people with hip or
knee involvement. The rate of progression varies, and joints may remain
stable for years in an early stage of deterioration.

Cause: The exact cause is unknown. Primary
osteoarthritis, a normal part of aging, results from varies things,
such as: metabolic, genetic, chemical, and mechanical factors.

Secondary osteoarthritis usually follows an identifiable
predisposing event, most commonly trauma or congenital deformity which
may lead to degenerative changes.

Symptoms:

Signs and symptoms increases with poor posture, obesity, and occupational stress

Joint pain – that occurs particularly after exercise or weight bearing and that is usually relieved by rest.

Stiffness in the morning and after exercise that is usually relieved by rest

Aching during changes in weather

‘Grating’ of the joint during motion

Limited movement

Irreversible changes in the distal joints (Heberden’s nodes) and
proximal joints (Bouchard’s nodes) occur in osteoarthritis of the
interphalangeal joints.

Nodes may be painless at first but eventually become red, swollen, and tender, causing numbness and loss of dexterity.

Treatment:

Non narcotic analgesics

In some cases, intra articular injections of corticosteroids.

Patients who have severe osteoarthritis with disability or
uncontrollable pain may undergo one or more of the following surgical
procedures:

-Arthroplasty (partial or total) – replacement of a deteriorated joint or part with a prosthetic appliance.

-Arthrodesis – surgical fusion of bones; used primarily in the spine

-Osteoplasty – scraping of deteriorated bone from a joint

-Osteotomy – excision of bone to change alignment and relieve stress

Septic arthritis: is a medial emergency. Bacteria
invade a joint, resulting in inflammation of the synovial lining. If
the organisms enter the joint cavity, effusion and pyogenesis follow,
with eventual destruction of bone and cartilage.

Septic arthritis can lead to ankylosis and even fatal septicemia.
Prompt antibiotic therapy and joint aspiration or drainage cure most
patients.

Causes: In most cases, bacteria spread from a
primary site of infection, usually in adjacent bone or soft tissue,
through the bloodstream to the joint.

Infecting organisms include four strains of gram positive
cocci:Staphylococcus aureus, Streptococcus pyogenes, Streptococcus
pneumoniae, and Streptococcus viridans.

Two strains of gram negative cocci: Neisseria gonorrhoeae and Hemophilus influenzae.

Several gram negative bacilli: Escherichia coli, Salmonella, and Pseudomonas to name a few.

Anaerobic organisms, such as gram positive cocci, usually infect
adults and children over age 2. H. influenzae most often infects
children under age 2.

There are various factors that can predispose a person to septic
arthritis. Any concurrent bacterial infection (such as, upper
respiratory tract or genitourinary), or serious chronic illness (such
as renal failure, RA, diabetes, or cirrhosis) heightens susceptibility.
Intravenous drug abuse ( heroin addicts, for example) can also cause
septic arthritis. Other predisposing factors include recent articular
trauma, joint surgery, intra articular injections, and local joint
abnormalities.

Symptoms:

Acute septic arthritis begins abruptly, causing intense pain,
inflammation, and swelling of the affected joint, with low grade fever.
Most often develops in the large joints but can strike any joint,
including the spine and small peripheral joints. Systemic signs of
inflammation may not appear in some patients. If the bacteria invade
the hip, pain may occur in the groin, upper thigh, or buttock.
migratory polyarthritis sometimes precedes localization of the
infection.

Treatment:

Emergency action is needed. Seek medical attention promptly.

Antibiotic therapy (medication selection requires drug sensitivity
studies of the infecting organism) Bioassays or bactericidal assays of
synovial fluid and bioassays of blood may confirm clearing of the
infection.

Treatment requires monitoring of progress through frequent analysis
of joint fluid cultures, synovial fluid leukocyte counts, and glucose
determinations.

Propoxyphene or Codeine may be given for pain – (aspirin causes a
misleading reduction in swelling, hindering accurate monitoring of
progress)

The affected joint can be immobilized with a splint or put into traction until movement can be tolerated.

Arthrocentesis to remove grossly purulent joint fluid should be
repeated daily until fluid appears normal. Patient may require
arthrotomy with lavage of the joint with resistant infection or chronic
septic arthritis

Late reconstructive surgery is warranted only for severe joint
damage and only after all signs of active infection have disappeared,
may take up to several months. In some cases, the recommended procedure
may be arthroplasty or joint fusion.

Gout: Urate (a salt of uric acid) deposits lead to
painfully arthritic joints. Gout can strike any joint but favors those
in the feet and legs. Gout usually occurs in men older than age 30 and
in post menopausal women. Secondary gout occurs in the elderly. Gout
follows an intermittent course and often leaves patients totally free
of symptoms for years between attacks. Gout can lead to chronic
disability or incapacitation an, rarely, severe hypertension and
progressive renal disease. Prognosis is good with treatment.

Cause: Exact cause of primary gout is unknown. It
may be linked to a genetic defect in purine metabolism, which causes
overproduction of uric acid (hyperuricemia), retention of uric acid, or
both.

Secondary gout can also follow drug therapy, especially after
hydrochlorothiazide or pyrazinamide, which interferes with urate
excretion. Increased concentration of uric acid leads to urate
deposits, called tophi, in joints or tissues, causing local necrosis or
fibrosis.

Symptoms:

There are four different stages: Asymptomatic, acute, intercritical, and chronic.

Asymptomatic gout: serum urate levels rise but produce no symptoms.
As the disease progresses, it may cause hypertension or nephrolithiasis
(a condition marked by the presence of renal calculi), with severe back
pain.

Acute gout: The first acute attack strikes suddenly and peaks
quickly. It may involve a few joint, but usually involves only one
joint, this initial attack is extremely painful. Affected joints appear
hot, tender, inflamed, dusky red, or cyanotic.

The metatarsophlageal joint of the great toe usually becomes
inflamed , then the instep, ankle, heel, knee, or wrist joints. May
develop a low grade fever. Mild acute attacks often subside quickly but
tend to recur at irregular intervals. Sever attacks may persist for
days or weeks.

Intercritical : Intercritical periods are the symptom free intervals
between gout attacks. Most patients usually have a second attack within
6 months to 2 years, but in some the second attack is delayed for 5 to
10 years. Delayed attacks are more common in those who are untreated
and tend to be longer and severer that initial attacks. Such attacks
are also polyarticular, invariably affecting joints in the feet and
legs, and are sometimes accompanied by fever. A migratory attack
sequentially strikes various joints and the Achilles tendon and is
associated with either sub deltoid or olecranon bursitis.

Chronic: Eventually, chronic polyarticular gout sets in. This final,
unremitting stage of the disease is marked by persistent painful
polyarthritis, with large, subcutaneous tophi in cartilage, synovial
membranes, tendons, and soft tissue.. Tophi (a deposit of urates in the
tissues about the joints) form in fingers, hands, knees, feet, ulnar
sides of the forearms, helix of the ear, Achilles tendons, and rarely,
in internal organs, such as the kidneys and myocardium. The skin over
the tophus may ulcerate and release a chalky, white exudate of pus.
Chronic inflammation and tophaceous deposits precipitate secondary
joint degeneration, with eventual erosions, deformity, and disability.
Kidney involvement, with associated tubular damage, leads to chronic
renal dysfunction. Hypertension and albuminuria occur in some patients,
also urolithiasis (a formation of urinary calculi) is common.

Pseudogout also causes abrupt joint pain and swelling but results
from an accumulation of calcium pyrophosphate in periarticular joint
structures. (See below)

Treatment:

To terminate an acute attack, reduce hyperuricemia, and prevent recurrence, complications, and calculi formation.

Acute gout: Bed rest, immobilization and protection of the inflamed,
painful joints, and local application of heat or cold. Analgesics to
relieve pain. Acute inflammation requires concomitant treatment with
colchicine, until the pain subsides or nausea, vomiting,
cramping, or diarrhea develops. Phenylbutazone or indomethacin in
therapeutic doses may be prescribed. Resistant inflammation may require
corticosteroids or corticotropin, or joint aspiration and an intra
-articular corticosteroid injection per doctors orders.

Chronic gout: Aims to decrease serum uric acid level. The doctor may
order continuing maintenance dosage of allopurinol to suppress uric
acid formation or control uric acid levels.(Caution used with patients
with renal failure)

Uricosuric agents – promote uric acid excretion and inhibit
accumulation of uric acid. (not to be used on patients with calculi –
unless your doctor says otherwise)v

Adjunctive therapy emphasizes a few dietary restrictions, –
avoidance of alcohol and purine rich foods. (obesity puts additional
stress on painful joints)

In some cases, surgery may be necessary to improve joint function or
correct deformities. Tophi must be excised and drained if they become
infected or ulcerated.

Pseudogout: Also called Calcium pyrophosphate
disease: Results when calcium pyrophosphate crystals collect in
periarticular joint structures. If left untreated it can lead to
permanent joint damage in about half of the patients it affects, most
of whom are elderly.

Paseudogout causes abrupt joint pain and swelling, most commonly
affecting the knee, wrist, ankle, and other peripheral joints. These
recurrent, self limiting attacks may be triggered by stress, trauma,
surgery, severe dieting, thiazide therapy, and alcohol abuse.

Symptoms are similar to those of rheumatoid arthritis. (see rheumatoid arthritis)

Treatment: joint aspiration to relieve fluid pressure

Instillation of steroids

Analgesics, or non steriodial anti inflammatories.

If appropriate, treatment of the underlying endocrine or metabolic disorder.

Intermittent hydrarthrosis: a rare, benign condition characterized by regular, recurrent joint effusions. Commonly affecting the knee joint.

Cause: unknown. Onset is usually at or soon after puberty and may be linked to familial tendencies, allergies, or menstruation.

Symptoms: May be asymptomatic. The patient may have difficulty moving the affected joint.

Treatment: No effective treatment exists

Traumatic arthritis: arthritis that is caused from
blunt, penetrating, or repeated trauma or from forced inappropriate
motion of a joint or ligament.

Symptoms: Swelling, pain, tenderness, joint instability, and internal bleeding.

Treatment: Analgesics, anti inflammatories,
application of cold followed by heat, and if needed, compression
dressings, splinting, joint aspiration, casting, or possibly surgery.

Schonlein-Henoch purpura: A vasculitic syndrome, it
is marked by palpable purpura, abdominal pain, and arthralgia that most
commonly affects the knees and ankles, producing swollen, warm, and
tender joints without joint erosion or deformity.

Symptoms: (those mention above). Most patients have
microscopic hematuria and proteinuria 4 to 8 weeks after onset. Renal
involvement is common. It is common in children and young adults,
occurring most often in the spring after a respiratory infection.

Treatment: may include corticosteroids.

Asthma:  a condition marked by recurrent attacks of paroxysmal
dyspnea, with wheezing due to spasmodic contraction of the bronchi. 
In some cases, it is an allergic manifestation in sensitized persons.

Asthma produces episodic, reversible airway obstruction by way of bronchospasms,
increased mucus secretion, and mucosal edema.  Although this common
condition can strike at any age, children under age 10 account for half
the cases.  Underlining the significance of hereditary predisposition,
approximately 1/3 of all asthmatics share the condition with at least one
member of their immediate family.

Cause:  Intrinsic asthma can result from irritants,
emotional stress, fatigue, temperature and humidity changes, endocrine
changes, or exposure to noxious fumes.

Extrinsic asthma follows exposure to pollen, animal dander,
house dust or mold, food additives containing sulfites, or other sensitizing
substances.

Other asthma causes can include aspirin, various nonsteroidal anti-inflammatory
drugs, exercise, or occupational exposure to various allergenic factors.

Symptoms:

Sudden dyspnea (labored or difficulty breathing)

Wheezing

Tightness in the chest

Coughing (with clear or yellow sputum)

Tachypnea (very rapid breathing) may occur along with use of accessory
respiratory muscles

Rapid pulse

May experience profuse perspiration

An acute asthma attack begins dramatically, with simultaneous onset
of severe multiple symptoms, or insidiously, with gradually increasing
respiratory distress

Asthma that occurs with cyanosis, confusion, and lethargy indicates
the onset of life-threatening status asthmaticus and respiratory failure.

Treatment:

Identifying and avoiding precipitating factors, such as allergens or
irritants, represents treatment’s goal.  Usually, such stimuli cannot
be removed entirely.  Desensitization to specific antigens may be
helpful but is rarely totally effective or persistent.

Bronchodilators – oral inhalers/oral pills

Corticosteroids

Patient teaching:  Adequate hydration and diet is important
in treating asthma

Peek flow helps to determine breathing level (not a full proof reliable
system)

Be aware and prompt treatment for respiratory infection

Keep inhalers with you at all times (use it as prescribed by your doctor)

Also keep nebulizer readily available at all times

Call or seek medical treatment immediately when medication does not
work and when patient has difficulty breathing.

Atelectasis:  Is an incomplete expansion
of lobules (clusters of alveoli) or lung segments may result in partial
or complete lung collapse.  The collapsed tissue, unable to perform
gas exchange, allows unoxygenated blood to pass through it unchanged, producing
hypoxemia (deficient oxygenation of the blood).  Atelectasis can be
present at birth (incomplete expansion of the lungs), or during adulthood
(from a  collapsed lung).  It may be chronic or acute. 
It occurs to some degree in many patients undergoing upper abdominal or
thoracic surgery.  Prognosis depends on prompt removal of any airway
obstruction, relief of hypoxia, and reexpansion of the collapsed lobule(s)
or lung(s).

Cause:  Atelectasis may be the result from:

Bronchial occlusion by mucus plugs (common problem  with 
-Chronic obstructive pulmonary disease patient)

Bronchiectasis

Cystic fibrosis

Heavy smoking

Occlusion by foreign bodies 

Bronchogenic carcinoma

Inflammatory lung disease

Idiopathic respiratory distress syndrome of the newborn (hyaline membrane
disease)

Oxygen toxicity

Pulmonary edema

Prolong immobility

CNS depression such as ; drug overdose

Any condition that inhibits full lung expansion or makes deep breathing
painful, such as; rib fractures, obesity, an abdominal surgical incisions

Symptoms:

Symptoms varies with the degree of hypoxia

Dyspnea (labored or difficulty breathing), may be mild and subside without
treatment if atelectasis involves only a small area of the lung. Severe if massive collapse occurs

Anxiety

Cyanosis

Diaphoresis

Decreased breath sounds

Dull sound on percussion if a large portion of the lung is collapsed

Peripheral circulatory collapse

Tachycardia

Substernal or intercostal retraction

Compensatory hyperinflation of unaffected areas of the lung

Mediastinal shift to the affected side

Treatment:

Incentive spirometry

Chest percussion

Postural drainage

Frequent coughing and deep-breathing exercise

If these measures fail, bronchoscopy may help remove secretions

Humidity and bronchodilators can improve mucociliary clearance and dilate
airways and are sometimes used with a nebulizer

Atelectasis secondary to an obstructing neoplasm may require surgery
or radiation therapy.

Postoperative thoracic or abdominal surgery patients require analgesics
to facilitate deep breathing, which minimizes the risk of atelectasis