Category: A

Attention Deficit Disorder or ADD:  difficulty
paying attention.  Patient with this disorder have short attention
span.  Commonly found in young children and may continue on through
their adulthood.  Many ADD patients has hyperactivity disorder. 
They usually have normal to high intelligence level.  Their activity
level can be anywhere from normal to hypoactivity, to excessive (higher
than normal ) called attention deficit hyperactivity disorder or ADHD. 
In most cases ADD patient have a specific learning disability that prevents
them from taking in too much and sorting out information in the same way
other children do.  ADD patients may require additional educational
assistance due to their learning disorder.

Cause:  Studies shows that it may be inherited, but true
cause is unknown.  Back in the 1970’s researchers believed that ADD
was caused by sugar intake along with food additives.  Today, that
theory is controversial.  Studies shows that specific foods such as;
wheat, and chocolate can trigger the condition in some hyperactive children.

Symptoms:

Continuous failure to pay attention

Short attention span

Excessive distractibility

Unable to organize or stick to an activity

Difficulty following instructions and difficulty completing a project

Hyperactivity, excessive talking and have frequent episodes of interruption

Impulsiveness

Treatment:

It is very important to have all those associated with the child to
have a close cooperation  and team effort.  From parents, teachers,
physicians, and psychological therapies.

Combination of medication  and Psychological therapy

Usually a stimulant such as Ritalin (methylphenidate) and Addereall
(close supervision with doctor is needed when taking these medication–Use
as prescribed by your doctor)

Note:  some stimulants for adults have a different affect
on children and the above medications mentioned often calm hyperactivity
in children.  IMPORTANT: monitoring and keeping in touch with
your doctor is essential.

Joining a support group is helpful.  Contact National Organization
for Children and Adults with Hyperactivity and Attention Disorders.

More Information:

Sometimes kids are rowdy and cranky just because they’re doing a kid thing.  Sometimes, though, a rowdy, cranky child may be showing the symptoms of an attention deficit disorder.

Two of the most common attention deficit disorders are most often referred to as ADD and ADHD.  Being diagnosed with either disorder is not confirmation that a child is bad, stupid, rebellious, or any of the other frustrating behaviors he or she may be known to exhibit.

Instead, a diagnosis of ADD or ADHD merely means your child’s brain is hardwired in a unique way, vividly different from your own.  The child is likely to be exceptionally gifted in an intellectual or academic way.  And he’s got a lot on his mind.

ADHD, or attention deficit hyperactivity disorder, is most often mentioned today.  An ADHD child will have problems focusing on one subject for very long, especially if the subject is of no personal interest.

Along with the attention deficiency, an ADHD child is restless, has a hard time sitting still.  Distractions come easily.  The urge to talk comes even easier.  An orderly, organized classroom can push limits of frustration, sometimes leading to impulsive behavior.

ADD, or attention deficit disorder, differs from ADHD by the absence of the hyperactivity characteristic of that disorder.  In either case, it is best for the child if all authority figures in his or her life collaborates on the diagnosis.  Parents, doctors, teachers, and adult relatives must understand that this child isn’t difficult.  The child just processes the world differently than most children do.

Acute Respiratory Failure (ARF): – This disorder occurs when the lungs no longer meet the body’s metabolic
needs.  It isn’t easily defined because it has many causes and variable
clinical presentation.

Cause:  Acute respiratory failure may develop in patients
with Chronic obstruction pulmonary disease (COPD ) from any condition that
increases the work of breathing and decreases the respiratory drive. 
Conditions includes:  respiratory tract infection, bronchospasm, or
accumulating secretions secondary t cough suppression.   Other
causes of ARF in COPD include:

Central nervous system (CNS) depression – head trauma or injudicious
use of sedatives, narcotics, tranquilizers, or oxygen

Cardiovascular disorders – myocardial infarction (MI), congestive
heart failure (CHF), or pulmonary emboli

Airway irritants – smoke or fumes

Endocrine and metabolic disorders – myxedema or metabolic alkalosis

Thoracic abnormalities – chest trauma, pneumothorax, or thoracic
or abdominal surgery.

Symptoms:

In COPD patients with ARF: hypoxemia (deficient oxygenation of
the blood) and acidemia affect all body organs.

Altered respirations. Rate may be increased, decreased, or normal;
respirations may be shallow, deep, or alternate between the two. Cyanosis
may or may not be present. Auscultation of the chest may reveal crackles,
rhonchi, wheezes, or diminished breath sounds.

Altered mentation. The patient show evidence of restlessness,
confusion, loss of concentration, irritability, tremulousness, diminished
tendon reflexes, and papilledema.

Cardiac dysrhythmias. Tachycardia (rapid heart rate), with increased
cardiac output and mildly elevated blood pressure secondary to adrenal
release of catecholamine, occurs early in response to low PaO2 (oxygen
level). With myocardial hypoxia, dysrhythmias may develop. Pulmonary hypertension also occurs.

Treatment:

Antibiotic for infection

Bronchodilators

Steroids

In COPD patients, ARF is an emergency that requires cautious
oxygen therapy

In significant respiratory acidosis persists, mechanical ventilation
through an endotracheal or a tracheostomy tube may be necessary

High – frequency ventilation may be used if the patient doesn’t respond
to conventional mechanical ventilation

Acute Renal Failure (ARF): – the sudden interruption of kidney function from obstruction, reduced
circulation, or renal parenchymal disease. If untreated, it can progress
to end-stage renal disease, uremic syndrome, and even death. ARF
is usually reversible with treatment.

Cause: Perenal failure is
associated with diminished blood flow to the kidneys. The cause may
be due to hypovolemia, shock, embolism, blood loss, sepsis, pooling of
blood in ascites or burns, CHF, dysrhythmias, and tamponade.

Intrinsic renal failure- cause may include;
acute poststreptococcal glomerulonephritis, acute tubular necrosis, systemic
lupus erythematosus, periarteritis nodosa, vasculitis, sickle cell disease,
bilateral renal vein thrombosis, acute pyelonephritis, ischemia, or renal
myeloma.

Postrenal failure – is associated with
bilateral obstruction of urinary outflow. The causes may include
renal calculi, blood clots, tumors, benign prostatic hypertrophy, strictures,
urethral edema from catherterization, and papillae from papillary necrosis.

Symptoms:

Oliguria (diminished urine secretion in relation
to fluid intake)
Anuria (complete suppression of urine formation
by the kidney) -Rarely seen
Anorexia
Nausea
Vomiting
Diarrhea or Constipation
Stomatitis
GI bleeding
Dry mucous membranes
Uremic breath
Headache
Drowsiness
Irritability
Confusion
Peripheral neuropathy
Convulsion
Skin dryness
Pruritus
Pallor
Purpura
Hypertension
Dysrhythmias
CHF
Systemic edema
Anemia
Coma

Treatment:

Goals: To reestablish effective renal function
(if possible), and to maintain the constancy of the internal environment
despite transient renal failure.

Supportive care: High in calories and low
in protein, sodium and potassium diet, with supplemental vitamins and restricted
fluids.

Electrolyte monitoring is essential to detect
hyperkalemia.

Prevention of hyperkalemia: treatment may
include – dialysis, sodium bicarbonate, and hypertonic glucose and insulin
infusions.

Alcoholism or Alcohol Abuse:  Chronic, uncontrolled
intake of alcohol is the nation’s largest  substance abuse problem,. 
It cuts across all social and economic boundaries, involves both sexes,
and occurs at all stages of the life cycle.  It can state as early
as elementary school age, and alcoholic mothers pass the disease on to
their unborn child.  Alcoholism has no known cure.

Many Alcoholics are difficult to identify because most are able to
function adequately at work. 

Cause:  There is no definite cause that has been clearly identified. 
However, biologic, psychological, and socio-cultural factors contribute
to the disorder.  Studies shows that women become intoxicated more
readily than men because they metabolize alcohol more slowly.

Symptoms:

Characteristically, the alcoholic patient depends on daily or episodic
use of alcohol to function adequately.

Inability to discontinue or reduce alcohol intake

May experience episodes of anesthesia, amnesia, or violence during intoxication

Later stages of alcoholism:  unexplained traumatic injuries or
mood swings, unresponsiveness to sedatives, poor personal hygiene, and
secretive behavior.

The patient may attempt to consume alcohol in any form when deprived
of his usual supply.

May experience ‘black out’ where the patient does not remember any activity
he has done during intoxication

Treatment:

Total abstinence is the only effective treatment

Admitting that one has a drinking problem is a start

Detoxification

Rehabilitation

Support group such as AA programs

Acquired immunodeficiency syndrome/AIDS:  Progressive weakening
of cell mediated (T-cell) immunity,  AIDS heightens susceptibility
to opportunistic infections and unusual cancers.  Diagnosis rests
on correlation of the patient’s history and clinical features rather than
on laboratory criteria.  The time between probable exposure to the
causative human immunodeficiency virus (HIV) and diagnosis averages 1 to
3 years. Incubation time for children appears to be shorter.

Studies shows more than 75% of AIDS patients die within 2 years
of diagnosis.  Some patients, though, have AIDS-related complex (ARC). 
In this condition, the patient’s signs and symptoms suggest AIDS and laboratory
tests reveal HIV antibodies.  However, no opportunistic infections
or neoplasms exist.

Clinical profile differ between adults and children with AIDS. 
For instance, pediatric patients rarely develop Kaposi’s sarcoma, B-cell
lymphoma, or acute mononucleosis-like symptoms.  Children with AIDS
usually don’t develop hepatitis B or peripheral lymphopenia.

Pediatric AIDS patients do, however, experience problems that
are uncommon or milder in affected adults.  These include hypergammaglobulinemia,
lymphoid interstitial pneumonitis, serious bacterial infection, and progressive
neurologic disease caused by CNS infection.  Pediatric patients may
also have dysmorphic facial features.  They may exhibit a normal ratio
of T-helper to T-suppressor cells, although they will have fewer T-helper
cells than normal.

Causes:  The retrovirus HIV causes AIDS.  This virus
appears in body fluids, such as blood and semen.  Modes of transmission
include sexual contact, especially associated with trauma to the rectal
or vaginal mucosa; transfusion of contaminated blood or blood products;
and use of contaminated needles.  The virus can also be transmitted
perinatally from mother to fetus.

Risk factors include multiple sexual contacts with homosexual
and bisexual men, heterosexual contact with someone who has AIDS or is
at risk for it, present or past abuse of I.V. drugs, and transfusions of
blood or blood products, Multiple sex partners increases the risk of AIDS. 
Prenatal an perinatal exposure to AIDS also increases the risk of AIDS
in infants.  Breast feeding if the mother has AIDS or is at risk of
it.

Symptoms:

Symptoms vary widely.  Nonspecific ones often precede complications
and may include:

Fatigue

Afternoon fevers

Night sweats

Weight loss

Diarrhea

Cough

Patient may be asymptomatic until abrupt onset of complications, such
as opportunistic infections, HIV encephalopathy, and Kaposi’s sarcoma (see
below)

A child with AIDS may exhibit dysmorphic features.

Diagnostic tests:  two HIV antibody tests detect antibodies
to the virus responsible for AIDS:  the enzyme-linked immunosorbent
assay (ELISA) and the Western blot assay.

NOTE:  A positive result indicates previous exposure
to the virus and means the patient may be contagious and capable of transmitting
the virus; it doesn’t mean that he has or will get ARC or AIDS.

An antigen test, known as the HIVAGEN test, can detect antigens to HIV
(HIV p24 core protein) as early as 2 weeks after infection.  Patients
who test positive for HIV antibodies and carry the antigen may be more
apt to develop AIDS than patients who carry antibodies only.  The
presence of HIV antigen along with HIV antibody indicated that the virus
is actively replicating.

Treatment:

Currently no cure exists for AIDS.  However, researchers continue
to explore methods to arrest growth of HIV or to restore lost immune function.

Kaposi’s Sarcoma:  is characterized by purple or
blue patches, plaques, or nodular skin lesions that spread widely in patients
with AIDS.  The lesions occur most commonly in the skin, oral mucosa,
lymph nodes, GI tract, lungs, and visceral organs.  Although they
seldom drain or bleed, the lesions can cause other problems.  GI lesions
are associated with diarrhea, nausea, anorexia, and weight loss. 
Lung lesions are associated with congestion and difficulty breathing. 
Lymphatic system lesions are associated with severe facial and extremity
swelling with secondary pain.

Treatment:

Currently, many experimental protocols are being used to treat Kaposi’s
sarcoma.

Surgical incision may remove skin lesions, with no need for further
treatment.

Local irradiation usually has proved effective when tumors require further
treatment.

Chemotherapeutic agents, including doxorubicin, vinblastine, bleomycin,
interferon, and interleukin-2, are also used with some success.