🩺Nursing Insight📚 02

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*Cholera* ⏭️Cholera is an acute diarrheal disease caused by Vibrio cholerae. ⏭️• I.P.- 1-2 days ⏭️First step in epidemic of cholera: Verification of diagnosis 📝 Stool appearance of cholera: “Rice watery stool” 📝Chemoprophylaxis of cholera: Tetracycline 500mg BID for 5 days. *🔖Drug of choice for cholera:* 💿Adults: Doxycycline 300 mg stat. *️⃣ Children: Azithromycin 20 mg/kg, single dose *️⃣Pregnant Female: Azithromycin 1 gm, single dose

Common Nerve Injuries ⌚ *Wrist drop – Radial nerve* 👠 *Foot drop – Either common peroneal nerve or sciatic nerve* ✊🏻 *Claw hand – Ulnar nerve* 🤞 *Paraesthesia of thumb, index and middle finger – Median nerve* 💪 *Numbness on superior aspect of upper arm just below shoulder joint – Axillary nerve* 👢 *Fibular neck fracture – Common peroneal nerve* 🦵 *Femur neck fracture or Acetabular fractures – Sciatic nerve* 🤰 *Fracture of humeral shaft – Likely Radial nerve* 🤰🏾 *Fracture of humeral Neck – Likely Axillary nerve* 🏓 *Monteggia fracture – Radial nerve* 🧤 *Paraesthesia and impaired sensation in both hands (glove distribution) – Peripheral neuropathy*

🔷Antara Programme 🔷 ▪️Injectable contraceptive ▪️MPA (medroxyprogesterone acetate) ▪️Dose - 150mg IM, every 3 months ▪️First dose can be taken : 🔸Anytime after regular menstruation (5th day of Menstrual cycle) 🔸After 6 weeks of delivery 🔸Immediately after abortion 🔷Other Injectible Contraceptive 🔹DMPA ▪️Depot Medroxy Progesterone Acetate ▪️Dose 150 mg (IM) ▪️Site -Gluteus Maximus ▪️Effectiveness -3 Month 🔹 NET-EN ▪️Norehisterone Enantate ▪️200 mg (IM ) ▪️Site - Gluteus Maximus ▪️Effectiveness -3 Month 🔹DMPA SC 104 mg ▪️New lower dose formulations DMPA ( depo subQ provera 104 also called DMPA SC ) Route - SC Site - Upper thigh or Abdomen ▪️Effectiveness -3 month 🔹 Mechanism of Action 🔸Inhibition of ovulation 🔸Cervical mucus thickening 🔸Endometrial atrophy preventing Implantation ▪️Contraindications 🔸Unexplained vaginal bleeding 🔸Stroke or severe diabetes 🔸Breast cancer (past or present) 🔸Active hepatitis or liver tumor 🔸A desire for rapid return of fertility ▪️Disadvantages 🔸Menstrual irregularities (light / heavy bleeding /amenorrhea) 🔸Slight weight gain 🔸No protection against sexually transmitted diseases 🔸A slight loss in bone mineral density during the first two years of use.

Admit card norcet 5.0

🔷Antara Programme 🔷 ▪️Injectable contraceptive ▪️MPA (medroxyprogesterone acetate) ▪️Dose - 150mg IM, every 3 months ▪️First dose can be taken : 🔸Anytime after regular menstruation (5th day of Menstrual cycle) 🔸After 6 weeks of delivery 🔸Immediately after abortion 🔷Other Injectible Contraceptive 🔹DMPA ▪️Depot Medroxy Progesterone Acetate ▪️Dose 150 mg (IM) ▪️Site -Gluteus Maximus ▪️Effectiveness -3 Month 🔹 NET-EN ▪️Norehisterone Enantate ▪️200 mg (IM ) ▪️Site - Gluteus Maximus ▪️Effectiveness -3 Month 🔹DMPA SC 104 mg ▪️New lower dose formulations DMPA ( depo subQ provera 104 also called DMPA SC ) Route - SC Site - Upper thigh or Abdomen ▪️Effectiveness -3 month 🔹 Mechanism of Action 🔸Inhibition of ovulation 🔸Cervical mucus thickening 🔸Endometrial atrophy preventing Implantation ▪️Contraindications 🔸Unexplained vaginal bleeding 🔸Stroke or severe diabetes 🔸Breast cancer (past or present) 🔸Active hepatitis or liver tumor 🔸A desire for rapid return of fertility ▪️Disadvantages 🔸Menstrual irregularities (light / heavy bleeding /amenorrhea) 🔸Slight weight gain 🔸No protection against sexually transmitted diseases 🔸A slight loss in bone mineral density during the first two years of use.

👉 Oligomenorrhea= irregular, infrequent menstrual cycle more than 35 day in duration 👉 Polymenorrhoea = Regular and frequent menstrual cycle less than 21day in duration. 👉 Menorrhagia= Excessive menstrual blood loss more than 80 ml with normal duration of cycle. 👉 Mettorhagea = Excessive irregular menstrual cycle with normal amount of menstrual blood loss. 👉 Meno-mettorhagea = Excessive irregular menstrual cycle with excessive amount of blood loss 👉 Hypomenorrhoea= decrease amount of blood loss Less than 20 ml and less than 2day in duration. 👉 Dysmenorrhea= Excessive painful menstrual bleeding with normal duration of menstrual cycle and normal amount of menstrual blood loss. 👉 Cryptomenorrhoea = present of menstrual like symptoms but absence of menstrual bleeding {Most common course- Imperforate hymen}

*SUMMARY OF CPR :* ∆ PULSE ASSESSMENT:           • ADULT - CAROTID           • CHILDREN (1-8YR) - CAROTID / FEMORAL           • INFANT (UPTO 1 YR) - BRACHIAL *∆ COMPRESSION METHOD:*           • ADULT - TWO HAND           • CHILDREN - TWO HAND / ONE HAND           • INFANT - TWO THUMB / TWO FINGER  *∆ COMPRESSION DEPTH :*            • ADULT - 2 INCH           • CHILDREN - 2 INCH           • INFANT -  1.5 INCH   *∆ COMPRESSION RATIO:*  1 RESCUER :            • ADULT -  30:2           • CHILDREN - 30:2           • INFANT - 30:2  2 RESCUER :            • ADULT - 30:2           • CHILDREN - 15:2            • INFANT - 15:2

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##Important points for NORCET:-) *.Pulmonary Tuberculosis (PTB)* —low-gradeafternoon fever. *. *Pneumonia* —rust-colored sputum. *.Asthma*—wheezing on expiration. *.Emphysema*—barrel chest. *.Kawasaki Syndrome*—strawberry tongue. *.Pernicious Anemia*—red beefy tongue. *.Down syndrome*—protruding tongue. *.Cholera*—rice-watery stool and washer woman’s hands (wrinkled hands from dehydration). *.Malaria*—stepladder like fever with chills. *.Typhoid*—rose spots in the abdomen. *.Dengue*—fever,rash, and headache. Positive Herman’s sign. *.Diphtheria*—pseudomembrane formation. *.Measles*—Koplik’s spots (clustered white lesions on buccal mucosa). *.Systemic Lupus Erythematosus*—butterfly rash. *.Leprosy*—leonine facies (thickened folded facial skin). *.Bulimia*—chipmunk facies (parotid gland swelling). *.Appendicitis*—rebound tenderness at McBurney’s point. Rovsing’s sign (palpation of LLQ elicits pain in RLQ). Psoas sign (pain from flexing the thigh to the hip). *.Meningitis*—Kernig’s sign (stiffness of hamstrings causing inability to straighten the leg when the hip is flexed to 90 degrees), Brudzinski’s sign (forced flexion of the neck elicits a reflex flexion of the hips). *.Tetany*—hypocalcemia, [+] Trousseau’s sign; Chvostek sign. *.Tetanus*— Risus sardonicus or rictus grin. *.Pancreatitis*—Cullen’s sign (ecchymosis of the umbilicus), Grey Turner’s sign (bruising of the flank). *.Pyloric Stenosis*—olive like mass. *.Patent Ductus Arteriosus*—washing machine-like murmur. *.Addison’s disease*—bronzelike skin pigmentation. *.Cushing’s syndrome*—moon face appearance and buffalo hump. *.Grave’s Disease (Hyperthyroidism)*—Exophthalmos(bulging of the eye out of the orbit). *.Intussusception—Sausage*-shaped mass. *.Multiple Sclerosis*—Charcot’s Triad: nystagmus, intention tremor, and dysarthria. *.Myasthenia Gravis*—descending muscle weakness, ptosis (drooping of eyelids). *.Guillain-Barre Syndrome*—ascending muscles weakness. *.Deep vein thrombosis (DVT)*—Homan’s Sign. *.Angina*—crushing, stabbing pain relieved by NTG. *.Myocardial Infarction (MI)*—crushing, stabbing pain radiating to left shoulder, neck, and arms. Unrelieved by NTG. *.Parkinson’s disease*—pill-rolling tremors. *.Cytomegalovirus (CMV) infection*—Owl’seye appearance of cells (huge nucleus in cells). *.Glaucoma*—tunnel vision. *.Retinal Detachment*—flashes of light, shadow with curtain across vision. *.Basilar Skull Fracture*—Raccoon eyes (periorbital ecchymosis) and Battle’s sign (mastoid ecchymosis). *.Buerger’s Disease*—intermittent claudication (pain at buttocks or legs from poor circulation resulting in impaired walking). *.Diabetic Ketoacidosis*—acetone breathe. *.Pregnancy Induced Hypertension (PIH)*—proteinuria, hypertension, edema. *.Diabetes Mellitus*—polydipsia, polyphagia, polyuria. *.Gastroesophageal Reflux Disease (GERD)*—heartburn. *.Hirschsprung’s Disease (Toxic Megacolon)*—ribbon-like stool. *.Sexual Transmitted Infections:* *.Herpes Simplex Type Il*—painful vesicles on genitalia *.Genital Warts*—warts 1-2 mm in diameter. *.Syphilis*—painless chancres. *.Chancroid*—painful chancres. *.Gonorrhea*—green, creamy discharges and painful urination. *.Chlamydia*—milky discharge and painful urination. *.Candidiasis*—white cheesy odorless vaginal discharges. *.Trichomoniasis*—yellow, itchy, frothy, and foul-smelling vaginal discharges.