Focus on Headache

Focus on Headache

Headache

* Probably the most common type of pain experienced by humans
* Majority of people have functional headaches
o Migraine or tension-type headaches
* Not all cranium tissues are sensitive to pain
* Pain-sensitive structures include venous sinuses, dura, cranial blood vessels, divisions of the trigeminal nerve, facial nerve, glossopharyngeal nerve, vagus nerve, and the first three cervical nerves
* Classification from the International Headache Society diagnostic criteria
* Primary classifications
o Tension-type
o Migraine
o Cluster


Tension-Type Headache

* Most common type
* Bilateral, band-like feeling of pressure around the head
* Constant, squeezing tightness
* Not aggravated by physical activity
* Usually mild or moderate
* Often subcategorized into
o Infrequent episodic
o Frequent episodic
o Chronic

Tension-Type Headache Etiology and Pathophysiology

* Mechanism in all patients with tension-type headaches has neurovascular factors similar to those involved in migraine headaches

Tension-Type Headache Clinical Manifestations
* No nausea or vomiting
* May involve sensitivity to light and sound
* May occur intermittently
* Can have combination of migraine and tension-type headaches
* Careful history taking
* Electromyography may be performed
o May reveal sustained contraction of neck, scalp, or facial muscles
o May not show increased tension even when test is done during headache

Tension-Type Headache Diagnostic Studies

Migraine Headache
* Recurring
* Characterized by unilateral or bilateral throbbing pain
* Triggering event or factor
* Strong family history
* Manifestations associated with neurologic and autoimmune nervous system function
* More common in females than males
* In United States, prevalence highest in those of lower socioeconomic status

Migraine Headache Etiology and Pathophysiology

* Evidence suggests vascular, muscular, and biochemical factors are involved
* Exact cause is unknown
* Can be preceded by an aura and prodrome
o May precede by days or hours
o Aura associated with wave of oligemia beginning at occipital lobe and spreading forward
* May be precipitated or triggered by
o Food
o Hormonal fluctuations
o Head trauma
o Physical exertion
o Fatigue
o Stress
o Pharmacologic agents

Migraine Headache Clinical Manifestations
Migraine Headache Diagnostic Studies
Cluster Headache Etiology and Pathophysiology
Cluster Headache Diagnostic Studies
Headache Other Types
Headache Collaborative Care
Headache Nursing Management

Focus on Headache.ppt
from South Texas College
(Relates to Chapter 59,“Nursing Management: Chronic Neurologic Problems,” in the textbook Copyright © 2007, 2004, 2000, Mosby, Inc., an affiliate of Elsevier Inc. All Rights Reserved. )

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Nutrition

Nutrition
Presentation lecture by:Amy C. Chavarria, RN, MSN, MBA, HCM, CCE

Dr.Chavarria described every vitamin / mineral in detail such as functions, sources, deficienties etc.
Essential Nutrients and Sources

* Water
* Carbohydrates
* Protein
* Fats
* Micronutrients
o Vitamins
o Minerals
Carbohydrates
Digestion, Absorption, and Metabolism: Carbohydrates

* Major enzymes include ptyalin (salivary amylase), pancreatic amylase, and the disaccharidases
* End products are monosaccharides
* Absorbed by the small intestine in healthy people
* Body breaks carbohydrates into glucose
o Maintain blood levels
o Provide a readily available source of energy

Proteins
Digestion, Absorption, and Metabolism: Protein

* Digestion begins in the mouth with enzyme pepsin
* Most protein digested in the small intestine
* Pancreas secretes the proteolytic enzymes trypsin, chymotrypsin, and carboxypeptidase
* Glands in intestinal wall secrete aminopeptidase and dipeptidase which break protein into amino acids
* Amino acids absorbed by active transport through small intestines
* Anabolism, catabolism, nitrogen balance

Lipids/Fats
Digestion, Absorption, and Metabolism: Lipids/Fats

* Digestion begins in the stomach, but mainly digested in the small intestine
* Digestion primarily by bile, pancreatic lipase, and enteric lipase
* End products of lipid digestion are glycerol, fatty acids, and cholesterol
* Reassembled inside the intestinal cells into triglycerides and cholesterol esters
Digestion, Absorption, and Metabolism: Lipids/Fats

* Small intestine and the liver convert these into soluble compounds called lipoprotein
* Converting fat into useable energy occurs through lipase that breaks down triglycerides in adipose cells releasing glycerol and fatty acids into the blood

Micronutrients
* Vitamins
* Minerals

VITAMIN A

FUNCTIONS: -maintenance of normal vision especially in dim light

* maintenance of healthy epithelium
* promotion of normal skeletal and teeth development
* promotion of cellular proliferation

SOURCES: liver, fish, liver oils, fortified milk and dairy products

DEFICIENCY/IES: Night blindness, Cessation of bone growth, Decreased mucous secretion of stomach and intestine, Dry eyes, scaly skin

VITAMIN D

FUNCTIONS: - intestinal absorption of calcium

* mobilization of calcium and phosphorus from bone
* renal absorption of calcium

SOURCES: exposure to sunlight

DEFICIENCY/CIES:
Rickets
Osteomalacia
Tetany

VITAMIN E FUNCTIONS: - antioxidant

* assists in maintaining the integrity of cellular membranes and protecting vitamin A from oxidation
SOURCES: vegetable oils, wheat germ, leafy vegetables, soybeans, corn, peanuts, margarine
DEFICIENCY/CIES: Rare-increase hemolysis of RBC
* poor reflexes

VITAMIN K

* Intake of this vitamin is needed in the liver for the formation of prothrombin & other clotting factors ----- ‘blood coagulation’

SOURCES: green leafy vegetables, cheese, egg yolk, liver
DEFICIENCY/CIES: Hemorrhage, Hemorrhagic Disease of the Newborn


VITAMIN B1 (THIAMINE)

FUNCTIONS: - aids in energy metabolism especially in carbohydrates metabolism

* provides normal nervous system functioning, normal appetite and digestion

SOURCES: pork, liver, organ meats, potatoes, eggs, nuts, legumes, milk, whole grains

DEFICIENCY/CIES: Beriberi – characterized by neurological, cerebral and cardiovascular abnormalities

S/S: anorexia, indigestion, constipation, apathy, fatigue, muscle weakness, cardiac failure – death may occur

VITAMIN B2 (RIBOFLAVIN)
FUNCTIONS: - aids in protein and carbohydrate metabolism and contributes to healthy skin and normal vision
SOURCES: milk and dairy products, organ meats, eggs, green leafy vegetables
DEFICIENCY/CIES: Cheilosis – cracking and fissures at the corners of the mouth
Dermatitis – inflammation of the skin evidenced by itching, redness, and various skin lesions
Photophobia – unusual intolerance to light

VITAMIN B3 (NIACIN)

FUNCTIONS: - involved in glycogen metabolism, tissue regeneration and fat synthesis
SOURCES: liver, fish, poultry, peanut butter, whole grains
DEFICIENCY/CIES: Pellagra – characterized by 4Ds: dermatitis, diarrhea, dementia, death, headache, weight loss and abdominal pain

VITAMIN B12 (CYANACOBALAMIN)
FUNCTIONS: - formation of RBC and synthesis of DNA and RNA
* maintenance of nervous tissue
* blood formation

SOURCES: liver, meats, milk, eggs, cheese, shrimp
DEFICIENCY/CIES: Pernicious Anemia – inadequate RBC formation due to lack of intrinsic factor from the stomach which is required for the absorption of Vitamin B12
S/S: numbness, confusion, depression, delusion, psychosis

FOLIC ACID (FOLACIN)
FUNCTIONS: co-enzyme of in protein metabolism and cell growth
* RBC formation
Note: Important in early pregnancy which is essential for spine and spinal cord development in the fetus
SOURCES: green leafy vegetables, liver, organ meats, eggs, milk
DEFICIENCY/CIES: Glossitis, Anemia, Birth Defects (Neural tube defects)

VITAMIN C FUNCTIONS: - antioxidant

* protects against infection
* promotes healing
* aids in absorption of iron

SOURCES: citrus fruits, green peppers, broccoli, cabbage
DEFICIENCY/CIES: Scurvy – characterized by small skin hemorrhages, sore gums
MINERALS

* are inorganic substances found in nearly all body tissues and fluids
* Help build body tissue and regulate metabolism

CALCIUM

* bone and teeth formation and maintenance
* conversion pf prothrombin to thrombin and other steps in coagulation process
* nerve impulse transmission
* contraction and relaxation of muscles
* regulation of materials in and out of cells

DEFICIENCY/CIES:
Rickets
Osteomalacia
Osteoporosis
IRON
* most iron in the body is found in hemoglobin – is the red pigmented, iron containing protein
* Hemoglobin- carries oxygen from the lungs to the tissues and helps transport CO2 to the lungs

DEFICIENCY/CIES: Iron deficiency anemia
SODIUM

* found primarily in the extracellular fluid in the body and as an ion, helps maintain the body’s fluid and acid–base balance
POTASSIUM

* is found primarily in intracellular fluid and functions as protein synthesis, fluid balance, regulation of muscle contraction

IODINE

* primarily located in the thyroid gland
* is a component of thyroid hormone
* regulates energy metabolism
* nervous and muscle cell functioning
* mental and physical growth
* DEFICIENCY/CIES: Goiter, Cretinism – characterized by muscle flabbiness, weakness, dry skin thick lips, skeletal retardation and severe mental retardation

A & P Review
Energy Balance
* Caloric value
* Basic Metabolic Rate (BMR)
* Resting Energy Expenditure (REE)

Healthy Body Weight
Nutrition assessment
Factors Influencing Nutrition
Developmental Nutritional Considerations
PREGNANCY & LACTATION
LACTATING MOTHER
Diets
Food Pyramids
Nutritional Screening and Assessment
NUTRITIONAL STATUS
Guide for BMI Evaluation
IDEAL BODY WEIGHT
APPROXIMATING IDEAL BODY WEIGHT
PHYSICAL STATUS
Malnutrition
Malnutrition Risk Factors
Nursing Interventions for Optimal Nutrition
Nursing Interventions
NANDA Nursing Diagnoses
Desired Outcomes
Planning and Evaluation
Enteric Tube Feeding
COMMUNITY RESOURCES
Happy eating!!

Nutrition.ppt

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Bioterrorism

Bioterrorism
Presentation lecture by:Amy C. Chavarria, RN, MSN, MBA, HCM, CCE

The Face of Bioterrorism
BIOTERRORISM
HISTORY OF BIOLOGICAL WARFARE

* 18th Century: Smallpox Blankets
* 20th Century:
o 1943: USA program launched
o 1953: Defensive program established
o 1969: Offensive program disbanded

BIOLOGICAL WARFARE AGREEMENTS

* 1925 Geneva Protocol
* 1972 Biological Weapons Convention
* 1975 Geneva Conventions Ratified

Bioterrorism: Who are 1st Responders?

* Primary Care Personnel
* Hospital ER Staff
* EMS Personnel
* Public Health Professionals
* Other Emergency Preparedness Personnel
* Laboratory Personnel
* Law Enforcement
* Firefighters

PUBLIC HEALTH

ISSUES

* Existing local, regional, and national surveillance systems
o Adequate to detect traditional agents
o Inadequate to detect potential biowarfare agents
* Specific training for health care professionals
o clinical personnel will be “first responders”
* Civilian biodefense plans are usually based on HAZMAT models
o Assumes responders enter a high exposure environment near the source
o Assumes site of exposure is separate from the health care facility
o Assumes no time pressure for decontamination
o Maximum protection is provided for a minimum number of workers / rescuers
* HAZMAT
o OSHA mandates use of PPE based on site hazard, but site hazards are more easily defined at the point of release
o Traditional HAZMAT products are expensive, take time to set up, and are inadequate for large numbers of patients
o Difficult to train and maintain proficiency in a civilian work force with high turnover

Key Problems

* Managing an outbreak
o The hard problem
* Investigating the attack if it is bioterrorism
o Does not require any special laws
o Demands effective public health infrastructure
* Preventing bioterrorism
o Laws on control of agents and personnel

Minimal Threat

* Limited and non-communicable
o Anthrax Letters
* Scary, but very small risk to a small number of people
* Gross Overreaction in Government Office Buildings
* Huge Costs dealing with copycats
* No special legal problems

Significant Threat, Not Destabilizing
* Broad and non-communicable
o Anthrax from a crop duster over a major city
* Could be managed with massive, immediate antibiotic administration and management of causalities
* Panic will quickly become the core problem

Significant Threat, Potentially Destabilizing
* Limited and communicable
o A few cases of smallpox in one place
* Demands fast action
* If it spreads it can undermine public order
* Probably controllable, but with significant vaccine related causalities

Imminent Threat of Governmental Destabilization

* Broad and communicable
o Multiple cases of smallpox, multiple locations
* Would demand complete shutdown on transportation
* Would quickly require military intervention
* Local vaccination plans are mostly unworkable

POTENTIAL BIOTERRORISM AGENTS

* Bacterial Agents
o Anthrax
o Brucellosis
o Cholera
o Plague, Pneumonic
o Tularemia
o Q Fever
Source: U.S. A.M.R.I.I.D.
* Viruses
o Smallpox
o VEE
o VHF-viral hemorrhagic fever
* Biological Toxins
o Botulinum
o Staph Entero-B
o Ricin
o T-2 Mycotoxins

CRITICAL BIOLOGICAL AGENTS
CATEGORY A

* High priority agents that pose a threat to national security because they:
o can be easily disseminated or transmitted person-to-person
o cause high mortality, with potential for major public health impact
o might cause panic and social disruption
o require special public health preparedness
* Variola major (smallpox)
* Bacillus anthracis (anthrax)
* Yersinia pestis (plague)
* Clostridium botulinum toxin (botulism)
* Francisella tularensis (tularemia)
* Filoviruses
o Ebola hemorrhagic fever
o Marburg hemorrhagic fever
* Arenaviruses
o Lassa (Lassa fever)
o Junin (Argentine hemorrhagic fever) and related viruses

CRITICAL BIOLOGICAL AGENTS CATEGORY B

* Second highest priority agents that include those that:
o are moderately easy to disseminate
o cause moderate morbidity and low mortality
o require specific enhancements of CDC’s diagnostic capacity and enhanced disease surveillance
* Coxiella burnetti (Q fever)
* Brucella species (brucellosis)
* Burkholderia mallei (glanders)
* Alphaviruses
o Venezuelan encephalomyelitis
o eastern / western equine encephalomyelitis
* Ricin toxin from Ricinus communis (castor bean)
* Epsilon toxin of Clostridium perfringens
* Staphylococcus enterotoxin B
* Subset of Category B agents that include pathogens that are food- or waterborne
* Salmonella species
* Shigella dysenteriae
* Escherichia coli O157:H7
* Vibrio cholerae
* Cryptosporidium parvum

CRITICAL BIOLOGICAL AGENTS CATEGORY C

* Third highest priority agents include emerging pathogens that could be engineered for mass dissemination in the future because of:
o availability
o ease of production and dissemination
o potential for high morbidity and mortality and major health impact
* Preparedness for Category C agents requires ongoing research to improve detection, diagnosis, treatment, and prevention
* Nipah virus
* Hantaviruses
* Tickborne hemorrhagic fever viruses
* Tickborne encephalitis viruses
* Yellow fever
* Multidrug-resistant tuberculosis

ADVANTAGES OF BIOLOGICS AS WEAPONS

* Infectious via aerosol
* Organisms fairly stable in environment
* Susceptible civilian populations
* High morbidity and mortality
* Person-to-person transmission (smallpox, plague, VHF)
* Difficult to diagnose and/or treat
* Previous development for BW
* Easy to obtain
* Inexpensive to produce
* Potential for dissemination over large geographic area
* Creates panic
* Can overwhelm medical services
* Perpetrators escape easily

BIOTERRORISM: HOW REAL IS THE THREAT?

Hoax vs. Actual BT Event
ANTHRAX BIOTERRORISM
ISSUES

* Existing local, regional, and national surveillance systems
o Adequate to detect traditional agents
o Inadequate to detect potential biowarfare agents
* Specific training for health care professionals
o clinical personnel will be “first responders”
* Civilian biodefense plans are usually based on HAZMAT models
o Assumes responders enter a high exposure environment near the source
o Assumes site of exposure is separate from the health care facility
o Assumes no time pressure for decontamination
o Maximum protection is provided for a minimum number of workers / rescuers

Threats reported to FBI Source: FBI personal communication

CHEMICAL & BIOLOGICAL TERRORISM
SALMONELLOSIS CAUSED BY INTENTIONAL CONTAMINATION
CLINICAL STATUS OF PATIENTS EXPOSED TO
SHIGELLOSIS CAUSED BY INTENTIONAL CONTAMINATION
FEDERAL AGENCIES INVOLVED IN BIOTERRORISM
COST OF BIOTERRORISM
AGENT TRANSMISSION
ROUTES OF INFECTION
* Skin
o Cuts
o Abrasions
o Mucosal membranes
* Gastrointestinal
o Food
+ Potentially significant route of delivery
+ Secondary to either purposeful or accidental exposure to aerosol
o Water
+ Capacity to affect large numbers of people
+ Dilution factor
+ Water treatment may be effective in removal of agents
* Respiratory
o Inhalation of spores, droplets & aerosols
o Aerosols most effective delivery method
o 1-5F droplet most effective

MEDICAL RESPONSE TO BIOTERRORISM
* Pre-exposure
o active immunization
o prophylaxis
o identification of threat/use
* Incubation period
o diagnosis
o active and passive immunization
o antimicrobial or supportive therapy
* Overt disease
o diagnosis
o treatment
+ may not be available
+ may overwhelm system
+ may be less effective
o direct patient care will predominate

PUBLIC HEALTH RESPONSE TO BIOTERRORISM
PRIORITIES FOR PUBLIC HEALTH PREPAREDNESS

* Emergency Preparedness and Response
* Enhance Surveillance and Epidemiology
* Enhance Laboratory Capacity
* Enhance Information Technology
* Stockpile

COMPONENTS OF PUBLIC HEALTH RESPONSE TO BIOTERRORISM

* * Detection - Health Surveillance
* * Rapid Laboratory Diagnosis
* * Epidemiologic Investigation
* * Implementation of Control Measures


LABORATORY RESPONSE NETWORK FOR BIOTERRORISM
CDC BT RAPID RESPONSE AND ADVANCED TECHNOLOGY LAB
BIOTERRORISM: What Can Be Done?

* Awareness
* Laboratory Preparedness
* Plan in place
* Individual & collective protection
* Detection & characterization
* Emergency response
* Measures to Protect the Public’s Health and Safety
* Treatment
* Safe practices

BIOTERRORISM AND THE PUBLIC HEALTH SECTOR
Bioterrorism Preparedness and Response Program
Centers for Disease Control and Prevention
Planning for Bioterrorism
Overt is the observable disease

Bioterrorism.ppt

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