Description:
INTRODUCTION-It is a coronargry heart disease may lead to development of heart failure. Heart failure is not a disease but group of manifestation inwhich inadequate pump performance of heart that leads to pulmonary & systemic congestion.
Definition-Heart failure is a physiological state inwhich the heart can not pump enough blood to meet the metabolic demand of the body. It is also known as heart failure.
Etiology-
1. Abnormal loading condition
– Hypervolemia
-Congenital heart disease
-Pulmonary hypertension
– Valvular stenosis [Narrowing of valve]
– Valvular regurgitation [In complete closure of valve]
– Valvular prolapse [Protrusion of valvular leaflet into the atrium]
2.Malfuncton of myocardium-
– coronary artery disease
– cardiomyopathy [Abnormality of myocardium muscles]
– Pericarditis
– Myocarditis
– Endocarditis
3. Condition which precipitate heart failure –
– Pregnancy
– Anemia
– Hypertension
– Renal disease
– Smoking, tobacoo, & alcohol
– Excess administration of fluid
– High intake sodium
PATHOPHYSIOLOGY
Due to etiological factor

Left ventricular hypertrophy

Ventricular hypertrophy leads to increase muscles fibers diameter

Increase contractile function of cardiac muscle fibers

Increase heart work load

When heart fail then compensatory mechanism of heart is do act (States)

If it is fail then Increase residual volume of left ventricles.

Receiving capacity of heart

Pulmonary edema

Pressure Increase on right ventricles

Right ventricles fail

Systemic congestion
Clinical manifestation:-
(1) RHF/RVF:-
• Oedema of ankle, knee & extremities
• Juglar vein distension
• Weight gain
• Hepatomegaly
• Spleeno megaly
• Ascites(Bowel sound absent)
• A, N, V & constipation
(2) LHF/LVF:-
• Dyspnoea
• Pulmonary oedema
• Crackle sound in lungs
• Coughing
• Wheezing
• Tachypnoea
• Cyanosis
• Paroxysmal nocturnal dyspnoea
Diagnostic Measures:-
• History taking
• Physical examination
• E.C.G (QRS-Large)
• Echo cardiography( Hypertrophy & dilataion Ejection Fraction)
• X-ray, USG, Lipid profile,CBC, BNP,CT-Scan, MRI
Treatement:-
• Digitalis/Digoxin/cardiac glucosides
Action:- Increase the force of myocardial contraction, increase cardiac output.
• Diuretics:- ex. Furosemide, thiazide
• Angiotensin coverting enzyme inhibitors ex. Captopril, Analapril

Surgical Management:– Heart transplantation

INTRODUCTION
Lactation is a complex physiologic process under neuroendocrine control. It is the biologic completion of the reproductive cycle. Starting at about 16 week’s gestation the breasts develop and prepare for full lactation. In the first few postpartal hours and days the breast respond to hormones and the stimulation of the infants suck to produce and release milk.
PHYSIOLOGY OF LACTATION
The physiological basis of lactation is divided into four phases:
Mammogenesis or preparation of breasts
Lactogenesis or initiation of milk sectetion
Galactokinesis or ejection of milk and
Galectopoiesis or maintenance of established milk secretion.
MAMMOGENESIS
Pregnancy is associated with a remarkable growth of both buctal and lobulo-alveolar system. During lactation the breast tissue is characterized by large numbers of alveoli. After lactation when, milk is no longer removed from the breast by the infant the alveoli gradually collapse and adipose tissue increases.
LACTOGENESIS
Complex nervous and endocrine factors are involved in the establishment of milk production in the first 2 to 5 days postpartum. Child birth results in a rapid decrease in oestrogen and progestron and an increase in prolactin secretion. Prolactin from the pituitary gland triggers milk production by stimulating the alveolar cells of the breast. Prolactin levels increase in responsible to tactile stimulation of the breast and sucking by the infant.
GALACTOKINESIS
Discharge of milk from mammary glands depends not only on the suction exerted by the baby during sucking, but also on the contractile mechanism which expresses the milk from the alveoli into the ducts. The milk ejection is inhibited by factors such as pain, breast engorgement or adverse psychic condition.
GALECTOPOIESIS
Prolactin is the most important galactopoietics – hormone. For maintenance of effective and continuous lactation, suckling is essential as it causes release of porlactin. Milk pressure reduces the rate of production and hence periodic breast feeding is necessary to relieve the pressure which in term maintains the secretion.

Percentage Composition of colostrums and breast milk
PROTEIN FAT CARBOHYDRATES WATER
COLOSTRUM 8.6 2.3 3.2 86
BREAST MIKL 1.2 3.2 7.5 87

INTRODUCTION
Amniocentesis is a prenatal test that allows healthcare practitioner to gather information about baby’s health from a sample of amniotic fluid. This is the fluid that surrounds baby in the uterus.
The most common reason to have an “amnio” is to determine whether a baby has certain genetic disorders or a chromosomal abnormality, such as Down syndrome.
Amniocentesis is usually done when a woman is between 14 and 16 weeks pregnant. The test is invasive and carries a small risk of miscarriage.

PROCEDURE

Amniocentesis.
Before the start of the procedure, a local anesthetic can be given to the mother in order to relieve the pain felt during the insertion of the needle used to withdraw the fluid. After the local anesthetic is in effect, a needle is usually inserted through the mother’s abdominal wall, then through the wall of the uterus, and finally into the amniotic sac. With the aid of ultrasound-guidance, a physician punctures the sac in an area away from the fetus and extracts approximately 20ml of amniotic fluid. If used for prenatal genetic diagnosis, fetal cells are separated from the extracted sample. The cells are grown in a culture medium, then fixed and stained. Under a microscope the chromosomes are examined for abnormalities. The most common abnormalities detected are Down syndrome (trisomy 21), Edwards syndrome (trisomy 18), and Turner syndrome (monosomy X). In regard to the fetus, the puncture seals and the amniotic sac replenishes the liquid over the next 24–48 hours.
INDICATIONS AND RESULT
Genetic diagnosis
Early in pregnancy, amniocentesis is used for diagnosis of chromosomal and other fetal problems such as:
• Down syndrome (trisomy 21)
• Trisomy 13
• Trisomy 18
• Fragile X
• Rare, inherited metabolic disorders
• Neural tube defects (anencephaly and spina bifida) by alpha-fetoprotein levels.
Lung maturity
Amniocentesis can predict fetal lung maturity, which is inversely correlated to the risk of infant respiratory distress syndrome.
Other
Amniocentesis can also be used to detect problems such as:
• Infection, in which amniocentesis can detect a decreased glucose level, a Gram stain showing bacteria or an abnormal differential count of white blood cells.[6]
• Rh incompatibility
• Decompression of polyhydramnios

DEFINITION
It is a non – progressive neuro-muscular disorder of cerebral origin it is a condition manifested by impaired muscle co-ordination.
CAUSES
Disorder development of brain structure
Brain trauma
Metabolic disturbance like Hypoglycemia
RISK FACTOR1]
PRENATAL FACTOR—
Metabolic disease, maternal exposure to radiation, genetic disorder, maternal bleeding etc.
2] PERINATAL FACTOR—
Immaturity at birth, trauma at birth time, anesthesia at labour etc.
3] POSTNATAL FACTOR—
Intracranial injury infeaction such as meningitis and encephalitis.
1] Spastro cerebral palsy- Most common type in this cortical pyromidial.
Cell’s of brain involved symptoms are-
Abnormal limb position
Hemiplegia ,increase starch reflex
Paraplegia
Lack of normal position
2] Dyskinetic cerebral palsy-[Athetosis]
In this type , basal ganglion and corpus stratum are involved symptoms are-
Warm like movement
Difficulty in speaking
Deafness
3] Ataxia palsy-
in this cerebellum is involved,failure of muscle coordination, irregular
moments
4] Mixed type—
There is a combination of spastro and dyskinetic palsy . mixed condition
in which regular slow and twisting moment occur in extremity specially in hand and figure
DIAGNOSTIC EVALUATION
Physical examination [neuro developmental examination]
E N G [Myography]
Vision test
Hearing test
Assessment of learning and language ability
PREVENTION—
Prevention of maternal and foetal infaction
Good maternal care
Early diagnosis and adequate management to prevent neural defact.
Adequate newborn care, prevention of brain damage
MANAGEMENT—
Management plan should involve family and newborn and based
Type of defact and other problems .
Treatment should given according to physician and therapist , occupational therapy in this provide for feeding dressing and other activities.
Education therapy in this stress should given on type of defact such as vision defact , learning capacity of child and other experience according to age.
Social support , family should given support to help and live with child.

Orthopedic support [light weight splint]
Symptomatic treatment should provide by physician

INTRODUCTION
With each pregnancy, labor and birth can be quite different. Some women follow the typical course of labor, while others may experience delays in labor or find it necessary to induce. Still, others experience rapid labor
DEFINITION:
Precipitate labour refers to a labour pattern that progresses rapidly and ends with delivery occurring in less than 3 hours after the onset of uterine activity.
CONTRIBUTOR FACTORS
• Maternal multiparous status.
• Small foetus
• Relaxed pelvic and vaginal musculature
• History of rapid labours with previous deliveries
RISKS OF PRECIPITATE LABOUR AND DELIVERY
• Delivery out of asepsis
• Maternal soft tissue injuries
• Foetal injuries from rapid explusion at delivery
MANAGEMENT
 Readiness of the health care team for delivery, when the client has a history of rapid labour.
 Medical induction of labour to ensure a hospital delivery and to increase the likelihood for a controlled delivery that minimizes the potential for maternal and foetal injuries.
NURSING CARE
Important nursing interventions include:
 Continuous assessment of maternal and foetal status
 Communicating to physician any change in status, maternal or foetal intolerance or signs of impending problems.
 Teaching and reinforcing relaxation techniques
 Administering tocolytic medications as ordered
 Side-lying position to enhance placental blood flow and to reduce the effects of aortocaval compression
 Oxygen to the mother and adequate blood volume with non-additive intravenous fluids
 Care for the Infant.
 (1) The nurse should cradle the infant against his (the nurse’s) body with the infant’s head supported by the palm of his hand and the body supported by the forearm. This method allows the nurse a free hand.
 (2) The infant should be held with his head tilted downward to facilitate the drainage of mucus and fluid from the upper airway.
 (3) The infant should be held at or below the level of the uterus until the umbilical cord stops pulsating to prevent loss of neonatal blood to the placenta.

AFTER DELIVERY
 Assessing uterine fundus for atony
 Checking perineum for haematoma or laceration
 Assessing neonate for soft tissue injuries
 Monitoring vital signs to ensure stability

WHO has characterized telemedicine as “The conveyance of medicinal services administrations, where separation is a basic variable, by all social insurance experts utilizing data and correspondence innovations for the trading of legitimate data for conclusion, treatment and anticipation of sickness and wounds, examination and assessment, and for the proceeding with training of human services suppliers, all in light of a legitimate concern for propelling the soundness of people and their groups”.
Lifetime bulletin purported telemedicine “recuperating by wire”. In any case initially peaceful “advanced” and “trial,” telemedicine is at present an irrefutably. Telemedicine has a make of utilizations in spread be pulled in to, foundation, exploration, organization and general wellbeing
Telemedicine has the bent to association this separation and subvention social insurance in these remote ranges. The most convincing explanation behind the proposal of far reaching utilization of telemedicine is the unjust appropriation of qualified restorative professionals. 75% of specialists practice in urban ranges and 23% in semi-urban regions. The quantity of healing center beds accessible per 1000 populace is 2.2 in urban zones while it is just 0.19 in provincial regions (Report of the Technical Working Group on Telemedicine Standardization).
This speaks to the gross imbalance in the dissemination of social insurance administrations between the urban and rustic regions. To extend the gravity of the circumstance, all things considered, let us take the instance of Chennai. Chennai has no less than 20 clinics which can offer renal transplant while numerous urban communities don’t have even a solitary healing facility which can perform it. Chennai alone has a bigger number of neurosurgeons than the whole north-eastern states set up together.
As the doctor’s administrations are insufficiently accessible in rustic regions, the country occupants frequently need to rely on upon quacks, those are not qualified to analyze maladies or endorse pharmaceuticals.
Utilizing telemedicine is one of the best alternatives for conveyance of human services administrations in far off and remote regions. It is more sparing and financially savvy to connection remote and country places with an information transfers join than to physically send the specialists to these spots.

Description: – Diphtheria typically causes a sore throat, fever, swollen glands and weakness. But the hallmark sign is a sheet of thick, gray material covering the back of throat. This material can block windpipe so that struggle for breath
Today, Diphtheria is extremely rare in the United States and other developed countries to widespread vaccination against the disease.
Medication is available to treat diphtheria. However, in advance stages, diphtheria can cause damage to heart, kidneys and nervous system. Even with treatment, diphtheria can be deadly as many as 10% of people who get Diphtheria die of it
Cause: – The Bacterium CORYNEBACTERIUM DIPTHERIAE cause Diphtheria. Usually C. Diphtheria multiply on or near the surface of the mucous membranes of the throat. C. diphtheria spreads via 3 routes:
1) Airborne Droplets. When an infected person’s sneeze or cough releases a mist of contaminated droplets, people nearby may inhale C. Diphtheria.
2) Contaminated personal items. People occasionally catch diphtheria from handling an infected person’s used tissues, drinking from the person’s unwashed glass, or coming into similarly close contact with other items on which bacterial-laden secretion may be deposited.
3) Contaminated household items. In rare cases, diphtheria spreads on shared household items, such as towels or toys.
Signs and Symptoms :- signs and symptoms of Diphtheria may include:-
1) A sore throat and hoarseness
2) Swollen gland (enlarged lymph nodes) in neck
3) A thick gray membrane covering throat and tonsils
4) Difficulty breathing or rapid breathing
5) Nasal discharge
6) Fever and chills
7) Malaise

Remedies:-
1) Recovering from diphtheria requires lots of bed rest.
2) Avoiding any physical exertion is particularly important if heart has been affected.
3) Strict isolation while contagious also is important to prevent spread of the infection
Once recover from diphtheria, need a full course of diphtheria vaccine to prevent a recurrence.

DEFINITION: Appendicitis is the inflammation of appendix.
CAUSES: – Block by faeces
-Foregin object
-Tumor
– Intestinal worms
– Lymphadenitis
– Trauma
PATHOPHYSIOLOGY: Due to the above causes
Appendix become inflamed & edematous
Increase intraluminal pressure
Initiating progressive & severe pressure
Generalized upper abdominal pain
Inflamed appendix fill with pus
Appendicitis
SIGNS AND SYMPTOMS:
• Abdominal pain, nausea, vomiting, and fever
• Lower abdomen (rebound tenderness)
• Coughing causes point tenderness in this area (McBurney’s point)
• Anorexia
• Muscle spasm
DIAGNOSIS:
Blood and urine test
Imaging
• Ultrasound
• Computed tomography
• Magnetic resonance imaging
• X–Ray

MANAGEMENT:
Acute appendicitis is typically managed by surgery. However, in uncomplicated cases antibiotics are both effective and safe. While antibiotics are effective for treating uncomplicated appendicitis, 20% of people had a recurrence within a year and required eventual appendectomy
Pain
Pain medications (such as morphine) do not appear to affect the accuracy of the clinical diagnosis of appendicitis and therefore should be given early in the person’s care.

Laparoscopic appendectomy.
The surgical procedure for the removal of the appendix is called an appendicectomy. Appendectomy can be performed through open or laparoscopic surgery. Laparoscopic appendectomy has several advantages over open appendectomy as an intervention for acute appendicitis.
 Pre surgery
The treatment begins by keeping the person who will be having surgery from eating or drinking for a given period of time, usually overnight. An intravenous drip is used to hydrate the person who will be having surgery. Antibiotics given intravenously such as cefuroxime and metronidazole may be administered early to help kill bacteria and thus reduce the spread of infection in the abdomen and postoperative complications in the abdomen or wound. If the stomach is empty (no food in the past six hours) general anaesthesia is usually used. Otherwise, spinal anaesthesia may be used.
 Post surgery
• Place the patient in semi-fowler position.
• Start IV fluids
• Monitor carefully for signs of secondary haemorrhage
• Prevent infection at the surgical site

Description:-
To reduce the risk of transmission of micro-organism, mask, gown, caps, scarf, gloves, protective eye wear etc. are used. Along with these aids of infection control some basic techniques are also used. Always remember the Hand Washing is the single most method to reduce the spread of infection.
WHEN TO WASH HANDS:-
a. At the beginning of the work day.
b. Before and after providing any nursing Care.
c. Before assisting the patient for eating.
d. Before and after any invasive procedures.
OBJECTIVES:-
a. To prevent patient from noso-comial infection.
b. To prevent pathogenic microorganism from spreading through hands from patient to patient.
c. To provide patient care with non infected hands.
d. To provide spiritual and hygienic satisfaction.
EQUIPMENTS:-
a. Soap
b. Warm running water
c. Paper towel/Cloth towel
d. Nail Sticks or Nail Cleaner
PROCEDURES:-
1. Stand well away in front of sink:- A. Standing close to running water exposes the uniform to get wet. B.Outside and inside of the sink is considered as contaminated. C. If hands touch the sink during the procedures repeat the procedures.
2. Turn on water and adjust the flow of temperature:- a. Warm is more comfortable rather than the hot water, hot water may cause irritation to the hands.
3. Wet hand sand forearms with water, keep hands lower than elbow during washing:- a. Water should flow least to most contaminated area.
4. Apply Soap: – a. Soap and water cleanses skin.
5. Rub Palms and fingers together for 10 to 15 minutes: – a. to remove the dirt.
6. Pay more the places attention where microorganism can hide.
7. Repeat the steps for 4 to 7 times.
8. Dry hand thoroughly with dry cloth towel
9. Turn off water with foot or Knee pedals.
NURSE ALERT AND CONSIDERATION
a. Working area should be kept dry and clean during and after procedures
b. If hands are looking soiled proper time should be given to the patient.

Description:-
It is also called as helping relationship. Helping relationship is the foundation of nursing practice.
In such relationship nurse assumes the role of professional helper and comes to know the client as an individual who has health needs, human responses and pattern of living.
DIMENSIONS:-
a. Trust:- Unless client believe that a nurse wishes to care for their needs , a trusting relationship cannot develop honesty in sharing information with client and also builds trusts.
b. Empathy and sympathy:- Empathy is the ability to enter into the life of another. Sympathy is the expression of one’s own feelings about another prediction.
c. Caring:- Nurse show caring who they are and respecting them as individual.
d. Autonomy:- It is an ability to be self directed.
PHASES OF HELPING RELATIONSHIP:-
There are 4 phases under helping relationship:-
1. Preinteraction phase:- Before a first meetings with the a client nurse reviews information pertaining to the client. Such information includes the medical or nursing history, an entry in nurse’s notes of the medical record or discussion with another nurse who cared for the client.
2. Orientation phase: – The orientation phase begins when the nurse and client first meet. It includes:- Testing Building trust, Identifying problems and goals , clarifying roles, Forming contracts.
3. Working phase: – During the working phase of a helping relationship the nurse strives to meet goals set during the orientation phase. The relationship broadens and becomes more flexible as the nurse and clients are more willing to share feelings and discuss problems.
4. Termination phase: – The primary objectives at the end of the working phase helping relationship are termination in a planned and satisfying manner. Nurse can evaluate the condition of client. It also includes the separation in which the nurse plans time to allow the client to share concerns or fear.