DESCRIPTION:-
A clean, fresh, comfortable, bed is very important for people who have to spend time in Bed during their illness. A comfortable Bed uplifts one mentally, provides physical relaxation and may prevent serious complications.
HOSPITAL BEDS:-
The four general types of beds are used in patient care units. These are
a. Standard beds:- These are hospital bed made of metal. These are easy to handle, clean, strong, durable and simple in design. It is 200 cm long, 100 cm wide and 75 cm high from the floor.
b. Manual bed:- It requires the use of hand cranks or foot pedals to manipulate the bed into desired positions .Cranks are elevate the head and foot end of the bed . Foot Pedals are used to raise the height of the bed from the floor. Manual beds are generally less expensive in comparison to hydraulic and electric beds.
c. Hydraulic beds: – It functions through the use of compressed air fed to the system. Manual operation of the bed is also possible through the use of foot pedals.
d. Electric beds: – It is having Electric motors .An advantage of this bed is the patient can control the positions.
TYPES OF BEDS:-
Unoccupied beds: – The patient is out of bed while it is being made.
Closed bed or Empty bed:- A bed is not being used by bathe patient. The linen is left to cover the bed.
Open bed: – A bed which is about to be occupied by the patient
Admission bed: – A bed just like an open bed. A long mackintosh and bath blanket is put over the open bed for giving the bath to patient.
Occupied bed:- The patient remains in the bed.
Surgical bed:- After the Anesthesia.
Orthopedic bed:- For orthopedic patient.
Renal bed: – A bed for the renal patient.
Cardiac bed:- For the heart patient.
OBJECTIVES:-
To provide a clean and comfortable to the patient.
To avoid patient exertion by making bed.
To eliminate irritants to skin.
To dispose of soiled linens properly.
To provide a unit or ward neat appearance.

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.

DEFINITION:
A stroke, or cerebrovascular accident (CVA), is the rapid loss of brain function due to disturbance in the blood supply to the brain. This can be due to ischemia (lack of blood flow) caused by blockage (thrombosis, embolism, spasm), or a hemorrhage.
As a result, the affected area of the brain cannot function, which might result in an inability to move one or more limbs on one side of the body, inability to understand or formulate speech, or an inability to see one side of the visual field.
CAUSES OF STROKE: A stroke usually caused by-
1. Thrombosis :- Thrombosis is the most common cause of stroke and is usually due to atherosclerosis.
2. Embolism :- The occlusion of a cerebral artery by an embolus cause an embolic stroke. An embolus forms outside the brain which travals through the cerebral circulation until it occludes a cerebral artery.
3. Ischemia :- Cerebral ischemia is occur when the blood supply to a part of the brain is interrupated or totally occluded.
4. Intra cerebral Hemorrhage :- Intracerebral Hemorrhage results from the rupture of a cerebral vessel which causes bleeding into brain tissue.
5. Spasm :- Cerebral arterial spasm, due to some irritation which reduces blood flow to the area of brain, supplied by the constricted vessel.

RISK FACTORS:
• Hypertension
• Cardiovascular disease
• Elevated hematocrit increase the risk of cerebral infarction
• Diabetes mellitus
• Smoking, Alcohol consumption
• Drug abuse
• Emotional stress

TYPES OF CVA/STROKE-
Stroke can be classified in to two major categories:
1. Ischemic stroke
2. Hemorrhagic stroke
3. Transient ischaemic attack

1. ISCHEMIC STROKE-An ischemic stroke or brain attack is a sudden loss of function due to inadequate blood flow to the brain from partial or complete occlusion of an artery.
2. HEMORRHAGIC STROKE:Hemorrhagic stroke account for about 15% of all strokes and In this Bleeding is occurs into the brain tissue (intra-cerebral hemorrhage) or the subarachnoid space (subarachnoid hemorrhage).
3. TRANSIENT ISCHAEMIC ATTACK:-It is a sign that part of the brain is not getting enough blood, and there is a risk of a more serious stroke in future. As with major strokes, you must seek medical attention immediately

SIGN AND SYMPTOMS:
 Confusion or changes in the mental status.
 Loss of balance or coordination
 Motor loss or dysfunction
 Memory and judgement may be impaired
 Visual disturbances
 Decreased tolerance to stressful situation
 Numbness and tingling of extremity
DIAGNOSTIC EVALUATION:
 Brain CT scan – to determine cause and location of stroke.
 MRI, EEG
 Cerebral angiography
 CSF analysis
COMLICATION:
• Brain injury
• Paralysis
• Dysphagia
• Deep vein thrombus
• Pneumonia
• Muscular spasticity

DEFINITION: Ulcerative Colitis is the inflammation that affects the lining of the large intestine.
CAUSES: – Genetic factor
– Auto immune disorder
– Environmental factor
– Diet & breast feeding
PATHOPHYSIOLOGY: ulcerative colitis affects the superficial mucosa of the colon
It becomes edematous and inflamed
The disease process usually begin in rectum
The bowel narrow, shortness and thicker
Obstruction, perforation and bleeding
Ulcerative Colitis
SIGNS AND SYMPTOMS:
• Abdominal pain, nausea, vomiting, and fever
• Rectal Bleeding
• Eye Lesions
• Anorexia
• Anemia
• Dehydration
• Weight Loss

DIAGNOSIS:
Blood test
Imaging
• Ultrasound
• Computed tomography
• Magnetic resonance imaging
• X–Ray
• Endoscopy
• Colonoscopy
MANAGEMENT:
Medical management:
Medication are dependent on severity, disease location and complication.
1. Sedative Drugs
2. Anti- Diarrheal
3. Antibiotics
4. Corticosteroids
5. Immunodulators
Nutritional Therapy: Suggest about oral fluid, high protein diet with supplement vitamin therapy and iron replacement.
Control Pain and Diarrhea
Avoid cold foods and smoking.
Surgical management:
1. Total Colectomy with ileostomy:
The surgical creation of an opening into the ileum or small intestine allowed drainage of fecal matter from the ileum to the outside of body.
2. Total Colostomy with continent ileostomy:
The removal of entire colon this procedure eleminance the need and external fecal collection bag.
3. Total Colostomy with ileonal anastomosis:
The total colostomy with ileonal anastomosis
Nursing Management:
Patient in community settings or those recently diagnosed may primarily require education about diet, medication and referral to support group.
For Hospitalized Patients:
1. Parental Nutrition
2. Fluid Replacement
3. Physical care
4. Psychological Support
Nursing Diagnosis:
1. Diarrhea related to inflammation process.
2. Acute pain related to increased peristalsis and gastro-intestinal inflammation.
3. Fluid Volume Deficit related to anorexia, nausea and diarrhea.
4. Imbalanced Nutrition less than body requirement related to dietary restrictions.
5. Impaired Skin Integrity related to malnutrition.
6. Activity intolerance related to fatigue.
7. Knowledge deficit related to disease conditions.

Description
Normally, an egg and sperm are fertilized inside a woman’s uterus. If the fertilized egg attaches to the lining of the uterus and continues to grow, a baby is born about 9 months later. This process is called natural or unassisted conception.
IVF is a form of Assisted Reproductive Technology (ART). This means special medical techniques are used to help a woman become pregnant.

There are five basic steps to IVF:
Step 1: Stimulation, also called super ovulation
• Medicines, called fertility drugs, are given to the woman to boost egg production.

Step 2: Egg retrieval
• A surgery, called follicular aspiration, is done to remove the eggs from the woman’s body.
• The health care provider inserts a thin needle through the vagina and into the ovary and sacs (follicles) containing the eggs. The needle is connected to a suction device, which pulls the eggs and fluid out of each follicle, one at a time.
• The procedure is repeated for the other ovary.
Step 3: Insemination and Fertilization
• The man’s sperm is placed together with the best quality eggs. The mixing of the sperm and egg is called insemination.
• Eggs and sperm are then stored in an environmentally controlled chamber. The sperm most often enters (fertilizes) an egg a few hours after insemination.
Step 4: Embryo culture
• When the fertilized egg divides, it becomes an embryo. Laboratory staff will regularly check the embryo to make sure it is growing properly.
Step 5: Embryo transfer
• Embryos are placed into the woman’s womb 3 – 5 days after egg retrieval and fertilization.
• The procedure is done in the doctor’s office while the woman is awake. The doctor inserts a thin tube (catheter) containing the embryos into the woman’s vagina, through the cervix, and up into the womb. If an embryo sticks to (implants) in the lining of the womb and grows, pregnancy results.
• Unused embryos may be frozen and implanted or donated at a later date.

DEFINITION: Pancreatitis is the inflammation of pancreas.
TYPES: Pancreatitis is divided into two types:
• Acute
• Chronic
CAUSES: – Long term use of alcohol
-Bacterial or viral infection
-Auto immune problems
– Gall stones
– Injuries to the pancreas
PATHOPHYSIOLOGY:
Due to the above causes
Self digestion of pancreas by its own proteolitic enzyme

Gall stone enter the common bile duct
Obstructing the flow of pancreatic juice
Activating the powerful enzyme within the pancreas
Leads to vasodilatation, increased vascular permeability, necrosis, erosion Pancreatitis

SIGNS AND SYMPTOMS:
• Abdominal pain, nausea, vomiting, and fever
• Diaphoresis
• Hypotension
• Cyanosis
• Weight loss
• Tachycardia
• Hyperglycemia
• Respiratory distress

DIAGNOSIS:
Blood
Imaging
• Ultrasound
• Computed tomography
• Magnetic resonance imaging
• X–Ray
ERCP(Endoscopic retrograde choliangio pancreatography)

MANAGEMENT:
An acute attack of pancreatitis usually lasts a few days. An acute attack of pancreatitis caused by gallstones may require removal of the gallbladder or surgery of the bile duct. After the gallstones are removed and the inflammation goes away, the pancreas usually returns to normal.

Treatment for chronic pancreatitis
Chronic pancreatitis can be difficult to treat. Doctors will try to relieve the patient’s pain and improve the nutrition problems. Patients are generally given pancreatic enzymes and may need insulin. A low-fat diet may also help.
Surgery may be done in some cases to help relieve abdominal pain, restore drainage of pancreatic enzymes or hormones, treat chronic pancreatitis caused by blockage of the pancreatic duct, or reduce the frequency of attacks.
Patients must stop smoking and drinking alcoholic beverages, follow their doctor’s and dietitians dietary advice.
Maintain fluid volume and prevent renal failure.

COMPLICATIONS
Early complications include shock, infection, systemic inflammatory response syndrome, low blood calcium, high blood glucose, and dehydration. Blood loss, dehydration, and fluid leaking into the abdominal cavity (ascites) can lead to kidney failure. Respiratory complications are often severe. Pleural effusion is usually present. Shallow breathing from pain can lead to lung collapse.

INTRODUCTION:- snoring is the vibration of respiratory structure and the resulting sound, due to obstructed air movement during breathing while sleeping. In some cases the sound may be loud and unpleasant. Snoring during sleep may be a sign, or first alarm of obstructive sleep apnea (OSA). Researchers say that snoring is a factor of sleep deprivation
CAUSES:- Generally speaking the structures involved are the uvule and soft palate. The irregular airflow is caused by a passageway blockage and is usually due to the following:-
 Throat weakness, causing the throat to close during sleep.
 Mispositioned jaw, often caused by tension in the muscles.
 Fat gathering in and around the throat.
 Obstruction in the nasal passageway.
 Obstructive sleep apnea.
 The tissues at the top of airway touching each other, causing vibration.
 Relaxants such as alcohol or other drugs relaxing throat muscles.
 Sleeping on one’s back, which may result in the tongue dropping to the back of the mouth

IMPACT:- Snoring is known to cause sleep deprivation to snore and those around them, as well as daytime drowsiness, irritability, lack of focus and decreased libido. It can cause significant psychological and social damage to sufferers. Multiple studies reveal a positive correlation between loud snoring and risk of heart attack (about +34% chance) and stroke (about + 67% chance)
PREVALENCE:- Statistics on snoring are often contradictory, but at least 30% of adults and perhaps as many as 50% of people in some demographics snore. One survey of 5713 American residence identified habitual snoring in 24% of men and 13.8% of women. This suggests an increased susceptibility to snoring as age increase.

TREATMENT:- Almost all treatment for snoring revolve are as following :-
 Clearing the blockage in the breathing passage.
 Advised to lose weight (to stop fat from pressing on the throat)
 Stop smoking ( smoking weakens and clogs the throat)
 Sleep on their side (to prevent the tongue from blocking the throat)
OTHER TREATMENT:- Nasal sprays, Nasal strips or Nasal clips, lubricating sprays, oral appliances and “ANTI-SNORE” clothing and pillow, to such unusual activities as playing the didgeridoo.

Description:- What is mental health? Describe components, criteria, indicators and characteristics of mental health.

It is a state of balance between the individual and the surrounding world, a state of harmony between oneself and others ,co-existence between the realities of the self and that of other people and the environment.
Definitions:- Karl Menninger defines mental health as an adjustment of human beings to the world and to each other with a maximum of effectiveness and happiness.
Components :-
1. The Ability to accept self:- A mentally healthy individual feels comfortable about himself.
2. The capacity to feel right towards others:-An individual who enjoys good mental health is able to be sincerely interested in others welfare.
3. The ability to fulfill life task:- The third important component of mental health is bestows on an individuals the ability to meet the demand of life.

Criteria:-
a. Adequate contact with reality
b. Control o9f thought and imagination
c. Efficiency in work and play
d. Social acceptance
e. Positively self concept
f. A healthy emotional life
INDICATORS:-
1. A positive attitude towards self
2. Growth, deve4lopment and the ability for self actualization
3. Integration
4. Autonomy
5. Perception of reality
6. Environmental mastery
CHARACTERISTICS:-
a. He has an ability to make an adjustment
b. He has a sense of personal wealth
c. He solves his problems largely by his own efforts
d. He has a sense of responsibility
e. He can give and accept love
f. He lives in world of reality rather than fantasy
g. He shows emotional maturity in his behavior
h. He has developed a philosophy of life that gives meaning and purpose to his daily activities
i. He has a variety of interest and generally lives a well balanced life of work, rest and recreation

INTRODCATION:-The umbilical cord or Funnies extend from the fetus to the placenta & transmit the umbilical cord vessels which are two arteries & one vein. These are enclosed& protected by gelatinous substance which known as Wharton’ Jelly which form from the mesoderm.
Structure of umbilical cord:-
(1) Covering Epithelium:- It is lined by a single layer of amniotic membrane or amniotic epithelium.
(2) Wharton s jelly :-It consist of elongated cells in a gelatinous substance , it has got protected function to the umbilical cord .
(3) Blood vessels :- Initially there are four vessels–Two veins
–Two arteries
The arteries are derived from the internal iliac arteries of the fetus & carry the venous blood from the fetus to the placenta . The two umbilical veins, the right one is disapper by the four month of pregnancy. Leaving behind one vein which carries blood from the placenta to the fetus .
Characteristics:- It is about 50 cm in length with an usual variation 30-100 cm with variation of 1-2.5 cm . It shows a spiral twist from the left & right from as early as 12 weeks due to spiral turn taken by the vessels , vein around the arteries.
Anatomical variations of the umbilical cord:-
(1) Succenturiate lobe of placenta:- A small extra lobe is present , separate from the main placenta & join to it by blood vessels that run through the membrane to reach it. The danger is that this small lobe may be retain in uterus after the placenta is delivered or born . If it is not remove , it may leave to infection & hemorrhage. The nurse must examine every placenta for identify of a retain lobe of placenta in uterus.
(2) Circumvallates placenta
(3) Battledore insertion of the cord
(4) Velamentius insertion of the cord
(5) Bipartile placenta
(6) Tripartile placenta

Definition:- An Anal fissure or Rectal Fissure is a break or tear in the skin of the anal canal
Description:- Anal fissures may be noticed by bright red anal bleeding on toilet paper, sometimes in the toilet. If acute they may cause pain after defecation but with chronic fissures pain intensity is often less. Anal fissures usually extend from the anal opening and are usually located posteriorly in the relatively unsupported nature and poor perfusion of the anal wall in that location. Fissure depth may be superficial or sometimes down to the underlying sphinter muscle.
Causes :-
 Most anal fissures are caused by STRETCHING of the mucosa beyond its capability
 The most common cause of non healing is spamming of the internal anal sphincter of the internal anal sphincter muscle which results in impaired blood supply to the anal mucosa.
 Other common causes of anal fissures include; Childbirth trauma in women Crohn’s Disease Ulcerative Colitis
Epidemiology:- The incidence of anal fissure is around 1 in 350 adults. They occur equally commonly in men and women and most often occur in adults aged 15 to 40
Prevention:- For Adults;
 Avoiding straining when defecation,
 Careful anal hygiene after defection,
 In case of pre-existing or suspected fissure, use of a lubricating ointment,
 In infants, frequent diaper change can prevent anal fissure
Treatment:- Non- surgical treatment are recommended initially for acute and choric anal fissures. These include topical Nitroglycerin or calcium channel blockers or injection of Butulinum toxin into the anal sphincter
Other measures include warm Sitz baths, topical anesthetics, high fiber diet and stool softerners
Medication:-
 Local application of medication to relax the sphincter muscle, thus allowing the healing to proceed, with Nitroglycerine ointment
 Calcium channel blocker with Nifedipine ointment
 A combined surgical and pharmacological treatment, administered by colorectal surgeons, is direct injection of Botulinum toxin(Botox) into the anal sphincter to relax it.
Surgery:-
1) Lateral internal sphincterotomy
2) Anal dilation
3) Stretching