Introduction:

Mental health 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 other people and the environment.

Definition:

According to Karl Menninger (1947):

“Mental Health is an adjustment of human beings to the world and to each other with a maximum of effectiveness and happiness.”

Thus, mental health would include not only the absence of Diagnostic labels such as schizophrenia and obsessive compulsive disorder (OCD) but also the ability to cope with the stress of daily living freedom from anxiety and generally an existence outlook towards and cope of with those.

Concept of Mental Health:

1. A positive attitude towards self: A positive attitude towards self includes an objective view of self including knowledge and acceptance of strength and limitations. The individual feels a strong sense of personal identity and security in the environment.
2. Growth, development and the ability of self actualization: Growth development and the ability for self actualization indicator correlates with each level of development.
3. Integration: It includes the ability to adaptively respond to the environment and the development of the philosophy of life, both of which help the individual to maintain anxiety in stressful situation.
4. Autonomy: It refers to the individual’s ability to perform in an independent self directed manner, the individual make choices and accepts responsibility for the outcomes.
5. Perception of reality: It includes perception of the environment without distortion as well as the cap3for empathy and social sensitivity.
6. Environmental mastery: Environmental mastery indicator suggests that the individual has achieved a satisfactory role within the group, society and environment. He is able to love and accept the love of others.

Characteristics of Mentally Healthy persons:

• He has ability to make adjustments.
• He has a sense of personal worth, feels worthwhile and important.
• He solves his problems largely by his own efforts and makes his own decisions.
• He has a sense of personal security and feels secure in a group.
• He shows emotional maturity in his behaviour.
• He has developed a philosophy of life that gives meaning and purpose to his daily activities.
• He develops a capacity to tolerate frustration and disappointment in his daily life.

Nursing Signs of Poor Mental Health:

Symptoms of mental disorders vary depending on the type and severity of the condition.

Some general symptoms that may suggest a mental disorder includes:

1. In younger children:

• Change in school performance
• Poor grades despair strong efforts
• Excessive worrying or anxiety
• Hyperactivity
• Persistent nightmares
• Persistent aggressive behavior
• Frequent tempor tantrums.

2. Adolescence/In older children:

• Abuse of drugs or alcohol
• In ability to cope with daily problems and activities
• Changes in sleeping and eating habits
• Excessive complaints of physical problems
• Skipping school, stealing or damaging property
• Intense fear of gaining weight
• Long lasting negative mood, often alog with poor aptitude and thought of death.
• Frequent outburst of anger.

3. In adults:

• Confused thinking, long lasting sadness or irritability
• Extreme high and low mood
• Excessive fear, worrying and anxiety
• Social withdrawal
• Changes in eating and sleeping habits
• Strong feelings of anger
• Delusion or hallucination
• Increasing inability to cope with daily problems and activities
• Thoughts of suicide
• Many explained physical problems
• Abuse of drugs or alcohol.

Definition: –
Encephalitis is defined as inflammation of the brain tissue. It means encephalitis is different from meningitis, which is defined as inflammation of the layers of tissue.

Causes: –
Encephalitis is most often caused by a viral infection. Exposure to viruses can occur through:
• Breathing in respiratory droplets from an infected person
• Contaminated food or drink
• Mosquito, tick, and other insect bites
• Skin contact
Routine vaccination has greatly reduced encephalitis due to some viruses, including – Measles, Mumps, Polio, Rabies, Rubella, Varicella (chickenpox)

Symptoms: –
Some people may have symptoms of a cold or stomach infection before encephalitis symptoms begin.
When this infection is not very severe, the symptoms may be similar to those of other illnesses:
• Fever that is not very high
• Mild headache
• Low energy and a poor appetite
Other symptoms include:
• Clumsiness, unsteady gait
• Confusion, disorientation
• Drowsiness
• Irritability or poor temper control
• Light sensitivity
• Stiff neck and back (sometimes)
• Vomiting
Investigations: –
• Brain MRI
• CT scan of the head
• Culture of cerebrospinal fluid (CSF), blood, or urine (however, this test is rarely useful)
• Electroencephalogram (EEG)
• Lumbar puncture and CSF examination
• Tests that detect antibodies to a virus (serology tests)
• Test that detects tiny amounts of virus DNA (polymerase chain reaction — PCR)
Treatment: –
The goals of treatment are to provide supportive care to help the body fight the infection, and to relieve symptoms.
Medications
• Antiviral medicines, if a virus caused the infection
• Antibiotics, if bacteria is the cause
• Anticonvulsive medicines to prevent seizures
• Steroids to reduce brain swelling
• Sedatives for touchiness or restlessness
Prevention: –
Children and adults should avoid contact with anyone who has encephalitis.
Scheming mosquitoes may reduce the chance of some infections that can lead to encephalitis.
• Apply an insect repellant contain the chemical, DEET when you go outside (but do not use DEET products on infants younger than 2 months).
• Take away any sources of standing water (such as old tires, cans, gutters, and wading pools).
• Wear long-sleeved shirts and pants when outside, particularly at dusk.

DEFINITION:
It is an inflammation of lining of brain and spinal cord by bacteria or virus and less commonly certain drugs.
CLASSIFICATION:
1. Bacterial Meningitis
2. Viral Meningitis
3. Fungal Meningitis
4. Non-infectious Meniningitis

CAUSES:
– Winter and spring season
– Tobacco use
– Upper respiratory infection
– Immune system deficiency
– Oititis media
SIGN AND SYMPTOMS:
Symptoms
Viral meningitis occurs more often than bacterial meningitis, and is milder. It usually occurs in the late summer and early fall. It most often affects children and adults under age 30.
Bacterial meningitis is an emergency. You will need immediate treatment in a hospital. Symptoms usually come on quickly, and may include:
• Fever and chills, especially in newborns and children
• Mental status changes
• Nausea and vomiting
• Sensitivity to light (photophobia)
• Severe headache
• Stiff neck
Other symptoms that can occur with this disease:
• Agitation
• Bulging fontanel’s in babies
• Decreased alertness
• Poor feeding or irritability in children
• Rapid breathing
• Unusual posture, with the head and neck arched backwards
DIAGNOSTIC EVALUATION:
1. Blood culture
2. MRI
3. CT-scan
4. CSF examination
– Cell count
– Glucose level
MEDICAL MANAGEMENT:
1. Antibiotics
Cephalosporin in combination with vancomycin.
2. Anticonvulscent
3. Corticosteroids
NURSING MANAGEMENT:
 Neurological status and vital signs assessed regularly.
 Taking blood pressure alternately
 Monitoring daily body weight , serum alkaline and urine volume specially if syndrome of inappropriate antidiuretics hormone
 Prevent complicated associated with immobility such as pressure and bed sore.
Prevention
Certain vaccines can help prevent some types of bacterial meningitis:
• Hemophilic vaccine given to children helps
• Pneumococcal vaccine is given to children and adults
• Meningococcal vaccines are given to children and adults; some communities hold vaccination campaigns after an outbreak of meningococcal meningitis.
Household members and others in close contact with people who have meningococcal meningitis should receive antibiotics to prevent becoming infected.

Definition:-
“Hyper emesis gravid arum is excessive nausea and vomiting during pregnancy. This pernicious vomiting is differentiated from the more common and normal morning sickness by the fact that it is of greater intensity and extends beyond the first semester.”
Causes:-
• High levels of HCG or undue sensitivity to normal levels of HCG may cause vomiting.
• Psychological factors- Women with a previous history of hyper emesis are likely to experience it in subsequent pregnancies.
• An allergic factor- It may also be operative, since large amounts of histamine are found in cases of hyper emesis.
Sign and Symptoms:-
• Pernicious vomiting.
• Poor appetite and poor nutritional intake.
• Loss of more than 25 percent of body weight.
• Acidosis due to starvation.
• Low urine output.
• Rapid pulse and low blood pressure.
• Hem concentration with rising blood urea nitrogen and falling sodium, potassium and chloride.
Complication:-.
• Debilitating, chronic nausea
• frequent vomiting of bile or blood
• Chronic ketosis and dehydration
• Muscle weakness and extreme fatigue
• Medication does not stop vomiting/nausea
• Inability to care for self (shower, prepare food)
• Loss of over 5-10% of your pre-pregnancy weight
• Weight loss (or little gain) after the first trimester

MANAGEMENT-
In some cases hyper emesis gravid arum is so severe that hospitalization may be required.
Hospital treatment may include some or all of the following:
• Intravenous fluids (IV) – to restore hydration, electrolytes, vitamins, and nutrients
• Tube feeding:
o Nasogastric – restores nutrients through a tube passing through the nose and to the stomach
o Percutaneous endoscopic gastrostomy – restores nutrients through a tube passing through the
Abdomen and to the stomach; requires a surgical procedure
• Medications – metoclopramide, antihistamines, and ant reflux medications.
Other treatments may include:
• Bed Rest –This may provide comfort, but be cautious and aware of the effects of muscle and weight loss due to too much bed rest.
• Acupressure
• Herbs – ginger or peppermint
• Homeopathic remedies are a non-toxic system of medicines. Do not try to self medicate with homeopathic methods; have a doctor prescribe the proper remedy and dose.
• Hypnosis

Definition:– A hospital for the care and treatment of patients affected with acute or chronic mental illness, Also called mental hospital.
Types of admission: Under the Mental Health and Welfare Law, there are various types of admission to hospital: voluntary admission; admission for medical care and protection; emergency admission; involuntary admission and emergency involuntary admission.

Voluntary admission: The patient is admitted of his or her own volition after a doctor at this hospital has decided that inpatient treatment is necessary. However, discharge within 72 hours can be restricted at the discretion of a designated mental health doctor.

Admission for medical care and protection: The patient is admitted even without their consent if a designated doctor regards their admission as necessary and the patient’s guardian consents. The following persons are classified as guardians under the Mental Health and Welfare Law.
1. If the patient has a legal guardian: the legal guardian
2. If the patient is a minor: the parents
3. If the patient has a spouse: the spouse
4. In the absence of any of the above: A guardian appointed by the family court who is aged 20 years or more and is the patient’s parent, child, sibling, grandparent, grandchild, or other relative (person with a duty to support the patient)
5. In the absence of 4. above: The mayor of the municipality where the patient resides

Emergency admission: The patient is admitted for up to 72 hours even without their consent or that of their guardian or person with a duty to support them, if a designated mental health doctor regards emergency admission as necessary

Involuntary admission: The patient is admitted on the authority of the governor if two designated mental health doctors ordered by the governor to examine the patient determine that the patient’s admission is necessary as a result of examination because of a risk of self-harm or hurting others.

Emergency involuntary admission: The patient is admitted for up to 72 hours on the authority of the governor as a result of examination by a single designated mental health doctor if a hospital cannot complete the official procedures for involuntary admission and speed is required.

Description:-
Burns and scalds are damage to the skin caused by heat. Both are treated in the same way.
A burn is caused by dry heat – by an iron or fire, for example. A scald is caused by something wet, such as hot water or steam.
Burns can be very painful and may cause:
• red or peeling skin
• swelling
• white or charred skin
The amount of pain you feel isn’t always related to how serious the burn is. Even a very serious burn may be relatively painless.
Types:-there are 5 types of burns:-
Most burns are minor injuries that occur at home or work. It is common to get a minor burn from hot water, a curling iron, or touching a hot stove. Home treatment is usually all that is needed for healing and to prevent other problems, such as infection.
There are many types of burns.
• Heat burns (thermal burns) are caused by fire, steam, hot objects, or hot liquids. Scald burns from hot liquids are the most common burns to children and older adults.
• Cold temperature burns are caused by exposure conditions.
• Electrical burns are caused by contact with electrical sources or by lightning.
• Chemical burns are caused by contact with household or industrial chemicals in a liquid, solid, or gas form. Natural foods such as which contain a substance irritating to the skin, can cause a burning sensation.
• Radiation burns are caused by the sun, tanning booths, sunlamps, X-rays,
• Friction burns are caused by contact with any hard surface such as roads carpets, or gym floor surfaces. They are usually both a scrape (abrasion) and a heat burn. Athletes who fall on floors, courts, or tracks may get to the skin. Motorcycle or bicycle riders who have road accidents while not wearing protective clothing also may get friction burns.

Home management of burns;-
Here are the top 10 home remedies for minor burns.
• Cold Water. Stop a burn from spreading by running cold water over the burn area for several minutes within seconds of being burned. …
• Raw Potato. …
• Aloe Vera. …
• Coconut Oil and Lemon Juice. …
• Honey. …
• Sterile gauze to cover burns site.

Description:-fats &oils belong to a group of compounds called lipids. they are characterized by greasy feel, insolubility in water &solubility n some organic solvent.
Lipids contain a small proportion of oxygen &a larger proportion of hydrogen &carbon. fats are solid at 20 degree Celsius. They are called oils if they are liquid at that temperature.
Fatty acids: – A fatty acid is a long hydrocarbon chain capped by a carboxyl group (COOH). There are many common fatty acids that you hear about, four of which are shown below along with acetic acid for comparison:
The COOH cap is what makes these molecules acids. You are probably familiar with acetic acid because this is the acid found in vinegar. You can see that the fatty acids are like acetic acid, but they have much longer carbon chains.

Functions of fats: – there are many functions of fats which are following:-Fatty acids have many functions in the body, and play a role in:
• oxygen transport throughout the body
• providing energy (when glucose, a form of sugar, is not available)
• development of strong tissues and organs
• brain functioning
• lowering cholesterol and reducing risk of heart disease
• healthy looking skin
• immune system health
• Fatty acids, in particular essential fatty acids (EFAs) — alpha-linolenic (omega-3) and linoleum acid (omega-6) — are intimately related to managing inflammation in the body. Fatty acids provide the building blocks for your body to make prostaglandins, agents that increase and decrease inflammation in the body. In a nutshell, saturated fats create the prostaglandins that increase inflammation and omega-6 and omega-3 create the prostaglandins that decrease inflammation. Both inflammation and anti-inflammation are important functions in our bodies, because they are the agents of healing. But as important as it is to be able to inflame (bring healing agents to a site of damage in your body), it is just as important to then be able to anti-inflame, removing those healing agents when they’ve done their job. We need to have a balance of both.

Position :- The pharynx is the part of the throat that is behind the mouth and nasal cavity and above the esophagus and the trachea, or the tubes going down to the stomach and the lungs.
The pharynx is an organ found in vertebrates and invertebrates, though the structure is not universally the same across all of those species. In humans the pharynx is part of the digestive system and also of the respiratory system.

Parts of pharynx:-The conducting zone also includes :-
• nose
• larynx
• trachea
• bronchi
• Bronchioles
Function of pharynx:- They are following—
(1) to filter
(2) warming
(3) moisten air
(4) conducting the lungs
Sections of pharynx:-The pharynx has three sections:-
— The nasopharynx
— the oropharynx
—the laryngopharynx.
(1)Nasopharynx:-The upper portion of the pharynx, the nasopharynx, extends from the base of the to the upper surface skull of soft palate. It includes the space between the internal nares and the soft palate and lies above the oral cavity. The adenoid is a part of nasal cavity also known as the pharyngeal tonsils.
The lymphoid tissue structures located in the posterior wall of the nasopharynx.
(2)Oropharynx:-The oropharynx lies behind the oral cavity, extending from the uvula to the level of the hyoid bone.
It opens anteriorly , through the isthmus faucium into the mouth.The anterior wall consists of the base of the tongue and the epiglottic vallecula. The lateral wall is made up of the tonsil, tonsillar fossa, and tonsillar (faucial) pillars.
The superior wall consists of the inferior surface of the soft palate and the uvula. Because both food and air pass through the pharynx, a flap of connective tissue called the epiglottis closes over the glottis when food is swallowed to prevent aspiration. The oropharynx is lined by non-keratinised squamous stratified epithelium.
(3)Laryngopharynx:- The laryngopharynx, also known as hypopharynx. The part of the throat that connects to the esophagus.
It lies inferior to the epiglottis and extends to the location where this common pathway divers into the respiratory and digestive pathways.
At that point, the laryngopharynx is continuous with the esophagus posteriorly. The esophagus conducts food and fluids to the stomach; air enters the larynx anteriorly. During swallowing, food has the “right of way”, and air passage temporarily stops

INTRODUCTION:
The liver is a vital organ, plays a major role in metabolism with numerous functions in the human body, including regulation of glycogen storage, decomposition of red blood cells, plasma protein synthesis, hormone production, and detoxification. It is an accessory digestive gland and produces bile, an alkaline compound which aids in digestion via the emulsification of lipids.

STRUCTURE
The liver is a reddish brown wedge-shaped organ with four lobes of unequal size and shape. A human liver normally weighs 1.44–1.66 kg (3.2–3.7 lb). Located in the right upper quadrant of the abdominal cavity, it rests just below the diaphragm, to the right of the stomach and overlies the gallbladder.

MICROSCOPIC ANATOMY
The study of microscopic anatomy, shows two major types of liver cell: parenchymal cells and non-parenchymal cells. 70–85% of the liver volume is occupied by parenchymal hepatocytes. Non-parenchymal cells constitute 40% of the total number of liver cells but only 6.5% of its volume. The liver sinusoids are lined with two types of cell, sinusoidal endothelial cells, and phagocytic Kupffer cells. Hepatic stellate cells are non-parenchymal cells found in the perisinusoidal space, between a sinusoid and a hepatocyte. Additionally, intrahepatic lymphocytes are often present in the sinusoidal lumen.

FUNCTIONAL ANATOMY
The central area or hilum, known as the porta hepatis is where the common bile duct, hepatic portal vein, and the hepatic artery proper enter the liver. The duct, vein, and artery divide into left and right branches, and the areas of the liver supplied by these branches constitute the functional left and right lobes.The functional lobes are separated by the imaginary plane, Cantlie’s line, joining the gallbladder fossa to the inferior vena cava. The plane separates the liver into the true right and left lobes. The middle hepatic vein also demarcates the true right and left lobes. The right lobe is further divided into an anterior and posterior segment by the right hepatic vein. The left lobe is divided into the medial and lateral segments by the left hepatic vein.
BLOOD SUPPLY
The liver receives a dual blood supply from the hepatic portal vein and hepatic arteries.