APPENDICITIS: (revisar sobre todo para poner mas actividades y vigilancia enfermera y las pruebas mas ordenado todo)

Age > 17. Age > 50 (the sympthoms are lower, more perforation risk). Its an acute (aguda) inflammation of the vermiform appendix, a narrow, blind tube that extends from the inferior part of the cecum. The appendix has no know functions but does fill and empty as food moves through the gastrointestinal tract. Appendicitis begins when the appendix becomes obstructed or inflamated. Irritation and inflamamation lead to (lleva, conduce) engorged (congestionada, injurgitada) veins stasis, and arterial occlusion. Eventually bacteria accumulate and the appendix can develop gangrene. Appendicitis is the most common cause of acute inflammation in the right lower quadrant of the abdominal cavity and is the most common surgical emergency. Causes: Obstruction:It may be caused by a fecalith (a hard mass of feces), a foreign body in the lumen of the appendix, fibrous disease of the bowel (intestino) wall, infestation of parasites or twisting (torsin) and rectal bleeding. 60% are associated with hiperplasia of the submucosal lymphoid follicles, and 35% to fecal stasis or fecalith. Patient Instruct the patient to avoid (evitar) enemas and rectal thermometers because of the risk of rectal perforation. Teach the patient to recognize the indicators of a systemic infection. Stress the fact (hacer enfasis) that fever and usual wound infection sings may or may not be present since the immune system may be depressed. Stress the importance of anemia, progressive fatigue, weakness (debilidad), paresthesias, blurred vision, palpitations, and dizziness (mareo). Symptoms: Pain that initially comes in waves (oleadas). Many patients report a discomfort that creates and urge to defectate to obtain relief (alivio). As the diseases process progresses, patients complain of a constant epigastric or periumbilical pain localizated in the right lower quadrant of the abdomen. Others may report a more diffuse lower abdominal pain or referred pain. (remisin del dolor). Should perforation of the appendix occur, pain may subside to generalized abdominal discomfort and in adition patients could be complain of anorexia, nausea, vomiting, abdominal distension, and temporary constipation (extreimiento) and temperature elevations. Observe the patient for typical sings of pain, including facial grimacing (mueca de dolor), clenched fists (puos apretados), diaphoresis (mucho sudor), tachycardia, and shallow but rapid respirations (respiracin superficial y rpida) Patient with appendicitis commonly guard the abdominal area by lying still with the right leg flexed at the knee (postura antialgica en la que te posicionas cuando te duele algo). This posture diminishes tension on the abdominal muscles and increases comfort.

Exploration: Early palpation of the abdomen reveals slight muscular rigidity and diffuse tenderness (sensiblidad) around the umbilicus and midepigastrium. Later, as the pain shifts (se difunde) to the right lower quadrant, palpation generally elicits tenderness at McBurneys point (a point midway between the umbilicus and the right anterior iliac crest). Right lower quadrant rebound(rebote) tenderness (production of pain when palpation pressure is relieved (palpas, comprimes y en la descomprensin se produce dolor).

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Also a positive Rovsings sing may be elicited by palpating the left lower quadrant with results in pain in the right lower quadrant. (Signo de Rovsing positivo: si la presin en un punto del cuadrante inferior izquierdo del abdomen provoca dolor en el cuadrante derecho. Puede indicarnos apendicitis u otras patologas). (Sin embargo, si la presin en el cuadrante izquierdo nicamente causa dolor en ese lado, o en ambos, se podran dar otras etiologas, infecciones de la vescula biliar, vejiga, tero, colon descendente izquierdo, trompas de falopio, ovarios) Leukocytosis may range from 10.000 to 16.000 L. Neutrophil count is frequently elevated above 75%. Pregnancy test on woman who might be pregnant. Appendectomy (surgical removal of the appendix). Mc Burney point incision. A laparosccopic appendectomy may be used in females of childbearing age and for obese patients. If the appendix has ruptured and there is evidence of peritonitis or an abscess, conservative treatment consisting of antibiotics and intravenous fluids is given 6 to 8 hours prior to an appendectomy. Gennerally, an appendectomy is performed (realizada) within 24-48 h after the onset (comienzo)of symptoms under either general or spinal anesthesia. The development (desarrollo) of peritonitis complicates recovery (recuperacion) and hospitazation may extend 5 to 7 days. The physician (mdico) generally orders oral fluids and diet as tolerated within 24 to 48 hours after surgery. Medication or Drug Class: Crystalloid intravenous fluids: normal saline solution or lactated Ringers Solution. 100500 ml/h depending on the volumen state of the patient. Replaces fluids and electrolytes

lost throught fever and vomiting, replacement continues until urine output is 1cc/kg of body weight and electrolytes are replaced. Antibiotics: Broad-spectrum antibiotic coverage. Nursing and patient: Note the color and odor (olor) of the drainage, any edema, the approximation of the wound edges (bordes), and the color of the incision. Encourage (animar) the patient to splint (sujetarse, inmobilizar) the incision during deep-breathing exercises. Answer the patients questions concerning the impending surgery, and provide the patient with structions regarding splinting the incision with pillows during coughing, deep breathing, and moving. Encourge the patient to deep breathing and coughing (toser) 10 times every 1 to 2 hours for 72 hours. Encourage the patient to assume a semi-Fowler position while in bed to promote lung (pulmon) expansion. Explain the need to keep the surgical wound clean and dry. Teach the patient to observe the wound (herida) and report to the physician (medico) any increased swelling (hinchazn), redness, drainage, odor or separation of th wound edges (bordes herida). Also instruct the patient to notify the doctor if a fever develops. The patient need to know these maybe symptoms of wound infection. Sutures are generally removed in 5 to 7 days.

MONONUCLEOSIS
The term it refers to the presence of an abnormally high number of mononuclear leukocytes (white blood cells) in the body. The infection results from a viral syndrome that is caused by the Epstein-Barr virus (a kind of herpes virus) The virus is introduced into the host by close contact with another individual who is shedding (liberando) EBV in the oropharynx. The virus replicates in epithelial cells of the pharynx and salivary glands. A localized inflammatory response produces the pharyngeal exudate. The virus is then carried (llevado) via the lymphatics to the lymph nodes. Local and generalized lymphadenopathy develops. Major complications are rare but may include splenic or liver rupture (liver: hgado) aseptic meningitis or encephalitis, pericarditis or hemolytic anemia. EBV has been linked (relacionado) to Burkitts lymphoma, in Africa, and to nasopharyngeal carcinoma, particulary in Asians. Mononucleosis can also lead to Guillain-Barr syndrome. Causes: EBV is spread via oropharyngeal or respiratory route. It is also transmitted by blood transfusion. Althoug children have a short incubation period of about 10 days, symptoms in adults may not appear until 1 to 2 months after exposure to the EBV. Fever or fatigue for 1 week, folloed by a sore throat (dolor garganta) (often described as the most painful the patiend has ever experienced).

Other symptoms include anorexia, painful swallowing (al tragar), and swelling of the lymph node (hinchazn en nodulos linfticos). Examination Note the redness of the pharynx and observe for exudate. Observe for petechiae that may appear at the junction of the hard and soft palades (occurs in 25% of patients). Note any facial edema, particulary eyelid edema. Facial edema is rarely encountered in other illnesses of young adults and is suggestive of Infectious mononucleosis. Some patients have a maculopapular rash (discolored patches of skin mixed ith elevated red pimples (granos)) Palpate for enlarged (ampliado, extendido) lympt nodes in the cervical and epitrochlear (around the elbow (codo)) areas. Significant adenopathy is almost always present, and its absence should make one doubht the diagnosis. During and abdominal examintion, palpate for an enlarged spleen (50% patients) and liver.
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Enlarged Spleen (Bazo extendido, ampliado) (occurs 50% of patients):

Lymphatic nodules. Structure unencapsulated or has an incomplete connective tissue capsule. Functions: filter and attack antigens. Location: throughout body. (por todo el cuerpo) Lymph nodes. Organ which has a complete connective tissue capsule encircling it. Functions: filter lymph, mount immune response (if necessary). Location: throughout body, frequently in clusters (racimo, grupo) in the axilary, inguinal, and cervical regions. Spleen. (bazo) Organ. Filters blood and recycles aged erythrocytes and platelets, serves as a blood reservoir, houses lymphocytes, mounts immune response to foreign antigens in the blood. In left upper quadrant of abdomen, near 9th-11th ribs and inferior to diaphragm. Liver.(hgado) Organ. It is located in the right upper quadrant of the abdomen, resting just below the diaphragm MALT: (mucosa-associated lymphatic tissue). Structure. Functions: filter and attack antigens in air, food, or urine. Location: within walls of gastrointestinal, respiratory, genital and urinary tracts.

Tonsils (amgdalas): structure. Protect against inhaled and ingested mterials. Withing pharynx (faringe). Thymus. (Timo). Organ. Functions: site of T-lymphocte maturation and differentiation: sotres maturing lymphocytes. Location. Superior mediastium (in adults): anterior and superior mediastinum (in children).

Diagnosis Test: Monospot: The monospot test, a form of the heterophile antibody test (which is sensitive for heterophile antibodies produced by human immune system in response to EBV, Epstein-Barr virus infection). It is a rapid test for infectious mononucleosis due to EpsteinBarr virus (EBV). Commercially-available test kits are 70-92% sensitive and 96100% specific. It will generally not be positive during the 4-6 week incubation period before the onset of symptoms. It will also not generally be positive after active infection has subsided, even though

the virus persists in the same cells in the body for the rest of the carrier's life. Identifies 90% of adult cases with EBV, most common and specific test to confirm. Complete blood count with differential: Determines extent of viral infection and immune dysfunction. The normal result is: () segmented neutrophils: 54-62%, band neutrophils (3-5%) eosinophils (1-3%), basophils: (<1%), monocytes (37%), lymphocytes: (25-33%) Abnormality with condition (EBV): lymphocytosis with characteristic atypical lymphocytes in peripheral blood. IgM antibodies. Identifies presence of EBV. Abnormality with condition (EBV): presence of specific antibodies for EBV antigens (viral capsid antigens, early antigens, or Epstein-Barr nuclear antigen). Pharmacologic. Acetominaphen (Paracetamol) (for fever) and bedrest for fatigue. To prevent upper airway obstruction from severe tonsillar enlargement, (amigdalas extendidas), treatment with corticosteroids (prednisone 40 mg/ day for 5 to 7 days). About 20% of patients also need a 10-day course of antibiotic therapy because of streptococcal pharyngotonsilitis. Ruptured slpeen is an unusual but serious complication that causes sudden abdominal pain and is managed surgically by removal of the spleen (ciruga de extirpar el bazo). Nursing and patient: most patients do no require hospitalization. Risk for ineffective airway clearance related or oropharyngeal swelling. (Riesgo de intercambio respiratorio ineficaz relacionado con orofaringe hinchada). Sore throat and severe tonsillar enlarged. (dolor de garganta y anginas agrandadas). Anxiety, fatigue, pain management, fever, constipation (extreimiento), soft diet. Encourage to patient to use anesthetic lozenges or warm saline gargles for pharyngitis. A soft diet such as milkshakes, sherbets, soups, and puddings provides additional liquid and nutritional supplements. Teach patients to avoid stenous activities and contact sports until liver and spleen enlarged subsides (1 or 2 months). Teach strategies to avoid constipations because these problems cause increased presure on the spleen. Encourage the patient to rest during the acute illness and convalescence period. Note that prolonged fatigue is not uncommon.

CANDIDIASIS (Moniliasis, thrush)

Chessy white plaque that looks like milk curds (curds: cuajada); when rubbed off, it leaves an erythematous and often bleeding base. Candida albicans fungus: predisposing factores include diabetes, antibiotic therapy and immunosuppresion. TTO: antifungal medications such as nystatin (Mycostatin) Amphotericin B, clotrimazole, or ketaconazole may be prescribed, these may be takin in pill form or as a suspension, when used as a suspension, instruct the patient to swish vigorously for at least 1 minute and then swallow.

HERPEX SIMPLEX
Herpex simplex 1 (cold sore or fever blister). Symptoms may be delayed up to 20 days (retrasados) after exposure, insuglar or clustered (en grupo, racimo) painful vesicles that may rupture. An opportunistic infeccion, frequently seen in immunosuppresed patients, very contagious, may recur with menstruation, fever, or sun exposure. Use acyclovir or zovirax ointment or systemic medications as prescribed. Administer analgesic as prescribed. Instruct patient to avoid irritating foods. 976 Parotitis. Mumps (paperas).