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By S. Faesul. Northwestern College, Saint Paul, MN. 2018.

These factors put stress on the articular cartilage that covers the surfaces of bones at synovial joints 125 mg sinemet with mastercard, causing the cartilage to gradually become thinner cheap sinemet 300mg with amex. The joint responds by increasing production of the lubricating synovial fluid generic 125mg sinemet free shipping, but this can lead to swelling of the joint cavity purchase sinemet 300 mg online, causing pain and joint stiffness as the articular capsule is stretched. The bone tissue underlying the damaged articular cartilage also responds by thickening, producing irregularities and causing the articulating surface of the bone to become rough or bumpy. In its early stages, symptoms of osteoarthritis may be reduced by mild activity that “warms up” the joint, but the symptoms may worsen following exercise. In individuals with more advanced osteoarthritis, the affected joints can become more painful and therefore are difficult to use effectively, resulting in increased immobility. Treatments may include lifestyle changes, such as weight loss and low-impact exercise, and over-the-counter or prescription medications that help to alleviate the pain and inflammation. However arthroplasty can provide relief from chronic pain and can enhance mobility within a few months following the surgery. This type of surgery involves replacing the articular surfaces of the bones with prosthesis (artificial components). For example, in hip arthroplasty, the worn or damaged parts of the hip joint, including the head and neck of the femur and the acetabulum of the pelvis, are removed and replaced with artificial joint components. The replacement head for the femur consists of a rounded ball attached to the end of a shaft that is inserted inside the diaphysis of the femur. The parts, which are always built in advance of the surgery, are sometimes custom made to produce the best possible fit for a patient. Gout is a form of arthritis that results from the deposition of uric acid crystals within a body joint. A diet with excessive fructose has been implicated in raising the chances of a susceptible individual developing gout. Other forms of arthritis are associated with various autoimmune diseases, bacterial infections of the joint, or unknown genetic causes. Autoimmune diseases, including rheumatoid arthritis, scleroderma, or systemic lupus erythematosus, produce arthritis because the immune system of the body attacks the body joints. As the disease progresses, the articular cartilage is severely damaged or destroyed, resulting in joint deformation, loss of movement, and severe disability. The most commonly involved joints are the hands, feet, and cervical spine, with corresponding joints on both sides of the body usually affected, though not always to the same extent. Rheumatoid arthritis is also associated with lung fibrosis, vasculitis (inflammation of blood vessels), coronary heart disease, and premature mortality. Exercise, anti-inflammatory and pain medications, various specific disease-modifying anti-rheumatic drugs, or surgery are used to treat rheumatoid arthritis. These cause erosion and loss of the articular cartilage covering the surfaces of the bones, resulting in inflammation that causes joint stiffness and pain. Each movement at a synovial joint results from the contraction or relaxation of the muscles that are attached to the bones on either side of the articulation. While the ball-and-socket joint gives the greatest range of movement at an individual joint, in other regions of the body, several joints may work together to produce a particular movement. Overall, each type of synovial joint is necessary to provide the body with its great flexibility and mobility. Body movements are always described in relation to the anatomical position of the body: upright stance, with upper limbs to the side of body and palms facing forward. These movements take place at the shoulder, hip, elbow, knee, wrist, metacarpophalangeal, metatarsophalangeal, and interphalangeal joints. Adduction brings the limb or hand toward or across the midline of the body, or brings the fingers or toes together. Circumduction is the movement of the limb, hand, or fingers in a circular pattern, using the sequential combination of flexion, adduction, extension, and abduction motions. Adduction/abduction and circumduction take place at the shoulder, hip, wrist, metacarpophalangeal, and metatarsophalangeal joints. Medial and lateral rotation of the upper limb at the shoulder or lower limb at the hip involves turning the anterior surface of the limb toward the midline of the body (medial or internal rotation) or away from the midline (lateral or external rotation). Flexion and Extension Flexion and extension are movements that take place within the sagittal plane and involve anterior or posterior movements of the body or limbs. For the vertebral column, flexion (anterior flexion) is an anterior (forward) bending of the neck or body, while extension involves a posterior-directed motion, such as straightening from a flexed position or bending backward. These movements of the vertebral column involve both the symphysis joint formed by each intervertebral disc, as well as the plane type of synovial joint formed between the inferior articular processes of one vertebra and the superior articular processes of the next lower vertebra. In the limbs, flexion decreases the angle between the bones (bending of the joint), while extension increases the angle and straightens the joint. For the upper limb, all anterior-going motions are flexion and all posterior-going motions are extension. For the thumb, extension moves the thumb away from the palm of the hand, within the same plane as the palm, while flexion brings the thumb back against the index finger or into the palm. In the lower limb, bringing the thigh forward and upward is flexion at the hip joint, while any posterior-going motion of the thigh is extension. Note that extension of the thigh beyond the anatomical (standing) position is greatly limited by the ligaments that support the hip joint. Knee flexion is the bending of the knee to bring the foot toward the posterior thigh, and extension is the straightening of the knee. Flexion and extension movements are seen at the hinge, condyloid, saddle, and ball-and-socket joints of the limbs (see Figure 9. Hyperextension is the abnormal or excessive extension of a joint beyond its normal range of motion, thus resulting in injury. In cases of “whiplash” in which the head is suddenly moved backward and then forward, a patient may experience both hyperextension and hyperflexion of the cervical region. Abduction and Adduction Abduction and adduction motions occur within the coronal plane and involve medial-lateral motions of the limbs, fingers, toes, or thumb. Abduction moves the limb laterally away from the midline of the body, while adduction is the opposing movement that brings the limb toward the body or across the midline. For example, abduction is raising the arm at the shoulder joint, moving it laterally away from the body, while adduction brings the arm down to the side of the body. Similarly, abduction and adduction at the wrist moves the hand away from or toward the midline of the body. Spreading the fingers or toes apart is also abduction, while bringing the fingers or toes together is adduction. For the thumb, abduction is the anterior movement that brings the thumb to a 90° perpendicular position, pointing straight out from the palm. Abduction and adduction movements are seen at condyloid, saddle, and ball-and-socket joints (see Figure 9.

Disinfections and Sterilization Measures Disinfections is mainly used as a barrier to contamination by discharges from the patient purchase sinemet 110 mg with amex. It is frequently used to treat the excretions and discharges of patients and also fomites and various objects with which the sick person discharges come in contact discount 300mg sinemet otc. Methods: Ä Chemicals Ä Heat Ä Steam proven sinemet 110mg, boiling Ä Large steam sterilizing 68 Ä Dry heat Ä Light Chemical Agents Ä 5% chlorine solution to disinfect sputum and feces -effective if the chemical agent is in solution form Ä Alcohol (as antiseptic and germicide) -effective germicide in solution of 50-70% Ä Iodine -2 sinemet 125mg without a prescription. Disinfecting Bed and Body Linen Ä Steaming, boiling or soaking for one hour in a 5% carbolic solution, or 10%formaline before laundering Ä During the period of illness cleaning rooms should be accomplished by scrubbing and other dustless method (hot water and detergent) at least three times a day (dampened cloth) Ä For soiled walls -washing, painting or repapering may be advisable. Management of Infectious Wastes and Sharps „ Infectious wastes including wastes from laboratories are good media for growth of infectious agents. Treatment and Disposal of infectious Wastes Ä Thermal process o Static - grate single chamber incinerator o Drum or brick incinerator o Open air burning Ä Wet thermal disinfections o Exposure of waste to increase temperature and increase pressure steam Ä Autoclaving Ä Chemical disinfections o E. B Contents should not be directly handled (free hand) B The containers should be cleaned with disinfectants after emptying. B Sharp needles, syringes, etc should be put into a special container before disposal to avoid puncturing in collectors. The following sections are about how to handle these body fluids: ⇒ Blood ⇒ Pus ⇒ Stool and urine ⇒ Sputum and vomits Blood from Wounds and Bleeding Steps 1. Note: Wrap contaminated wastes in newspapers, if available, for disposal in a pit Stool, Urine, Vomits and Sputum Stool and urine should be thrown down into the pit latrine immediately. Prepare containers for re -use Body Fluids on Surfaces if any body fluids spill on the floor, seats or objects, it should be cleaned up immediately and the surfaces decontaminated. Identify the types of supportive tests that could be conducted at a health center level to diagnose opportunistic infections, 5. As counts decrease, the risk of serious opportunistic infection wvr the subsequent 3-5 years increases. False positive screening tests may occur as normal biologic variants or association with recent influenza vaccination or other disease states such as connective tissue disease; These are usually detected by negative confirmatory tests. However, one should be aware of the moral as well as legal consequences of mislabelling specimens and/or coming up with incorrect or inconclusive results. It is therefore vital that local resources from the community itself be utilized in order to motivate such people to seek health services or provide local care to the sick at home level. The virus weakens the defense system and hence predisposes (weakens) the body to other killer diseases. Therefore, the control lies on prevention of the infection, which can only be achieved through modification of behavior. The following activities should be carried out to teach the public in general and the high-risk groups in particular. Avoid unsafe sexual practices by reducing the number and frequency of sexual contacts, avoiding high-risk practices and using barrier protection such as condoms 2. The high-risk behaviors are promiscuity, extramarital sexual intercourse and excessive alcohol consumption, harmful traditional practices involving use pf blades. Sexual -abstain sex before marriage and remain faithful after marriage, safe sex (use condom), reduce number of partners, b. Parenteral -avoid using un-sterile injections, transfuse screened blood, avoid village injectors, avoid needle sharing c. This is because, at the moment, health sector resources that can be devoted to this situation are so minimal that home care of patients will continue to be the mainstay of treatment. Post-mortem Care Clean the body, bathe if necessary Close eyes and mouth Place the body parts in normal position(arms, legs, head, etc) 86 Pack cotton/pads in the rectum and vagina Cover any draining wounds with clean dressing Tie extremities loosely Pad ankles and wrists Wrap the body in clean shroud or discarded sheet or any other garment depending on the culture. Perform role-play among two volunteering students dealing with issues related to ethical concerns in 5 minutes. List and describe the various laboratory What are the most commonly used laboratory diagnostic methods. Describe the safety Discuss safety precautions in handling body fluids and precautions in handling soiled body fluids/soiled materials materials 100 Table 6 -Learning objectives and Activities for Caregiver 6. Control - Control lies on prevention of the infection, which can only be achieved through modification of behavior. Counseling - Advising, educating, informing of all possible outcomes -as Pre-and post-test counseling, also allowing persons express Feelings and questions. Cytopenias - Advising, educating, informing of all possible outcomes -as Pre-and post-test counseling, also allowing persons expressFeelings and questions. Cytopenias - Deficiency of cellular elements in blood or tissue Diagnosis - Statement of the nature of a disease condition made after observing its signs, symptoms and other indications. Epidemic - Occurrence of a disease in an a excess of usual or normal Prevalence Epidemiology - The study of the distribution of diseases and related conditions in terms of their distribution by time, place. Usually used for microbial causative agents 104 Flu like syndrome - lllness looking like a bad cold and with fever Hetero sexual - Having sex to the people of the opposite sex. Kaposi Sarcoma - Cancer which takes the form of many hemor(bleeding) nodes affecting the skin, especially on the extremities Knowledge - information stored in the brain. Leukopinia - Reduction in the number of leucocytes in the blood, usually as a result of a disease Leukoplakia - Condition where white patches form on mucous membranes (Such as tongue or inside of the mouth) Lymphadenitis - inflammation of the lymph nodes Opportunistic infection - infections that occur when the defense mechanisms of the body are weakened Parenteral - Drugs and solutions administered through the intravenous route during the management of patients. Pathogenesis - The mechanism of causing damage to the tissue of the body which result in clinical manifestations of a disease. Perinatal - The age of a newborn from birth to seven days 105 Practice - Way of doing things Prevention - Avoiding or averting harmful conditions or diseases from affecting individuals or communities by and large. Sensitivity - Ability of a diagnostic test to detect a disease when the disease is actually present Sentinel surveillance - An epiemiologic methodology where there is continuous Collection and analysis of data on a certain health issue from a specified target population. Sero-epidemiolgic survey - A monitoring mechanism for diseases and conditions throug the use of continuous serological and epidemiological measurements. Sero-prevalence - Presence of a condition in a certain population over time as detected in the serum of the individuals Specificity - Ability of a diagnostic test to declare negative when the disease is absent Stigma - A consequence or complication due to a disease leading to isolation, discrimination, labeling and prejudice. Prepare the following; few needles and syringes, some instrument which may mimic a testing kit, few pieces of paper marked on them either positive or negative using a red marker. Tell them that this game is about Having either protected or unprotected sexual intercourse in form of hand shaking. If some one scratches your hand while you shake with that person, it means that it was unprotected sexual intercourse; whereas if not scratched then it was a protected one. Begin the game them to close their eyes; and while doing wo you will go around from their backs, and pat the shoulder of one of the students playing the game. The initially infected person shall scratch hands of three other persons and each scratched person in turn will scratch another three persons. Among those who volunteer to be tested ,pretend that you tested them using the prepared kit, and provide them with the sheet of paper with result of the test. The following procedures should be followed: ; Clean the body, bathe if necessary ; Close eyes and mouth ; Place the body parts in normal position (arms, legs, head, etc) ; Pack cotton/pads in the rectum and vagina 114 ; Cover any draining wounds with clean dressing ; Tie extremities loosely ; Pad ankles and wrists ; Wrap the body in clean shroud or discarded sheet or any other garment depending on the culture.

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When partially digested food fills the duodenum order sinemet 110mg mastercard, intestinal mucosal cells release a hormone called intestinal (enteric) gastrin buy sinemet 300 mg line, which further excites gastric juice secretion discount sinemet 300 mg with amex. This stimulatory activity is brief order sinemet 300mg with visa, however, because when the intestine distends with chyme, the enterogastric reflex inhibits secretion. One of the effects of this reflex is to close the pyloric sphincter, which blocks additional chyme from entering the duodenum. The Mucosal Barrier The mucosa of the stomach is exposed to the highly corrosive acidity of gastric juice. Finally, stem cells located where gastric glands join the gastric pits quickly replace damaged epithelial mucosal cells, when the epithelial cells are shed. Ulcers: When the Mucosal Barrier Breaks Down As effective as the mucosal barrier is, it is not a “fail-safe” mechanism. Sometimes, gastric juice eats away at the superficial lining of the stomach mucosa, creating erosions, which mostly heal on their own. A potential complication of ulcers is perforation: Perforated ulcers create a hole in the stomach wall, resulting in peritonitis (inflammation of the peritoneum). Digestive Functions of the Stomach The stomach participates in virtually all the digestive activities with the exception of ingestion and defecation. Although almost all absorption takes place in the small intestine, the stomach does absorb some nonpolar substances, such as alcohol and aspirin. Mechanical Digestion Within a few moments after food after enters your stomach, mixing waves begin to occur at intervals of approximately 20 seconds. A mixing wave is a unique type of peristalsis that mixes and softens the food with gastric juices to create chyme. The initial mixing waves are relatively gentle, but these are followed by more intense waves, starting at the body of the stomach and increasing in force as they reach the pylorus. It is fair to say that long before your sushi exits through the pyloric sphincter, it bears little resemblance to the sushi you ate. The pylorus, which holds around 30 mL (1 fluid ounce) of chyme, acts as a filter, permitting only liquids and small food particles to pass through the mostly, but not fully, closed pyloric sphincter. In a process called gastric emptying, rhythmic mixing waves force about 3 mL of chyme at a time through the pyloric sphincter and into the duodenum. This prevents additional chyme from being released by the stomach before the duodenum is ready to process it. Chemical Digestion The fundus plays an important role, because it stores both undigested food and gases that are released during the process of chemical digestion. While the food is in the fundus, the digestive activities of salivary amylase continue until the food begins mixing with the acidic chyme. Ultimately, mixing waves incorporate this food with the chyme, the acidity of which inactivates salivary amylase and activates lingual lipase. Lingual lipase then begins breaking down triglycerides into free fatty acids, and mono- and diglycerides. Its numerous digestive functions notwithstanding, there is only one stomach function necessary to life: the production of intrinsic factor. The intestinal absorption of vitamin B12, which is necessary for both the production of mature red blood cells and normal neurological functioning, cannot occur without intrinsic factor. People who undergo total gastrectomy (stomach removal)—for life-threatening stomach cancer, for example—can survive with minimal digestive dysfunction if they receive vitamin B12 injections. The contents of the stomach are completely emptied into the duodenum within 2 to 4 hours after you eat a meal. Since enzymes in the small intestine digest fats slowly, food can stay in the stomach for 6 hours or longer when the duodenum is processing fatty chyme. However, note that this is still a fraction of the 24 to 72 hours that full digestion typically takes from start to finish. In addition, called the small and large bowel, or colloquially the “guts,” they constitute the greatest mass and length of the alimentary canal and, with the exception of ingestion, perform all digestive system functions. The Small Intestine Chyme released from the stomach enters the small intestine, which is the primary digestive organ in the body. Since this makes it about five times longer than the large intestine, you might wonder why it is called “small. As we’ll see shortly, in addition to its length, the folds and projections of the lining of the small 2 intestine work to give it an enormous surface area, which is approximately 200 m , more than 100 times the surface area of your skin. This large surface area is necessary for complex processes of digestion and absorption that occur within it. Just past the pyloric sphincter, it bends posteriorly behind the peritoneum, becoming retroperitoneal, and then makes a C-shaped curve around the head of the pancreas before ascending anteriorly again to return to the peritoneal cavity and join the jejunum. The duodenum can therefore be subdivided into four segments: the superior, descending, horizontal, and ascending duodenum. Located in the duodenal wall, the ampulla marks the transition from the anterior portion of the alimentary canal to the mid-region, and is where the bile duct (through which bile passes from the liver) and the main pancreatic duct (through which pancreatic juice passes from the pancreas) join. This ampulla opens into the duodenum at a tiny volcano-shaped structure called the major duodenal papilla. The hepatopancreatic sphincter (sphincter of Oddi) regulates the flow of both bile and pancreatic juice from the ampulla into the duodenum. Jejunum means “empty” in Latin and supposedly was so named by the ancient Greeks who noticed it was always empty at death. No clear demarcation exists between the jejunum and the final segment of the small intestine, the ileum. The ileum joins the cecum, the first portion of the large intestine, at the ileocecal sphincter (or valve). Parasympathetic nerve fibers from the vagus nerve and sympathetic nerve fibers from the thoracic splanchnic nerve provide extrinsic innervation to the small intestine. Nutrient-rich blood from the small intestine is then carried to the liver via the hepatic portal vein. Histology The wall of the small intestine is composed of the same four layers typically present in the alimentary system. These features, which increase the absorptive surface area of the small intestine more than 600-fold, include circular folds, villi, and microvilli (Figure 23. These adaptations are most abundant in the proximal two-thirds of the small intestine, where the majority of absorption occurs. Beginning near the proximal part of the duodenum and ending near the middle of the ileum, these folds facilitate absorption. Their shape causes the chyme to spiral, rather than move in a straight line, through the small intestine. Spiraling slows the movement of chyme and provides the time needed for nutrients to be fully absorbed. There are about 20 to 40 villi per square millimeter, increasing the surface area of the epithelium tremendously.

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