How to Reduce Pain and Stiffness in Arthritis with Hot and Cold Therapy

How to Reduce Pain and Stiffness in Arthritis with Hot and Cold Therapy

Pain Management   January 25, 2017

You want to reduce pain and stiffness in the joints soon disappear? Now you can try to do hot and cold therapy. This therapy uses heat energy at once cold to relieve symptoms of arthritis. According to health experts, hot and cold works by stimulating the body's ability to heal itself.

According to the doctors, the heat is used, serves to dilate blood vessels, stimulate blood circulation and reduce stiffness. In addition, the heat also serves to eliminate the sensation of pain. You can use a variety of equipment such as heating pad, heat lamp, or using steam heat by warm baths or compresses with a cloth soaked in hot water.

In contrast to heat, cold compresses reduce the inflammation by means of screwed or shrink the blood vessels. Although the sensation of water ice compress or pack a bag of ice will cause discomfort in the beginning, but this way can reduce pain.

When using heat therapy of steam, make sure the temperature is not too hot to avoid the possibility of skin burns. Choose a temperature you can tolerate, either with a bath of warm water, using a bottle filled with hot water, or hot spa.

You can do a heat treatment of at least 15 minutes before physical exercise. Then you should immediately use again after exercise. Additionally, you can also use the steam any time you require additional treatment to relieve the pain.

Effectiveness of heat therapy. Many arthritis sufferers reported having experienced a reduction in pain and stiffness after a hot shower or do the hot spa. The use of hot steam otherwise effectively relax muscles, improve blood supply to the affected area and relieve muscle stiffness. However, avoid heat therapy if you suffer from diabetes, hypertension, cardiovascular disease, or if you are pregnant.

According to the doctor and patient reports, this therapy is also effective in relieving the pain of arthritis. Ice bag used as a compress on the inflamed area will be working to reduce inflammation and swelling. Ice bag is particularly good for relieving pain in joints due to the heat generated by arthritis. In addition to ice, you can also try the local spray as fluoromethane (nonflammable) on the back or the affected area before and after physical activity. This cooler serves to relieve muscle stiffness and improve your ability to withstand pain. Or to make things easier, you can make an ice pack to wrap vegetables that have been refrigerated or frozen.

Which is better, hot or cold? Some patients prefer cold therapy compared to vapor. While some other patients who claimed to get the best results by combining the two. To get the right choice, you could do the experiment.

To get the best results, try using steam heat therapy or a bag of ice at least twice a day. According to the American College of Rheumatology, compresses or massaging the affected area with ice for 5-10 minutes, within 48 hours of first relapse, can help to relieve pain. Medium heat should be used for pain that persists for more than 48 hours.

Lists of Reflexes You Need to Know

Lists of Reflexes You Need to Know

Health Articles   January 08, 2017

Lists of Reflexes

Accommodation Reflex

The accommodation reflex is a reflex action of the eye, in response to focusing on a near object, then looking at distant object (and vice versa), comprising coordinated changes in vergence, lens shape and pupil size (accommodation). It is dependent on cranial nerve II (afferent limb of reflex), superior centers (interneuron) and cranial nerve III (efferent limb of reflex).

Acoustic Reflex

The acoustic reflex is an involuntary muscle contraction that occurs in the middle ear in response to high-intensity sound stimuli or when the person starts to vocalize.


Asymmetrical Tonic Neck Reflex

The asymmetrical tonic neck reflex (ATNR) is a primitive reflex found in newborn humans, but normally vanishes around three months of age.
It is also known as the "fencing reflex" because of the characteristic position of the infant's arms and head, which resembles that of a classically trained fencer. When the face is turned to one side, the arm and leg on the side to which the face is turned extend and the arm and leg on the opposite side flex.


Ankle Jerk Reflex

The ankle jerk reflex occurs when the Achilles tendon is tapped while the foot is dorsi-flexed. A positive result would be the jerking of the foot towards its plantar surface. Being a deep tendon reflex, it is monosynaptic. It is also a stretch reflex. These are monosynaptic spinal segmental reflexes. When they are intact, integrity of the following is confirmed: cutaneous innervation, motor supply, and cortical input to the corresponding spinal segment.


Babinski Reflex

Babinski reflex is one of the normal reflexes in infants. Reflexes are responses that occur when the body receives a certain stimulus. The Babinski reflex occurs after the sole of the foot has been firmly stroked. The big toe then moves upward or toward the top surface of the foot. The other toes fan out. This reflex is normal in children up to 2 years old. It disappears as the child gets older. It may disappear as early as 12 months.


Biceps Reflex

Biceps reflex is a reflex test that examines the function of the C5 reflex arc and the C6 reflex arc. The test is performed by using a tendon hammer to quickly depress the biceps brachii tendon as it passes through the cubital fossa. Specifically, the test activates the stretch receptors inside the biceps brachii muscle which communicates mainly with the C5 spinal nerve and partially with the C6 spinal nerve to induce a reflex contraction of the biceps muscle and jerk of the forearm.


Brachioradialis Reflex

The brachioradialis reflex (also known as supinator reflex)is observed during a neurological exam by striking the brachioradialis tendon (at its insertion at the base of the wrist into the radial styloid process (radial side of wrist around 4 inches proximal to base of thumb)) directly with a reflex hammer when the patient's arm is relaxing. This reflex is carried by the radial nerve (spinal level: C6,C7)


Corneal Reflex

The corneal reflex, also known as the blink reflex, is an involuntary blinking of the eyelids elicited by stimulation of the cornea (such as by touching or by a foreign body), though could result from any peripheral stimulus.


Glabellar Reflex

Glabellar reflex is a primitive reflex. It is elicited by repetitive tapping on the forehead. Subjects blink in response to the first several taps. If the blinking persists, this is known as Myerson's sign and is abnormal and a sign of frontal release; it is often seen in people who have Parkinson's disease.


Golgi Tendon Reflex

The Golgi tendon reflex is a normal component of the reflex arc of the peripheral nervous system. In a Golgi tendon reflex, skeletal muscle contraction causes the agonist muscle to simultaneously lengthen and relax.


Jaw Jerk Reflex

The jaw jerk reflex or the masseter reflex is a stretch reflex used to test the status of a patient's trigeminal nerve (CN V) and to help distinguish an upper cervical cord compression from lesions that are above the foramen magnum.


Moro Reflex

The Moro reflex is an infantile reflex normally present in all infants/newborns up to 3 or 4 months of age as a response to a sudden loss of support, when the infant feels as if it is falling. It involves three distinct components; spreading out the arms (abduction), unspreading the arms (adduction), crying (usually).
The primary significance of the Moro reflex is in evaluating integration of the central nervous system. It is distinct from the startle reflex,[1] and is believed to be the only unlearned fear in human newborns.


Palmar Grasp Reflex

Palmar grasp reflex (sometimes simply called grasp reflex) is a primitive reflex. It appears as early as 16 weeks in utero and persists until five or six months of age. When an object is placed in the infant's hand and strokes their palm, the fingers will close and they will grasp it with a palmar grasp. The grip is strong but unpredictable; though it may be able to support the child's weight, they may also release their grip suddenly and without warning. The reverse motion can be induced by stroking the back or side of the hand.


Patellar Reflex

The patellar reflex or knee-jerk is a stretch reflex which tests the L2, L3, and L4 segments of the spinal cord.

Plantar Reflex

The plantar reflex is a reflex elicited when the sole of the foot is stimulated with a blunt instrument. The reflex can take one of two forms.


Pupillary Light Reflex

The pupillary light reflex (PLR) or photopupillary reflex is a reflex that controls the diameter of the pupil, in response to the intensity (luminance) of light that falls on the retinal ganglion cells of the retina in the back of the eye, thereby assisting in adaptation to various levels of lightness/darkness.


Rooting Reflex

The rooting reflex is present at birth(age of appearance 28weeks) and disappears around four months of age, as it gradually comes under voluntary control. The rooting reflex assists in the act of breastfeeding.


Righting Reflex

The righting reflex is a reflex that corrects the orientation of the body when it is taken out of its normal upright position.


Triceps Reflex

The triceps reflex, a deep tendon reflex, is a reflex as it elicits involuntary contraction of the triceps brachii muscle. It is initiated by the Cervical (of the neck region) spinal nerve 7 nerve root (the small segment of the nerve that emerges from the spinal cord). The reflex is tested as part of the neurological examination to assess the sensory and motor pathways within the C7 and C8 spinal nerves.


Source : wikipedia

Wilms Tumor - Causes, Clinical Manifestations, Diagnostic, Complication and Management

Wilms Tumor - Causes, Clinical Manifestations, Diagnostic, Complication and Management

Wilms Tumor   July 24, 2016

Wilms Tumor - Causes, Clinical Manifestations, Diagnostic, Complication and Management

Wilms tumor or nephroblastoma is a cancer of the kidneys that typically occurs in children, rarely in adults. It is named after Dr. Max Wilms, the German surgeon (1867–1918) who first described it.

Type of renal carcinoma is the most frequently encountered arise from renal epithelium and cause more than 85% of kidney tumors. These tumors metastasize first to the lungs, bones, liver, brain, and the contralateral kidney. A quarter of patients had metastatic disease at time of diagnosis. (Brunner & Suddarth, 2014).


Causes

1. Exactly unknown
2. Genetic predisposition
3. Can be associated with congenital anomalies: which often is sporadic aniridia, genitourinary anomalies, hemihypertrophy, microcephaly and cryptorchidism. (Suriadi & Rita Yulianni, 2006).


Clinical Manifestations
1. There is a mass in the abdomen.
2. haematuria.
3. Hypertension.
4. Abdominal pain.
5. Anemia.
6. Fever.
7. Metastatic to the lungs, shortness of breath, dyspnea, cough, chest pain.
8. Pale.
9. Lethargy.
10. Anorexia.


Diagnostic
1. Physical examination.
2. Ultrasound.
3. CT scan.
4. X-rays.
5. CBC, electrolytic, BUN, creatinine and urine analysis.
6. Biopsy.


Complication
1. Metastasis.
2. Poor Prognosis
3. Complications from surgery.


Management
1. Chemotherapy with or without radiation
2. Surgery

Fluid Volume Deficit related to Dehydration

Fluid Volume Deficit related to Dehydration

Fluid Volume Deficit related to Dehydration   July 24, 2016

Dehydration occurs when water or fluids out of the body more than the incoming fluid, so that the body is not able to function as it should. If the fluid needs are not immediately met, then the body will become dehydrated.

The initial signs of dehydration include:

• Feeling thirsty.
• Dizziness.
• Dark yellow urine color.
• Frequency of urination less than usual.

The most obvious indicator to determine the body dehydration / less fluid is to look at the color of urine: if bright and clear, the body hydrated, and if the yellow - dark red then it is almost certainly a sign of dehydration.

Dehydration mild - moderate effect and can cause the following symptoms:

• Dry mouth and sticky.
• Tired and sleepy.
• Thirst.
• The quantity of urine is reduced.
• Dry skin.
• Constipation.
• Headache.

In children, they usually become less active than usual when dehydrated.

Severe dehydration

If left unchecked, the body that dehydration can cause dehydration worse. Severe dehydration is an emergency medical condition, and must be given treatment.

Symptoms of severe dehydration can include:

• Very thirsty.
• Mouth, skin, and mucous membranes are very dry.
• Confusion and irritability.
• Not urinating more than 8 hours.
• Urine is very dark, and few in number.
• Eyes look sunken, heavy, dry and sore.
• Rapid heartbeat.
• Low blood pressure.
• Low level of awareness to a fever.

Fluid Volume Deficit related to excessive output, less input. (Doenges, 1999)

Goal: Adequate fluid volume, so the lack of fluid volume can be resolved.

Expected outcomes:

• Maintaining fluid balance.
• Vital signs (pulse = 80-100 x / min, temperature = 36-37 ° C)
• Capillary refill less than 3 seconds.
• Acral warm.
• Urine output is 1-2 cc / kg body weight / hour.

Action Plan

1) Monitor vital signs, capillary refill, status mucous membranes, turgor.
Rationale: circulation volume adequacy indicator, the data hypotension occurs with risk of injury after the change of position.

2) Monitor the amount and type of fluid intake, urine output measure accurately.
Rational: Patients should not consume fluids at all lead to dehydration, or changing caloric intake of fluids to affect electrolyte balance.

3) Discuss strategies to stop vomiting and use of laxatives / diuretics.
Rationale: Helping patients received the feeling that as a result of vomiting and / or use of laxatives / diuretics prevent further loss.

4) Identification of a plan to improve / maintain optimal fluid balance. For example: fluid intake schedule.
Rationale: Involving the patient in a plan to correct the imbalance.

5) Assess function test results electrolyte / kidney.
Rationale: The transfer fluids / electrolytes, renal function decline may extend affect healing.

6) Provide / supervise administration of IV fluids.
Rationale: Emergency measures to correct the imbalance of fluid.

7) Additional potassium, oral or N as indicated.
Rationale: It can prevent cardiac dysrhythmias.

Pain in Lower and Upper Right Side of the Abdomen

Pain in Lower and Upper Right Side of the Abdomen

Pain in Lower and Upper Right Side of the Abdomen   June 23, 2016

There are many kinds of pain that commonly occur in the stomach. Starting from the pain that is not too distracting to the sharp pain. There is also a type of stomach pain could slowly feel unbearable, then improve again. This condition needs to be examined whether the pain radiating to the specific direction, along with other symptoms that accompany.

The conditions generally can be the cause of Pain in Right Side of the Abdomen.

Ectopic pregnancy

Ectopic pregnancy is a condition in pregnancy where the egg is fertilized are not able to stick or cling to the mother's womb, but attached to another place, namely at the place known as the fallopian tubes, cervix, in the abdomen or in the ovaries. By the time the pregnancy reaches the age of 6-10 weeks, ordinary women who have an ectopic pregnancy will experience symptoms ; Pain in the pelvic area to one side and usually occur suddenly, abdominal pain that appears to be happening more and more often.


Appendicitis

Appendicitis is a condition in which infection occurs in the appendix. In mild cases may resolve without treatment, but many cases require laparotomy with the removal of the infected appendix. Symptoms of acute appendicitis include fever, nausea, vomiting, decreased appetite, pain around the navel is then localized in the lower right abdomen, pain worse for a walk, but not everyone will show symptoms like this, it could also just be chills, or nausea-vomiting only.


Hepatitis

Hepatitis is a disease that attacks the organs of the human heart. Here the liver inflammation that makes the function of the liver, which as a filter toxins in the blood, becomes impaired. With the disruption of liver function, then disrupted the function of other organs, thus making a person's health will be destroyed as a whole. Common symptoms of hepatitis are pain in the right abdomen, weakness, nausea, fever and diarrhea.


Gallstones

Gallstones are hardened bile deposits or petrified that form in the gallbladder. Bags or gallbladder is a small organ shaped like a pear that is located in the right abdomen, just below the heart. Gallstones have different sizes ranging from as small as a grain of sand to a golf ball-sized. Some people who are sick have only one gallstones, but did not rule gallstones are formed in large numbers at the same time. The main symptom of gallstones is pain in the abdomen sudden, abdominal pain usually lasts 1-5 hours (although sometimes it may last only a few minutes), known as biliary colic. The pain can be felt: In the middle of the abdomen, between the sternum and abdomen (solar plexus). Just below the rib cage to the right, the pain will spread to the side and back. The pain sometimes is triggered by eating fatty foods, but can also occur at any time of day and can awaken sufferers while sleeping at night.


Ovarian Cysts

Ovarian cysts is not a dangerous disease of the female body, the majority of cases cysts will disappear by itself in a woman's body. The existence of cysts tend not cause symptoms. But if the cyst cells rupture, large, or block blood flow to the ovaries, will show some of the symptoms. Menstrual pain and abnormal bleeding. Experiencing abdominal pain or bloating.




Pain in Right Side of the Abdomen also can be classified by the location :

Lower Right Abdominal Pain

• Injury.
• Disorders of the cervix.
• Endometriosis.
• Kidney stones.
• Inguinal hernia.
• Gastroenteritis caused by a virus.

Upper Right Abdominal Pain

• Gastritis.
• Hiatal hernia.
• Peptic ulcers.
• Pneumonia.
• Kidney stones, infections or cancer of the kidneys.
• Inflammation of the bile duct or cholangitis.
• Inflammation or pancreatic cancer.
• Gallbladder cancer.

Recognize Signs of Emergency

Abdominal pain should get immediate medical help or medical personnel if caused by trauma such as an injury or accident, or stomach pain along with pain or pressing on the chest.

Likewise, if the abdominal pain that occurs so severe that you can not afford to sit, or abdominal pain accompanied by bloody bowel movements, nausea and vomiting sustainable, yellow skin, or swelling in the abdomen.

Immediately consult a doctor if you experience abdominal pain right side, especially if there is prolonged to interfere with your activities. In addition, avoid all efforts to resolve this pain by taking drugs free because if it does not match the risk of making conditions more severe pain.

NCP for Psoriasis - 4 Nursing Diagnosis

NCP for Psoriasis - 4 Nursing Diagnosis

Psoriasis   December 08, 2015

Nursing Care Plan for Psoriasis

Psoriasis is a skin disease whose sufferers experience skin replacement process is too fast. The emergence of this disease sometimes for a longer period. In contrast to the normal human skin changes that usually lasts for three to four weeks, the skin changes in patients with psoriasis take place quickly is about 2-4 days, (it can even happen faster) that a lot of skin cell turnover and thickened.

Psoriasis can be found in all parts of the world with morbidity (incidence rate) is different. In terms of age, Psoriasis can be at any age, but usually more often found in adults.

Psoriasis is a skin disorder characterized by plaque, patches, scaly known papulosquamous disease. (Price, 1994).

The cause of psoriasis is unknown until now. Allegedly inherited polygenic. Although the majority of patients with psoriasis arises spontaneously, but in some patients found the existence of precipitating factors, among others:

1) Trauma
Psoriasis first arise in places that are exposed to trauma, scratching, incision, a former vaccination, and so on. The likelihood that this is a mechanism Koebner phenomenon. Typical in psoriasis arises 7-14 days after trauma.

2) Infection
In children, especially hemolytic streptococcal infections often cause guttate psoriasis. Psoriasis also arise after other bacterial infection and certain viral infections, but disappeared after infection healed.

3) Climate
Some cases tend to heal in the summer, while in the rainy season will recur.

4) Endocrine factors
The highest incidence at puberty and menopause. Psoriasis tends to improve during pregnancy and relapse and resistance to treatment after birth. Sometimes generalized pustular psoriasis arise during pregnancy and after high-dose progesterone treatment.

5) Sunlight
Although sunlight generally useful for patients with psoriasis, but in some patients the strong sunlight can stimulate the onset of psoriasis. Photochemical treatment has similar effects in some patients.

6) Metabolic
Hypocalcemia may cause psoriasis.


Patients usually complain of mild itching in places of predilection, namely the scalp, the border area with the face, extremities on the extensor, especially the elbows and knees, and the lumbosacral region. Skin disorders consisting of patches of elevated erythema (plaque) with scales on it. The scales are layered, rough, and white like mica, and transparent. In psoriasis there is the phenomenon of droplets of wax, Auspitz and Köbner.


Symptoms of psoriasis include:
Complained of mild itching.
Patches of erythema elevated, scaly thereon.
There is a phenomenon of the droplets of wax.
Cause nail abnormalities.


Nursing Diagnosis for Psoriasis

1. Impaired sense of comfort related to disease-related symptoms
characterized by: the itching, burning sensation on the skin, anxiety, clients seemed agitated, and disruption of sleep patterns.

2. Impaired skin integrity related to chemical irritation, mechanical factors, nutritional factors
characterized by: tissue damage of the skin (scaly skin, poor skin turgor, cracks, patches, itching).

3. Disturbed body image related to the biophysical, disease, and perceptual
characterized by: insecure, self-conscious, feelings of isolation, the interaction is reduced.

4. Anxiety related to changes in health status
characterized by: a client anxiety, fear, sleep disturbances, often sweating.

Altered Nutrition related to Nausea and Vomiting

Altered Nutrition related to Nausea and Vomiting

Vomiting   December 02, 2015

Alteration Nutrition: Less Than Body Requirements related to Nausea and Vomiting

Nutrients are substances in food that are needed for the organism to grow and develop properly in accordance with its function.

Nutrients in adequate amounts and in accordance with the need for providing energy for the body to be able to grow and develop, and repair damaged tissue. Nutritional deficiencies will make the body of the organism does not grow and develop, it can even cause disease to end in death. Disruption of the body's metabolic processes are early symptoms of nutritional deficiencies.

Definition of nutrition, according to some experts is as follows:

• Nutrition is the process of taking important nutrients. (Nuwer, 2008).
• Nutrients are organic substances required by the organism for normal functioning of the body systems, growth and maintenance of health. (Wikipedia).

After knowing the definition of nutrients, there are several types of nutrients that it needs to be absorbed by us every day. Such as carbohydrates, this is a kind of nutritional composition consisting of the elements carbon, hydrogen and oxygen. This type of substance found in rice, corn, wheat, tubers. There are fat as the types of nutrients that are needed by our bodies, fat acts as an energy source that is compacted. There is a protein that is an important constituent of all cells in the body. Vitamin is also a means of nutrition is no less important to regulate the body's metabolism. Meneral and water is also a kind of important nutrients for the body.

Understanding of nutrition is not just limited to the nutritionists or health researchers only. However, this definition also extends in particular to the health of the world. Nutrition for health is a kind of critical intake found in foods often consumed by us. Contains vital substances such as vitamins, minerals, carbohydrates and others. Knowledge of the nutrients it needs to be recognized as a regulator of eating patterns. The nutritional requirements for the human body is certainly very important as supporting a variety of activities and health. The nutrients needed by the body also had higher levels of clear and useful to the body. There are several types of foods that actually do not really have a clear nutritional. It would be very concerned if we always vulnerable consumption in a long time. After all essential nutrients is a necessity that should not be missed. Nutrition serves to keep your metabolism in the body because there is a substance in nutrients and important things to be absorbed. The function of internal organs of the body will also be maintained if the fulfillment of these nutrients stable and clear presence.

Nausea and vomiting is a symptom that is frequently encountered. Nausea is an uncomfortable sensation in the upper abdomen that creates a feeling like vomiting. While vomiting is the release of stomach contents through the mouth.

Nausea and vomiting are symptoms. Therefore, nausea and vomiting caused by various medical conditions (diseases) of the underlying. Knowing the causes of nausea and vomiting are very important for the management of nausea or vomiting appropriately.

Medical condition or disease causes nausea and vomiting, among others:

• Motion sickness.
• Young pregnant (nausea occurring in approximately 50% -90% of all pregnancies, vomiting in 25% -55%).
• Originator drug vomiting.
• Taste very pain.
• Emotional stress (such as fear).
• Excessive eating (satiety).
• Gallbladder disease, for example gallstones.
• Food poisoning.
• Viral infection of the gastrointestinal tract (diarrhea).
• Reaction to the odor or a particular smell.
• Sore throat (kids).
• Heart attack.
• Concussion or brain injury.
• Brain tumor.
• Gastric ulcer.
• Some forms of cancer.
• Bulimia or other psychological illnesses.
• Gastroparesis or slow emptying of the stomach (a condition that is often seen in people with diabetes).
• Swallowing poison or drink alcohol excessively.

Causes of vomiting may differ according to age.
Vomiting in children is most often caused by a viral infection, food poisoning, milk allergy, motion sickness, overeating, coughing, or intestinal blockage, and a disease in which the child has a high fever.

Time of nausea or vomiting may indicate the cause. When it comes shortly after a meal, nausea or vomiting may be caused by food poisoning, gastritis (inflammation of the lining of the stomach), gastritis, or bulimia.

Nausea or vomiting 1-8 hours after a meal may also indicate food poisoning. However, foods containing certain bacteria, such as salmonella (the cause of typhoid fever), it could take longer, causing the symptoms of nausea and vomiting. Continuous vomiting can cause a dangerous condition that is dehydration, especially vomiting in infants and children. Moreover, they have not been able to say what they are feeling. Therefore, parents should know the signs of dehydration in children.

Here is how to overcome the nausea and vomiting in general regardless of age and cause:

• Drink plenty of water gradually (a little but often).
• Avoiding solid food until the vomiting episode has passed.
• Stop all medications (which can irritate the stomach and make vomiting worsened). But, do not discontinue any medication before consulting a doctor.
• If there is vomiting and diarrhea lasting more than 24 hours, oral rehydration solution such as ORS should be used to prevent and treat dehydration.
• Pregnant women who experience morning sickness can eat some crackers before getting out of bed or eating a high-protein snack before bed (meat or cheese).
• Vomiting associated with cancer treatment (chemotherapy) can often be treated with other types of drug therapy. There are also prescription and non-prescription medications that can be used to control vomiting associated with pregnancy and motion sickness. However, you should consult a physician before using these drugs.

You should seek emergency medical care, if vomiting is accompanied by:

• There was blood in the vomit (bright red or black "coffee grounds").
• Severe headache or stiff neck, fear the occurrence of meningitis.
• Weak lethargy, confusion, or decreased consciousness.
• Severe abdominal pain.
• Fever higher than 38.5 C.
• Diarrhea.
• Frequency of breath and very rapid and weak pulse.