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.

Nausea and Vomiting related to Pregnancy

Nausea and Vomiting related to Pregnancy

Vomiting   December 02, 2015

Although the cause is unknown, nausea and vomiting during pregnancy related to changes in the hormonal levels in the body of a pregnant woman. When a pregnant woman, there will be increased levels of human chorionic gonadotropin (HCG), which is derived from the placenta. This hormone serves to maintain adequate production of the hormones estrogen and progesterone from ovaries, resulting in pregnancy to be healthy.

In addition, the effect of this hormone is thought to cause nausea and vomiting in the first three months of pregnancy (first trimester) and will fall back after the fourth month. Therefore, nausea and vomiting usually goes away by itself after entering the fourth month. Besides HCG, the hormone estrogen is considered also cause nausea and vomiting in pregnant women.

Signs and symptoms

Level 1 (mild)

• Nausea and vomiting constantly affecting the general condition.
• Feeling weak.
• No appetite.
• Body weight decreased.
• Feel pain in the epigastric.
• Pulse increased by about 100 per minute.
• Decreased blood pressure.
• Reduced skin turgor.
• Tongue dries.
• Sunken eyes.

Level 2 (moderate)

• Looks weaker and apathetic.
• Skin turgor started ugly.
• Tongue dry and looked dirty.
• Pulse small and quick.
• Body temperature rises (dehydration).
• Eyes began to jaundice.
• Weight down and sunken eyes.
• Drop in blood pressure, hemoconcentration, oliguria and constipation.
• Acetone smell of respiration and occurs acetonuria.

Level III (severe)

• General condition is more severe (decreased consciousness from somnolence to coma).
• Severe dehydration.
• Pulse small, fast and smooth.
• Increased body temperature and blood pressure drop.
• Fatal complications occur in the nervous system known as Wernicke encephalopathy with symptoms of nystagmus, diplopia and mental decline.
• Jaundice which indicate heart trouble.

Prevention

Avoiding strong-smelling food, cigarette smoke or perfume smelling that can trigger nausea and vomiting.
Some dietary supplements may help reduce nausea and vomiting as a drink ginger or vitamin B6.
Eat a desired food when the body is able to receive it.
Do not lie down immediately after eating, should sit upright for a while to avoid bloating or nausea.
Avoid lots of drinking at meals, wait 30 minutes after eating a new drinking water. Outside of mealtime, are expected to drink more.
Eat small meals but frequently (every 2-3 hours) to prevent nausea without risk of malnutrition.
A diet that is complete and balanced.
Enough rest.
Consultation obstetrician if nausea and vomiting continues.

Activity Intolerance related to Anemia

Activity Intolerance related to Anemia

Nursing Diagnosis and Interventions   November 22, 2015

Anemia is a term that indicates a low red blood cell and hemoglobin level, and hematocrit below the normal. Anemia is not a disease, but rather a reflection of the state of a disease or disorder of the body functions. Physiologically anemia occurs when there is a shortage of hemoglobin to carry oxygen to the tissues.
(Brunner & Suddarth, 2001)

This oxygen will be used to burn sugars and fats into energy. This may explain why anemia can cause symptoms of weakness and lethargy are not uncommon. Lungs and heart were also forced to work harder to get oxygen from the blood that causes shortness of breath.

Symptoms of anemia :

• Weakness, lethargy, dizziness, irritability, or trouble concentrating.
• Especially in the pale gums and eyelids or under the nails.
• Heart palpitations shortness of breath.
• Thrush of the mouth or tongue, welts or unusual bleeding.
• Numbness or tingling in the legs.
• Nausea and diarrhea.

Activity intolerance related to imbalance between the oxygen supply (delivery) and needs.

Goal: to maintain / improve ambulation / activity.

Expected outcomes:

• Reported increased exercise tolerance (including activities of daily living).
• Showed a decrease in the physiological signs of intolerance, such as pulse, respiration, and blood pressure is still within normal range.

Interventions:

• Assess the patient's ability to ADL.
• Assess lost or impaired balance, gait and muscle weakness.
• Observation of vital signs before and after the activity.
• Provide quiet environment, limit visitors, and reduce noise, keep bedrest when indicated.
• Use energy-saving techniques, advise patients to rest, in case of fatigue and weakness, advise patients to do his best activity (without imposing themselves).

Rationale:

• Affect the choice of intervention / assistance.
• Show neurological changes due to vitamin B12 deficiency affects patient safety / risk of injury.
• Cardiopulmonary manifestations of heart and lung efforts to bring an adequate amount of oxygen to the tissues.
• Increase rest to lower the oxygen needs of the body and lowers the strain the heart and lungs.
• Increase activity gradually, until normal and improve muscle tone / stamina without drawbacks. Boost self-esteem and sense of control.

Acute Pain and Hyperthermia related to Pharyngitis in Children

Acute Pain and Hyperthermia related to Pharyngitis in Children

Nursing   November 18, 2015

Acute pharyngitis is sore throat caused by a virus organism almost 70% and a group A streptococcal bacteria is a common organism with respect to acute pharyngitis were then referred to as "Strep Throat" (Brunner & Suddarth, 2001)

Chronic pharyngitis usually occurs in adult individuals who work / live in a dusty environment, use of excessive sound, suffer from chronic cough, habitual use of alcohol and tobacco.

There are 3 types of pharyngitis:

1. Hypertrophic (thickening of the common and congested mucous membrane of the pharynx).
2. Atrophic (the later stages of the first type: a thin membrane, whitish, smooth and wrinkled time).
3. Chronic granular (swelling of lymph follicles in the walls of the pharynx).

Acute Pain related to inflammation of the pharynx

Goal: expected, decrease pain

Expected outcomes: Children say:

• That pain is reduced.
• Adequate sleep and rest.
• Being able to use non-pharmacological methods to relieve pain.

Interventions:

• Perform a comprehensive pain assessment, including the location, characteristics, duration, frequency, quality factor and precipitation.
• Teach about non-pharmacological techniques (such as deep breath).
• Collaboration: Giving analgesics to reduce pain.
• Increase rest-sleep.

Rationale:

• Knowing the level of pain including the location, characteristics, duration, frequency, quality factor and precipitation.
• Deep breathing is one of relaxation to reduce tension and create a more comfortable feeling.
• Useful analgesic to relieve pain so that patients become more comfortable.
• Rest can relax so as to reduce the pain.

Hyperthermia related to inflammation of the pharynx.

Goal: expected normal body temperature.

Expected outcomes:

• Normal skin temperature.
• Body temperature.

Interventions:

• Assess body temperature every two hours.
• Encourage fluid intake and adequate nutrition.
• Give a warm compress for example in the armpit.
• Collaboration: Give antipyretic drugs.

Rationale:

• Knowing your child's temperature.
• Intake of fluids and nutrients can help speed the process of spending the body heat.
• Warm compresses can open the pores of the skin so as to accelerate the process of evaporation.
• Antipyretic drugs can help reduce the heat.

Risk Factors That May Affect the Occurrence of Malaria

Risk Factors That May Affect the Occurrence of Malaria

Risk Factors That May Affect the Occurrence of Malaria   November 16, 2015

Malaria is a disease caused by parasites. Malaria is spread by mosquitoes that have been infected by the parasite. Malaria can even be fatal if not treated properly.

Malaria infection can occur simply by a mosquito bite. Malaria is rarely spread directly from one person to another. Examples of conditions of transmission of this disease is in contact with the blood of the patient or fetus can be infected because of contracting out of the mother's blood.


Risk Factors That May Affect the Occurrence of Malaria :

1. Behavior
The behavior in question is the behavior of a person's life in an attempt to protect themselves from mosquito bites and keep clean sanitary environment in which he lived so that there is no possibility of the vector causing malaria to flourish.

2. Lighting
A healthy home requires sufficient light. Sunlight is very important because it can prevent the breeding of mosquitoes in the house. Therefore, the house must have enough driveway light such as windows and ventilation. Windows and vents have many functions such as to keep the flow of air inside the house to stay healthy, maintain the balance of oxygen and keep the humidity in the house.

3. Water temperature
Air temperature greatly affect the length - short of sporogonic cycle or extrinsic incubation period. The higher the temperature, the shorter the extrinsic incubation period and conversely the lower the temperature, the higher the extrinsic cycle.

4. Season
There is a direct relationship between the seasons and the development of the anopheles mosquito larvae into the adult form. Anopheles mosquito will grow faster during the rainy season especially in heavy rain with the number of rainy days are quite long, because it will affect where the anopheles mosquitoes or breeding.

5. Wind
The wind speed at the time of sunrise and sunset which is when flying into or out of the house is one of the factors that will determine the amount of contact between humans and mosquitoes.

6. Sewerage
Sewerage can also affect the occurrence of malaria, where sewerage is not addressed by either the state of sanitation and the flow of the waste is stagnant or not because the anopheles mosquitoes like the place where the water is static or flowing slightly as we know that the waste water that is not treated with either will cause various health problems of society and the natural environment or the transmission of them become breeding grounds for mosquitoes.

Nutrition for Wound Healing

Nutrition for Wound Healing

Nutrition for Wound Healing   November 16, 2015

Nutrition is a food that contains enough nutrients and energy value for the development and maintenance of optimal health.

Reason nutrients needed for the wound healing process
In the state of the wound, then, interrupted wholeness of body tissues and require sufficient nutrients to be able to repair the body's tissues are damaged.

Type of food that should be considered for wound healing
Among the foods that contain carbohydrates, proteins, fats, vitamins, minerals and water, then the most important for wound healing is a protein and vitamin C.

The reason: Protein and vitamin C very important role in the wound healing process. In addition, vitamin C has an important role to prevent infection and bleeding wounds.

Examples of foods that need to be considered for wound healing:

• Protein is divided into, vegetable and animal. Examples of vegetable such as tempe, tofu, nuts etc. Examples of animal protein, liver, eggs, chicken, shrimp, etc.
• Vitamin C include: nuts, citrus, guava, papaya leaves, spinach, tomatoes.

Definition, Signs and symptoms of Hallucinations

Definition, Signs and symptoms of Hallucinations

Health   November 16, 2015

Definition

Hallucinations are a response (perception) senses without stimulation from the outside (external)


Classification

Hallucinations can occur in any sensory modality:

• visual,
• auditory,
• olfactory,
• gustatory,
• tactile,
• proprioceptive,
• equilibrioception,
• nociceptive,
• thermoreceptive, and
• chronoception.

Signs and symptoms

• Pulling away, avoid others.
• Easily offended.
• Smile, speak for themselves.
• Anxiety, fear, face tense.
• Talks chaotic, sometimes unreasonable.
• Suspicion and hostility.
• Self-blame / others.
• Can be self-destructive, others and the environment.
• Unable to distinguish between the real and unreal.
• Unable to focus attention / concentration.
• Difficult to make a decision.
• Fear.
• Red face sometimes pale.
• Unwilling or unable to perform self care such as bathing, brushing teeth, dressing.

Gastritis - 5 Additional Tests to Determine a Clear Cause

Gastritis - 5 Additional Tests to Determine a Clear Cause

Health   November 10, 2015

When a patient is diagnosed with gastritis, usually followed by additional tests to determine a clear cause. The tests includes:

1. Blood tests.
This test is used to check for the presence of H. pylori antibodies in the blood. A positive test indicates that the patient has been in contact with the bacteria at some time in their lives, but it does not indicate that the patient is infected. Blood tests may also be done to check for anemia, which occurs due to gastric bleeding due to gastritis.

2. Breathing tests.
This test can determine whether a patient is infected by the bacteria H. pylori or not.

3. Feces Test.
This test checks whether there is H. pylori in the feces or not. A positive result could indicate infection. Test conducted for the presence of blood in the stool. It showed bleeding in the stomach.

4. The upper gastrointestinal endoscopy.
With this test can look for abnormalities in the upper gastrointestinal tract which may not be visible on X-rays. This test is done by inserting a small flexible hose (endoscope) through the mouth and into the esophagus, stomach and upper small intestine. Throat advance in anesthesia before the endoscope is inserted to ensure patients feel comfortable undergoing this test. If any tissue in the gastrointestinal tract looks suspicious, the doctor will remove a small sample (biopsy) of the tissue. The samples will then be taken to the laboratory for examination. This test takes approximately 20 to 30 minutes. Patients usually do not go home when the test is completed, but had to wait until the effects of anesthesia disappear, approximately one or two hours. Virtually no risk as a result of this test. Frequent complication is the discomfort of the throat from swallowing the endoscope.


5. X-rays of the upper gastrointestinal tract.
This test will look for signs of gastritis or other gastrointestinal diseases. Usually it will be asked to swallow a liquid barium X-ray done before. This liquid will coat the gastrointestinal tract and be seen more clearly when in the X-ray.

Classification and Pathophysiology of Gastritis

Classification and Pathophysiology of Gastritis

Health   November 10, 2015

Gastritis is an inflammation localized or spread on the gastric mucosa that develops when the mucosal protective mechanism is filled with bacteria or irritants. (J. Reves, 1999)

Classification of Gastritis

Gastritis by type is divided into 2 (two), namely:

1. Acute Gastritis
Gastritis (inflammation of the gastric mucosa) is most often caused by recklessness diet, such as eating too much, too fast, eating food too much seasoning or infected food. Other causes include alcohol, aspirin, bile reflux and radiation therapy. Gastritis may also be the first signs of acute systemic infection. Form of more severe acute gastritis caused by strong acid or alkaline, which can cause the mucosa into gangrene or perforation.

2. Chronic Gastritis
Prolonged inflammation caused by both benign and malignant gastric ulcers, by the bacteria H. pylori. Chronic gastritis may be classified as a Type A or Type B. Type A this occurs in the gastric fundus or corpus. Type B (H. pylori) of the antrum and pylorus. May be related to H. pylori bacteria. Dietary factors such as hot beverages, seasonings, use of drugs, alcohol, smoking or reflux of intestinal contents into the stomach.


Pathophysiology of Gastritis

Foodstuffs, drinks, drugs and chemicals that go into the stomach, causing irritation or erosion of the mucosa, so that the hull loss of barrier (protective). Furthermore, an increase in back diffusion of hydrogen ions. Interference diffusion of the mucosa and increased secretion of gastric acid increase / lot. Stomach acid and digestive enzymes. Then invade the gastric mucosa and there was an inflammatory reaction. This is called gastritis. Gastric mucosal responses against most of these irritants is with mucosal regeneration, therefore, such disorders often disappears by itself.

With a constant irritation, tissue becomes inflamed and bleeding can occur.

With the introduction of substances such as acids and strong bases which are corrosive resulting in inflammation and necrosis of the wall of the stomach (corrosive gastritis). Necrosis may result in perforation of the stomach wall to the next due to bleeding and peritonitis.

Chronic gastritis may lead to a state of atrophy of the gastric glands and mucous circumstances there are patches of thickened gray or gray-green (atrophic gastritis). The loss of the gastric mucosa will ultimately result in reduced secretion of the stomach and the emergence of pernicious anemia. Atrophic gastritis may be the prelude to gastric carcinoma. Chronic gastritis may also occur simultaneously with peptic ulcer or may occur after gastroyeyunostomía action.

Nursing Diagnosis for Skin Infections related to Fungi, Bacteria and Viruses

Nursing Diagnosis for Skin Infections related to Fungi, Bacteria and Viruses

Skin Infections   November 06, 2015

Infection is the process of invasive organisms and proliferate in the body that cause disease (Potter & Perry, 2005). Meanwhile, the skin infection is a disease caused by a bacteria / germs, viruses, fungi.

Bacterial Infections (Pyoderma)

Bacterial infections of the skin can be primary or secondary. Primary skin infections originated from previous skin looks normal, and usually these infections are caused by one type of microorganisms. Secondary skin infections caused by skin disorders preexisting or due to disruption of the integrity of the skin due to injury or surgery. In both these circumstances, some types of microorganisms can be involved, such as Staphylococcus aureus or group streptokus A. Primary bacterial infection that most often the case, among others:

• Bullous impetigo. Is a superficial infection of the skin caused by Staphylococcus aureus, characterized by bullae formation of vesicles origin. The bullae rupture and leave red lesions as well as wet.
• Folliculitis. A staphylococcal infections arising in the hair follicle. Lesions can be either superficial or deep. Often seen on the chin area men who shave the beard and the limbs of women.
• Pseudofolliculitis barbae ("shaving bumps"). An inflammatory reaction in the face of curly haired man who happens because hair growth inward, piercing the skin and trigger irritating reactions.
• Furuncles (boils). Is an acute skin inflammation resulting in one or more hair follicles and spread to the surrounding dermis layer. More often occurs in areas of irritation, such as: posterior neck, axilla or gluteus.
• Carbuncles. An abscess on the skin and subcutaneous tissue depicting expansion of a furuncle that have invaded several pieces of hair follicles. Carbuncles most often found in areas where the skin is thick and inelastic.

Virus Infection

The most common infection is herpes zoster. Shingles is a viral inflammatory disorder, in which the virus causes vesicular eruptions that cause pain along the sensory nerve distribution of one or more posterior ganglion.


Mycotic Infection (Fungus)

Fungus (mushroom) which is a member of the plant world are small and eating of organic matter, is the cause of various types of skin infections which are often found, among other things:

• Tinea pedis (foot fungus / athlete's foot). Is a fungal infection that most often found. These infections often affects adolescents and young adults although can occur in any age group as well as male and female.
• Tinea corporis (body fungal disease). Affects the face, neck, trunk and extremities. At the infected part will look ring-shaped lesions, or circle typical.
• Tinea capitis (scalp fungal disease). Is a contagious fungal infection that attacks the hair shaft and causes of hair loss are often found among children.
• Tinea cruris (groin fungal disease). Is a fungal infection of the groin that extends to the inner thighs and buttocks. Most often occurs in younger runners, people who are obese and who wear underwear too tight.
• Tinea unguium (onychomycosis). Is a chronic fungal infection of the toenails or fingernails. Usually accompanied by a fungal infection that is long in the legs.

Nursing Diagnosis for Skin Infections related to Fungi, Bacteria and Viruses

1. Acute Pain related to peripheral nerve damage.
2. Hyperthermia related to the inflammatory process.
3. Impaired skin integrity related to damage to the structure of the dermis layer.
4. Disturbed body image related to the lesions and skin structure changes.
5. Anxiety related to the disease process.

Erythrasma - Definition, Causes, Symptoms and Prevention

Erythrasma - Definition, Causes, Symptoms and Prevention

Health Articles   November 06, 2015

Erythrasma

DEFINITION

Erythrasma is an infection of the top layers of the skin caused by the bacterium Corynebacterium minutissimum.


CAUSE

Bacterium Corynebacterium minutissimum. Erythrasma common in adults and diabetics; The most commonly found in the tropics.


SYMPTOMS

Often found in areas where skin contact with the skin, such as under the breasts and armpits, between the toes and the genital area (especially in men, where the thighs touch the scrotum). Infection causes the formation of patches of pink with irregular shapes, which will then be transformed into smooth scales brown.

In some patients, the infection spreads to the torso and anal area. Could itching that are mild.


PREVENTION

Some actions can be done to reduce the risk of Erythrasma:

• Maintain cleanliness of the body.
• Keep skin dry.
• Using clean clothes with materials that absorb sweat.
• Avoiding excessive heat or moisture.

Nursing Diagnosis for Acute and Chronic Pancreatitis

Nursing Diagnosis for Acute and Chronic Pancreatitis

Pancreatitis   November 05, 2015

Acute and Chronic Pancreatitis

Pancreatitis is inflammation in the pancreas.
There are two types of pancreatitis, acute and chronic.

Acute pancreatitis
Acute pancreatitis is a serious condition where the pancreas becomes inflamed over a short period of time.

Symptoms most commonly begins with abdominal pain in the middle or upper left part of the abdomen and may increase after eating or lying flat the back.
Other symptoms :

• nausea,
• fever,
• rapid heartbeat, and
• dehydration.
• severe acute pancreatitis symptoms and signs may show skin discoloration around the belly button or the side of the body between the ribs and hip (flank), or small erythematous skin nodules.

Chronic pancreatitis
Chronic pancreatitis is a condition where the pancreas becomes permanently damaged due to inflammation.

Symptoms may or may not include abdominal pain that may include :

• bleeding due to anemia,
• liver problems (jaundice),
• weight loss,
• nutritional deficiencies, and
• inability to produce insulin resulting in diabetes.

Causes of acute and chronic pancreatitis are similar; about 80%-90% are caused by alcohol abuse and gallstones (about 35%-45% for each); while the remaining 10%-20% are caused by

• medications,
• chemical exposures,
• trauma,
• hereditary diseases,
• infections,
• surgical procedures, and
• high fat levels in the blood and genetic abnormalities with pancreas or intestine

Nursing Diagnosis for Acute and Chronic Pancreatitis

1. Ineffective breathing pattern related to a decrease in oxygen entering the lungs.
2. Impaired tissue perfusion related to a decrease in blood supply to the tissues.
3. Fluid volume deficit related to a decrease in the amount of fluid in the intravascular.
4. Acute pain related to abdominal distention capsule.
5. Fluid volume related to the buildup of excess fluid in the peritoneal cavity.
6. Hyperthermia related to an infection of the peritoneum and gallbladder.

Altered urinary elimination related to a decrease in urine output.
Risk for imbalanced nutrition: less than body requirements related to nausea and vomiting.
Activity intolerance related to a decrease in the formation of energy.

Definition, Causes and Symptoms of Non-typhoidal Salmonella Infections

Definition, Causes and Symptoms of Non-typhoidal Salmonella Infections

Non-typhoidal Salmonella Infections   November 04, 2015

Non-typhoidal Salmonella Infections

DEFINITION

Non-typhoidal salmonella infections are infections caused by salmonella bacteria that do not cause typhoid fever.


CAUSES

Salmonella bacterium. There are 2200 species of Salmonella, including the type that causes typhoid fever. Every type can cause disturbances in digestion, enteric fever, and specific localized infections.

Salmonella is found in infected meat, poultry, raw milk, eggs and processed eggs. Salmonella can also be found in reptiles that are kept, deep red dye.


SYMPTOMS

Salmonella infections can cause gastrointestinal or enteric fever; sometimes the infection is only about a specific part. Some people who are infected may have no symptoms, but they act as carriers of these bacteria.

Gastrointestinal disorders usually begin to occur within 12-48 hours after infection with Salmonella bacteria. Initial symptoms are nausea and cramping abdominal pain soon followed by diarrhea, fever, and sometimes vomiting. Usually diarrhea is very watery, but sometimes can be a semi-solid stool. This disorder is usually mild and lasts 1-4 days, but can last much longer. Diagnosis is reinforced by breeding bacteria in stool samples or rectal swabs of patients.

Enteric fever occurs when Salmonella into the blood. Fever causes tremendous fatigue. Bacteria can live and multiply in the digestive tract, blood vessels, heart valves, membranes of the brain and spinal cord, lungs, joints, bones, urinary tract, muscle or other organs. Sometimes the bacteria infect the tumor, thus forming an abscess which in turn can cause blood infections.

A carrier does not show symptoms but will continue to release the bacteria in the stool. Less than 1% of patients who went on to become carriers of the bacteria for a year or more.

Definition, Causes and Symptoms of Septic Shock

Definition, Causes and Symptoms of Septic Shock

Septic Shock   November 04, 2015

Septic Shock

DEFINITIONS

Septic shock is a condition in which blood pressure drops to levels that endanger lives as a result of sepsis.

Septic shock often occur in:

• newborn baby,
• age above 50 years, and
• people with immune system disorders.

CAUSES

Septic shock caused by toxins produced by certain bacteria and due to cytokines (substances made by the immune system to fight an infection). Toxins released by the bacteria can cause tissue damage and circulatory disorders.

Risk factors for septic shock:

• Chronic diseases (diabetes, blood cancer, genital-urinary tract, liver, gall bladder, intestine).
• Infection.
• Long-term use of antibiotics.
• Medical procedures or surgery.

SYMPTOMS

Early signs of septic shock is often a decrease in mental alertness and confusion that arise within 24 hours or more before the blood pressure falls. This phenomenon is caused by reduced blood flow to the brain. Outpouring of blood from the heart is indeed increased, but the blood vessels widen so blood pressure goes down. Breathing becomes fast so that the lungs secrete excessive levels of carbon dioxide in the blood decreases.

Early symptoms include shivering, body temperature rises very fast, warm and reddish skin, weak pulse and blood pressure fluctuated. Decreased urine production despite increased flow of blood from the heart. In later stages, the body temperature often drops to below normal.

When the shock worsens, several organs fail:

• Kidneys: urine production is reduced.
• Lungs: respiratory distress and decreased oxygen levels in the blood.
• Heart: fluid retention and swelling.

May develop blood clots in the blood vessels.