Thursday, September 30, 2010

Médula Renal

La médula renal es la parte del riñón ubicada internamente por debajo de la corteza renal. Se divide en 8 a 18 secciones llamadas pirámides renales. Dentro de la médula renal se encuentran localizadas las nefronas, alrededor de 1 millón en cada riñón. En comparación con el fluido que pasa por los túbulos renales, la médula renal tiene una concentración hipertónica, lo que permite la reabsorción de agua.

La médula renal es irrigada por la arteria renal, la cual se ramifica para formar las arterias arciformes, las cuales se localizan en el borde de la médula renal y son responsables de la circulación renal.

Médula renal

1: Parénquima
2: Corteza
3: Médula
4: Tejido adiposo
5: Cápsula
6: Uréter 7: Pelvis renal
8: Arteria renal y Vena renal
9: Hilo
10: Caliz

Wednesday, September 29, 2010

Vasa recta (riñón)

Los vasa recta son una serie de capilares rectos que irrigan la médula renal. Ubicados en paralelo al asa de Henle, los vasa recta se ramifican a partir de la arteriola eferente de las nefronas yuxtamedulares, que son las nefronas más cercanas a la médula, y se introducen en la médula renal, rodeando el asa de Henle. Transportando sangre a una velocidad muy lenta, cada vasa recta tiene la forma de un bucle.

La función de los vasa recta es la de aportar óxigeno y nutrientes a la médula renal, y la de retirar material de desecho del metabolismo. Los vasa recta realizan estas funciones sin alterar la hipertonicidad del intersticio medular.

Tuesday, September 28, 2010

Necrosis Papilar Renal

La necrosis papilar renal es una forma de nefropatía que se caracteriza por la necrosis de la papila renal, la cual es irrigada por la vasa recta.

Una nefropatía analgésica puede causar una necrosis papilar renal. El daño a la misma es acumulativa y la mayoría de los pacientes que padecen la necrosis papilar renal habrían ingerido por lo menos unos 20 kg de analgésicos a lo largo de sus vidas. Comparados con la aspirina y otros analgésicos no esteroides, el riesgo es mucho mayor con la ingesta de fenacetinas y acetaminófenos.

La necrosis papilar renal también puede ser causada por una diabetes mellitus, como así también por una pielonefritis aguda.

Monday, September 27, 2010

Cilindros epiteliales

Los cilindros epiteliales son cilindros urinarios compuestos por células epiteliales muertas y sus partículas desprendidas del túbulo renal. Cuando aparecen en un analisis de orina es muy grave, ya que por lo general los cilindros epiteliales son signos de una necrosis tubular renal.

Los cilindros epiteliales se forman por la descamación de la capa epitelial que reviste internamente el túbulo renal de la nefrona. El desprendimiento de células muertas epiteliales reflejan un daño severo al túbulo. Estas células muertas se adhieren unas a otra, formando estructuras de forma cilíndrica, las cuales se los distinguen por sus grandes núcleos y poca cantidad de citoplasma.

Los cilindros epiteliales pueden observarse en necrosis tubular aguda e ingestión de productos tóxicos, como mercurio.

Sunday, September 26, 2010

STRESS Part 2 How to Deal with it

As discussed in part 1, stress can be defined as the thoughts, feelings, behavioral and physiological changes that occur when the demands placed upon us exceed our perceived ability to cope. In other words, everyone experiences stress at some time, but how you deal with it can impact your quality of life. The following coping skills and lifestyle methods can help to prevent stress from taking a negative toll on your daily and long-term physical and mental health.

Regular Exercise
Exercise is one of the most effective stress management strategies. Aerobic activities such as jogging, swimming, kickboxing, or biking can help to relieve pressure and clear your mind. This type of exercise allows the body to release healthy chemicals in the brain called endorphins. Endorphins are similar to opiates in that they give our body and mind a “feel good” sensation. Regular exercise also eliminates the release of powerful stress hormones like cortisol. 
Remember, fifteen minutes of activity per day is all it takes to get your heart rate up. If you don’t have a lot of free time, try to incorporate physical activity into your everyday routine. Walk instead of taking the subway or bus, take the stairs instead of taking the elevator, or take a walk to pick the kids up from the bus stop instead of driving. In addition to the physical benefits of living an active lifestyle, exercise can build confidence and improve your mood by helping you stay fit. 


Peer Support
Fostering healthy friendships can also aid in the process of stress relief by providing emotional support. 
Talking with and seeking advice from your friends allows you to verbalize your thoughts, thus getting them off your chest. Once your friends listen to what’s troubling you, they may be able to offer a different perspective or help you work through the issue. You might be surprised to learn that your friends have been in a similar position in the past and can offer helpful advice. 
Beyond having a shoulder to lean on, it often helps to simply have people around. Being social satisfies the universal human need to come in contact with others. Surrounding yourself with those whose company you enjoy releases natural endorphins. Creating and maintaining relationships is a crucial part of a healthy social life. 


Relaxation Techniques 
Although it might seem impossible to relax when you are feeling high levels of stress, it is important to try. Effective approaches to relaxation include yoga, meditation, and breathing exercises which allow us to influence bodily functions that are ultimately out of our control like heart rate, blood pressure and digestion. 
As a breathing exercise, try inhaling for the same amount of time you exhale. This might be hard to do at first but will become easier with practice. This exercise should be done at least three times a week as a relaxation technique. Be mindful of where your breaths are coming from to ensure optimum oxygen flow. Breathing through your abdomen allows the oxygen in your body to circulate properly which in turn improves lung health. Practice the use of your abdomen as a breathing exercise. Place one hand on your chest and one hand on your stomach area. Take a deep breath in and see whether your chest or stomach rises higher. If your chest rises higher, you are not breathing ideally. Practice this a few times a week until you develops the proper technique. Using this method along with the inhaling and exhaling exercises will decrease stress while improving lung function and health. 

Sleeping Habits

Sleep is an essential part of a low stress life style. A routine that consists of a good eight hours of sleep, balanced diet, and daily exercise will make you less susceptible to stress and will allow you to deal with things more reasonably. A good night’s sleep is crucial for a productive, low stress day. In addition to the length of your sleep cycle, it helps to go to sleep around 10:00pm and wake up around 6:00 or 7:00am. Waking up early allows our body to re-energize before activities begin and also gives you time to eat a healthy breakfast. If you are not able to fall asleep, try listening to relaxing music or a white-noise sound machine. Watching television right before bed or sleeping with the lights on can disrupt the release of melatonin and serotonin in your brain. Eating right before bed makes you more susceptible to weight gain and nightmares. If you are feeling hungry before bed, heat up a glass of milk or drink chamomile tea. It’s best to avoid sweets and grains as they will increase your blood sugar which can contribute to weight gain and restlessness. 


Low Stress Living 
Stress is influenced by the internal health of our body, as well as our external environment. As humans, we are highly susceptible to stress and it is important that we try to reduce it and manage it in the most productive way possible. In order to be productive, it helps to maintain a healthy level of relaxation. Stress does not only affect you as an individual, but also affects those around you including your children, spouse and co-workers. By finding your own peace of mind, you can create a more peaceful environment and perpetuate a low stress lifestyle.

Saturday, September 25, 2010

Cilindros hialinos

Los cilindros hialinos son cilindros urinarios compuestos por partículas solidificadas de restos de la proteina Tamm Horsfall segregada por las células epiteliales de las nefronas. Son los cilindros más comunes que aparecen en la orina. Un bajo fluido de orina, u orina concentrada, y un ambiente ácido pueden contribuir a la formación de los cilindros hialinos.

La aparición de los mismos en un análisis de orina es común en individuos sanos luego de un período de ejercicios físicos muy rigurosos, en estado de deshidratación, o por ingesta de diuréticos. Los cilindros hialinos son de forma cilíndrica y claros, con un bajo índice refractivo. Es por eso que pueden pasar desapercibidos en un campo muy iluminado debajo del microscópio.


Cilindro hialino marcado con la flecha

Friday, September 24, 2010

STRESS Part 1 Get to know

Stress is defined as the body’s reaction to a change that requires a physical, mental or emotional adjustment or response. Any situation or thought that generates a feeling of frustration, anger, nervousness or anxiety can lead to stress. In modern society, where people are always competing against each other and trying to achieve so much in their life, almost everybody is said to be suffering from some amount of stress. But stress is not always bad. Some amount of stress in life is actually necessary as it motivates you to perform better. However, you should never allow stress to grow beyond a point where it breaks you down.
Stress is already a part of daily living. You may never know it but you are already affected by this issue. You shout at your kids or nag your partner about something. You seem to raise an issue out of a particular event even if it is not true. You also tend to be suspicious at some points. All these are due to stress.

Scientifically, stress is a state of high tension or pressure, resulting from an accident or injury or a psychological reaction of heightened emotional response. Certain occupations are particularly stressful, such as acting, advertising, controlling air traffic, politics, investing and gambling. As an effect of stressful emotions such as panic attacks, fear and anger, the blood pressure rises, the pulse beats faster, breathing is accelerated, digestion stops, and the adrenal glands become overactive.

Major Facts about Stress

The real issues behind stress can be best understood with a number of facts. Take a look at the following points:
1. It can be caused by many factors. Fear and anxiety are the greatest causes of psychological stress. In modern times people are constantly beset by the threat of calamities. They fear depression and inflation, unemployment, cancer and heart failure, missiles and bombs and famine. At home they may be confronted with marital incompatibility, quarrels, family illness, or financial troubles.
2. It can also cause something. Many illnesses are caused by mental stress, including ulcers, spastic constipation, diarrhea, high blood pressure and migraine headaches. Sometimes latent mental disorders are precipitated by stressful circumstances, as in the case of manic-depressive psychosis, schizophrenia, hysteria and neurasthenia.
3. It can worsen through time. When a person is subjected to repeated stresses, she is likely to develop what people call nervous breakdown, an unscientific but expressive term. The stress produced by the problems of everyday living has led to the widespread use of tranquilizers, a last resort when there seems to be no escape from a difficult situation.
4. It happens in daily living. Stress exists in almost every human activity and is not the same as nerve tension. Some stress is beneficial since it may stimulate action.
5. It can be lessened through healthy intimate relationships. Psychiatrists also found out that for the avoidance of excessive stress being married is better than being divorced or single.
6. There are major stressful events connected to it. Studies also showed that the death of a child is the most stressful of any life’s events. Other items include a jail sentence, major financial problems, divorce and the beginning of an extra-marital affair. Some of the environmental factors that may be related to stress are the status of health, the social class, and the size of the household.
7. There are also some stresses that cannot be controlled. Too much stress can show itself in various emotional, behavioral and physical signs, and the signs of stress differ extremely according to each individual.

Usual Physical, Emotional and Behavioral Signs of Stress

The physical indications of stress include sleep interruptions, tense muscles, annoyance, gastrointestinal problem, and exhaustion. Its emotional and behavioral indications consist of apprehension, fear, alterations in eating practices, depleted energy, and mood swings. All of the symptoms given cannot tell whether a person has an elevated stress level because these indications may be due to other medical or mental problems.
It is also a fact that persons in stress are most likely to maintain harmful activities like drug and alcohol addiction, excessive cigarette smoking, and poor eating habits. These harmful activities can extremely add to the severity of the indications connected to stress.
Remember that all people may be prone to stress – no matter what age you are in and no matter what status of life you have. The extent may vary also depending on how you take up the challenge that goes with it. If you have a support system with you, it is easy to do away with the situation. But at the worse, it may only lead you to panic attacks.


Therefore, the key to leading a happy life is learning to manage stress effectively. In case, you suffer from situations which are bound to be stressful such as a loss of a loved one, divorce or a loss of a job, you can enroll yourself for stress relief treatment and take control of your life.


Stress and illnesses 

Stress is the root cause of many illnesses. Every year millions of people lose their life because of heart disease, strokes and various forms of cancers caused primarily because of stress. Besides, stress is the root cause of many stomach problems such as constipation or diarrhea that can eventually lead to serious conditions such as ulcers. Headache and migraine can also be caused because of stress. Your skin may also get affected because of stress. Chronis stress is also known to weaken the immune system which makes you prone to frequent colds and upper respiratory infections. Stress can also cause depression and various types of anxiety disorders.

Stress management
 

Stress management is mainly the ability to take control of your emotions and reactions when situations, people and events make excessive demands. Your attitude towards a stressful situation plays an important role in successful stress management. Usually, people who have a negative attitude will report more stress than people with a positive attitude to life.
If you keep a record of situations that caused you stress, you’ll notice that a lot of stress in life can be avoided by simply altering the way you perceive that particular situation. The other effective way to reduce stress is through better time management. For instance, by making a habit of reaching a few minutes prior to the scheduled time can help you reduce a lot of stress in life. Taking a well-balanced diet at regular intervals and regular physical exercise can also help you calm down and thereby reduce the stress in your life.

Stress relief treatment


If you are reeling under the pressure of stress and find it tough to manage it on your own, it is time you take some stress relief treatment. You may try practicing yoga and other forms of meditation to calm yourself. You can spend more time in pursuits such as music, painting, dancing, sports or anything that interests you. Most importantly, do not become a silent recluse. Find someone that supports you. Somebody in your family or your friends will be willing to help you come out of stress. If you are still unable to come out of stress, take help from a counselor who can help you take control of your life and live positively. 

Cilindros cerosos

Los cilindros cerosos son cilindros urinarios mucho más grandes que los cilindros hialinos, con una consistencia lisa y extremos cuadrados como si fueran frágiles y fácil de quebrar. Comparados con los cilindros hialinos, los cilindros cerosos poseen un índice refractivo mucho más elevado y por lo tanto son mucho más facil para observarlos debajo del microscópio. La aparición en la orina de los cilindros cerosos delata una enfermedad renal avanzada o insuficiencia renal crónica, ya que indican daños severos en el túbulo renal.

Thursday, September 23, 2010

Erikson's Theory of Psychosocial Development

Psychosocial Development in Infancy and Early Childhood

By , About.com Guide


What is Psychosocial Development?

Erik Erikson’s theory of psychosocial development is one of the best-known theories of personality in psychology. Much like Sigmund Freud, Erikson believed that personality develops in a series of stages. Unlike Freud’s theory of psychosexual stages, Erikson’s theory describes the impact of social experience across the whole lifespan.

One of the main elements of Erikson’s psychosocial stage theory is the develoment of ego identity.1 Ego identity is the conscious sense of self that we develop through social interaction. According to Erikson, our ego identity is constantly changing due to new experience and information we acquire in our daily interactions with others. In addition to ego identity, Erikson also believed that a sense of competence also motivates behaviors and actions. Each stage in Erikson’s theory is concerned with becoming competent in an area of life. If the stage is handled well, the person will feel a sense of mastery, which he sometimes referred to as ego strength or ego quality. If the stage is managed poorly, the person will emerge with a sense of inadequacy.

In each stage, Erikson believed people experience a conflict that serves as a turning point in development. In Erikson’s view, these conflicts are centered on either developing a psychological quality or failing to develop that quality. During these times, the potential for personal growth is high, but so is the potential for failure.

Psychosocial Stage 1 - Trust vs. Mistrust

  • The first stage of Erikson’s theory of psychosocial development occurs between birth and one year of age and is the most fundamental stage in life.

  • Because an infant is utterly dependent, the development of trust is based on the dependability and quality of the child’s caregivers.

  • If a child successfully develops trust, he or she will feel safe and secure in the world. Caregivers who are inconsistent, emotionally unavailable, or rejecting contribute to feelings of mistrust in the children they care for. Failure to develop trust will result in fear and a belief that the world is inconsistent and unpredictable.

Psychosocial Stage 2 - Autonomy vs. Shame and Doubt

  • The second stage of Erikson's theory of psychosocial development takes place during early childhood and is focused on children developing a greater sense of personal control.

  • Like Freud, Erikson believed that toilet training was a vital part of this process. However, Erikson's reasoning was quite different then that of Freud's. Erikson believe that learning to control one’s body functions leads to a feeling of control and a sense of independence.

  • Other important events include gaining more control over food choices, toy preferences, and clothing selection.

  • Children who successfully complete this stage feel secure and confident, while those who do not are left with a sense of inadequacy and self-doubt.

Psychosocial Stage 3 - Initiative vs. Guilt
  • During the preschool years, children begin to assert their power and control over the world through directing play and other social interaction.

  • Children who are successful at this stage feel capable and able to lead others. Those who fail to acquire these skills are left with a sense of guilt, self-doubt and lack of initiative.

Psychosocial Stage 4 - Industry vs. Inferiority

  • This stage covers the early school years from approximately age 5 to 11.

  • Through social interactions, children begin to develop a sense of pride in their accomplishments and abilities.

  • Children who are encouraged and commended by parents and teachers develop a feeling of competence and belief in their skills. Those who receive little or no encouragement from parents, teachers, or peers will doubt their ability to be successful.

Psychosocial Stage 5 - Identity vs. Confusion

  • During adolescence, children are exploring their independence and developing a sense of self.

  • Those who receive proper encouragement and reinforcement through personal exploration will emerge from this stage with a strong sense of self and a feeling of independence and control. Those who remain unsure of their beliefs and desires will insecure and confused about themselves and the future.

Psychosocial Stage 6 - Intimacy vs. Isolation
  • This stage covers the period of early adulthood when people are exploring personal relationships.

  • Erikson believed it was vital that people develop close, committed relationships with other people. Those who are successful at this step will develop relationships that are committed and secure.

  • Remember that each step builds on skills learned in previous steps. Erikson believed that a strong sense of personal identity was important to developing intimate relationships. Studies have demonstrated that those with a poor sense of self tend to have less committed relationships and are more likely to suffer emotional isolation, loneliness, and depression.

Psychosocial Stage 7 - Generativity vs. Stagnation

  • During adulthood, we continue to build our lives, focusing on our career and family.

  • Those who are successful during this phase will feel that they are contributing to the world by being active in their home and community. Those who fail to attain this skill will feel unproductive and uninvolved in the world.

Psychosocial Stage 8 - Integrity vs. Despair

  • This phase occurs during old age and is focused on reflecting back on life.

  • Those who are unsuccessful during this phase will feel that their life has been wasted and will experience many regrets. The individual will be left with feelings of bitterness and despair.

  • Those who feel proud of their accomplishments will feel a sense of integrity. Successfully completing this phase means looking back with few regrets and a general feeling of satisfaction. These individuals will attain wisdom, even when confronting death.

Source :
http://psychology.about.com

Cilindros granulosos

Los cilindros granulosos son cilindros urinarios que están formados por fragmentos de células muertas con restos de proteinas plasmática (como albúmina). De acuerdo al tamaño, los cilindros granulosos se pueden clasificar en finos o gruesos. Esta clasificación no tiene importancia en el diagnóstico. El aspecto general de los mismos es la de una forma de cigarro y de un índice refractivo más elevado que los cilindros hialinos.

Los cilindros granulosos son evidencia de una enfermedad renal crónica, pero también se los pueden observar en la fase de recuperación de una insuficiencia renal aguda. También se los pueden observar temporariamente en pequeña cantidad luego de ejercicios físicos muy rigurosos.


Imagenes de cilindros granulosos

Wednesday, September 22, 2010

Nursing Care Plan for Dengue Hemorrhagic Fever (DHF)

Nursing Care Plan for Dengue Hemorrhagic Fever (DHF)

Dengue Hemorrhagic Fever

Dengue hemorrhagic fever is a severe, potentially deadly infection spread by certain species of mosquitoes (Aedes aegypti).


Causes

Four different dengue viruses are known to cause dengue hemorrhagic fever. Dengue hemorrhagic fever occurs when a person catches a different type dengue virus after being infected by another one sometime before. Prior immunityimmunity to a different dengue virus type plays an important role in this severe disease.

Worldwide, more than 100 million cases of dengue fever occur every year. A small number of these develop into dengue hemorrhagic fever. Most infections in the United States are brought in from other countries. It is possible for a traveler who has returned to the United States to pass the infection to someone who has not traveled.

Risk factors for dengue hemorrhagic fever include having antibodies to dengue virus from prior infection and being younger than 12, female, or Caucasian.


Symptoms

Early symptoms of dengue hemorrhagic fever are similar to those of dengue fever, but after several days the patient becomes irritable, restlessrestless, and sweaty. These symptoms are followed by a shockshock -like state.

Bleeding may appear as tiny spots of blood on the skin (petechiaepetechiae) and larger patches of blood under the skin (ecchymosesecchymoses). Minor injuries may cause bleeding.

Shock may cause death. If the patient survives, recovery begins after a one-day crisis period.

Early symptoms include:

* Decreased appetite
* Fever
* Headache
* Joint aches
* MalaiseMalaise
* Muscle aches
* Vomiting

AcuteAcute phase symptoms include:

* Restlessness followed by:
o Ecchymosis
o Generalized rash
o Petechiae
o Worsening of earlier symptoms
* Shock-like state
o Cold, clammy extremities
o Sweatiness (diaphoretic)


Nursing Care Plan for Dengue Hemorrhagic Fever (DHF)


Assessment
Assessment is the initial phase of the nurse to obtain the required data before performing nursing care. assessment in patients with "DHF" can be done with the interview technique, measurement, and physical examination. As for step-stages include:
* Identify potential sources and are available to meet patient needs.
* Assess the patient's medical history.
* Assess the increase in body temperature, signs of hemorrhage, nausea, vomiting, no appetite, heartburn, sore muscles and joints, signs of shock (rapid and weak pulse, hypotension, cold and moist skin, especially on the extremities, cyanosis, agitation, decreased consciousness).


Nursing Diagnosis and Intervention

1. Disorders of body fluid volume is less than body requirements related to increased capillary permeability, bleeding, vomiting and fever.

Objective: Disorders of body fluid volume can be solved
Result Criteria :
* Volume of body fluids back to normal

Intervention :
* Assess the patient's general condition and the condition
* Observation of vital signs (Temperature, Pulse)
Observation * signs of dehydration
* Observations drip infusion, and the location of the insertion of intravenous needles
* Balance fluid (the fluid input and output)
* Give the patient and family encourage patients to drink plenty
* Instruct the patient's family to change his clothes soaked in patients
sweat.

Colirio

Un colirio es una solución estéril de una o varias sustancias medicamentosas en un vehículo acuoso, destinadas a su instilación en el saco conjuntival.

Los componentes de un colirio vienen determinados por el grado de cumplimiento de las propiedades descriptas. El mismo puede estar compuesto de: solución base, principio activo, agentes antimicrobianos, agentes reguladores de la tonicidad, agentes reguladores del pH, incluidas soluciones tampón, y agentes viscosantes.

El colirio puede estar indicado para tratar la conjuntivis, uveitis, glaucoma, o xerocidad conjuntival.

Presbicia

La presbicia es un defecto de la vista que se caracteriza por la pérdida de capacidad del cristalino de enfocar los objetos cercanos. Este defecto está asociado a la edad y va empeorando a medida que se envejece. La presbicia es causada por la pérdida de elasticidad del cristalino, el cual es un lente biconvexo cuya forma canvia, por la acción de los músculos ciliares, para el enfoque lejano y cercano.

La presbicia aparece por lo general entre los 40 y 50 años de edad, cuando la capacidad de enfocar los objetos cercanos comienza a disminuir lentamente, desde las 20 dioptrías (habilidad de enfoque a 50 mm de distancia) en un niño hasta 0,5 o 1 dioptría (enfoque entre 1 y 2 m de distancia) a los 60 años.

En la presbicia el punto de enfoque queda detrás de la retina. Los primeros síntomas que la mayoría de las personas afectadas notan es la dificultad de leer letras pequeñas, en especial cuando hay mala iluminación, como así también cansancio de vista debido al esfuerzo para leer. Con el tiempo las letras u objetos cercanos se vuelven borrosos.

Para el tratamiento de la presbicia el oftalmólogo indica el uso de lentes convexas con una graduación adecuada que oscila habitualmente entre 1 y 3 dioptrias. Mediante su uso se debería poder leer con claridad a una distancia de 15 cm. Antes de adquirir las gafas es recomendable una visita al oftalmólogo u optometrista para que realice una valoración de la capacidad visual. Otra opción es el uso de lentes de contacto.


Tuesday, September 21, 2010

Degeneración Macular

La degeneración macular asociada a la edad es una enfermedad del ojo causada por el deterioro progresivo de la mácula, la cual es una capa amarillenta de tejido sensible a la luz que se encuentra en el centro de la retina. Esta region es responsable de la agudeza visual que nos permite percibir los detalles finos y pequeños. Cuando la mácula no funciona correctamente, las áreas del centro del campo visual empiezan a perder nitidez.

No solamente la edad avanzada, sino también un colesterol elevado y tabaquismo también pueden desencadenar la degeneración macular. La degeneración macular ocasiona diferentes síntomas en cada persona. En la cotidianidad podemos encontrar indicios de este enfermedad, como: líneas rectas que se ven distorsionadas, ver palabras borrosas, problemas para detallar y áreas oscuras o vacías en el centro de la visión.

La degeneración macular atrófica, o seca, está asociada con pequeños depósitos amarillos en la mácula que se llaman drusas. Presenta pérdida visual gradual y lenta. Si la degeneración macular atrófica afecta sólo a un ojo, los síntomas no sean notorios. Este tipo de degeneración macular no tiene ningún tratamiento eficaz y tan sólo puede frenarse su evolución para que no se pierda la visión por completo.

La degeneración macular asociada a la edad de tipo húmeda es la menos común y la más agresiva. Se desarrolla con la formación de vasos sanguíneos anormales en la parte posterior del ojo y cuando estos empiezan a presentar fuga líquida; ocasionando distorsión de la retina. Una de las posibles causas de esta forma de la enfermedad es la falta de oxígeno en la retina, que provoca un proceso de angiogénesis. El tratamiento suele ser cirugía láser o, recientemente, el uso de fármacos antiangiogénicos inyectados directamente en el ojo como el ranibizumab.


Monday, September 20, 2010

Vasos sanguíneos retinales

Los vasos sanguíneos retinales forman el sistema vascular de la retina. Éstos incluyen las bifurcaciones y ramificaciones de la arteria central retiniana y la vena central retiniana, como así también el círculo vascular del nervio óptico.

Los vasos sanguíneos que irrigan la parte interna de la retina están localizados en frente de la capa fotoreceptora, bloqueando el acceso de la luz. Éstos proyectan sombras que crean un patrón de ciego en el campo de visión que corresponde precisamente a la localización de los vasos sanguíneos más grande.

Saturday, September 18, 2010

Arteria Oftálmica

La arteria oftálmica es una bifurcación colateral de la arteria carótida interna destinada a la órbita. Ésta se ramifica aún más en las siguientes sub arterias: central de retiniana; lagrimal; ciliares cortas posteriores; ciliares largas posteriores; supraorbital; muscular inferior; muscular superior; etmoidal posterior; etmoidal anterior; palpebral superior, y palpebral inferior.

La arteria oftálmica se origina por dentro de las apófisis clinoides anteriores, penetra en la órbita por el conducto óptico, y por debajo y por fuera del nervio óptico da numerosas colaterales en el interior de la órbita, terminando en el ángulo interno del ojo mediante la arteria nasal.

Treatment for Pulmonary Tuberculosis

The goal of treatment is to cure the infection with drugs that fight the TB bacteria. Treatment of active pulmonary TB will always involve a combination of many drugs (usually four drugs). All of the drugs are continued until lab tests show which medicines work best.

The most commonly used drugs include:

* Isoniazid
* Rifampin
* Pyrazinamide
* Ethambutol

Other drugs that may be used to treat TB include:

* Amikacin
* Ethionamide
* Moxifloxacin
* Para-aminosalicylic acid
* Streptomycin

You may need to take many different pills at different times of the day for 1 year or longer. It is very important that you take the pills the way your health care provider instructed.

When people do not take their tuberculosis medications as recommended, the infection becomes much more difficult to treat. The TB bacteria may become resistant to treatment, and sometimes, the drugs no longer help treat the infection.

When there is a concern that a patient may not take all the medication as directed, a health care provider may need to watch the person take the prescribed drugs. This is called directly observed therapy. In this case, drugs may be given 2 or 3 times per week, as prescribed by a doctor.

You may need to be admitted to a hospital for 2 - 4 weeks to avoid spreading the disease to others until you are no longer contagious.

Your doctor or nurse is required by law to report your TB illness to the local health department. Your health care team will be sure that you receive the best care for your TB.

Source : http://www.nlm.nih.gov/medlineplus/ency/article/000077.htm

Friday, September 17, 2010

Arteria central de la retina

La arteria central de la retina, o arteria retiniana, es una bifurcación de la arteria oftálmica, recorriendo en forma paralela e inferior al nervio óptico, dentro de su vaina dural, hacia el glóbo ocular. La arteria retiniana penetra el nervio óptico cerca de la esclerótica y al entrar en el globo ocular envía ramificaciones hacia la superficie interna de la retina, siendo éstas el único suministro de sangre de la mayor parte de ella.

La fóvea y la mácula son las únicas partes de la retina que no son irrigadas por la arteria central retiniana, sino por la coroides, pero sí irriga todas las fibras nerviosas que van a formar el nervio óptico que transmite la información visual (impulsos nervios) hacia el cerebro.

Si la arteria central de la retina se ocluye (bloquea), se produce una pérdida completa de la visión en el ojo donde occurre la oclusión, aunque la fovea no sea afectada. En consecuencia toda la retina se torna pálida, inchada y opaca, y la fovea se vería como un punto rojizo.


Added sugar is the villain, not sugar nor fat!

Sugar exists in most foods we eat but sugar isn't nearly the bad guy. Sugar isn't a "slow poison," and doesn't cause cancer, diabetes, or heart disease, as some have claimed, nor is there evidence it causes behavior problems, such as hyperactivity. Small amounts of sugar have an important place in nutrition. For example, the only fuel the brain uses is sugar. There is some evidence showing sugar to have a calming effect on normal and hyperactive children. Too much sugar, on the other hand, like too much of anything, is detrimental to our health and eating too much sugar does contribute to tooth decay, obesity, constipation, and malnutrition. 
According to some expert, it's added sugar, not fat, that causes chronic overeating and adds extra pounds that won’t budge. Their solution: Slash sugar from the diet completely. Find out what the experts say about the truth--and the hype--when it comes to the sweet stuff.
Sugar Myth #1: You should eliminate all sugar from your diet.
First, a quick and painless science lesson: Sugars, aka carbohydrates, are made of carbon, hydrogen and oxygen. Individually, these strings of molecules are called monosaccharide, which include sugars such as fructose (found in fruit). Link two sets of molecules together and you have disaccharides, such as sucrose (table sugar) and lactose (the sugar found in milk). Combine a whole bunch of units, producing an even more complex molecule, and you've got starches and fiber.
And no matter what form you eat--from M&M to Lollypop--carbs contain 4 calories per gram, break down to simple sugars during digestion (except for fiber, which is indigestible) and are either used for immediate energy or stored for later. In other words, you need sugars in your diet to keep your body running. Most should come in the form of nutrient-rich starches like whole grains and cereals. You should also eat plenty of fruits, vegetables and low fat dairy products--which contain sugars, but also valuable vitamins, minerals and disease-fighting chemicals.
The kind of sugar that concerns health experts is added sugar--the sweeteners that are dumped into foods by manufacturers (and sometimes us, when we ladle out table sugar)--because most people eat way too much of it.  In fact, for the first time ever, experts identified added sugar as a part of our diet that we should limit. Why? Consuming lots of high-sugar foods such as cookies and soft drinks not only can lead to weight gain, but these foods often replace more nutritious fare.
If you eat a healthy diet and meet your nutritional needs on most days, you can still enjoy guilty pleasures like a decadently sweet dessert or an occasional sugary soda.  To give you an idea of how far your daily sugar quota goes one Hershey's milk chocolate bar has about 5 teaspoons of sugar, a Coke pack 10, and a 10-ounce Butterfinger McDonald's McFlurry contains nearly 14 teaspoons! 
Sugar Myth #2: It makes you fat.
Many diet books claim that sugar itself causes the body to store more food as body fat, and so even the natural sugars found in fruit should be avoided. But most health experts say that's misguided reasoning. Fruits and vegetables are loaded with good-for-you substances. The extra calories from added sugar in the diet are the real cause of unwanted pounds. Sugar is a significant factor when it comes to obesity, Obesity rates have raised as our intake of added sugar has climbed. If you eat a lot of empty calories, you run the risk of excessive calorie intake and weight gain.
Sugary soft drinks and fruit-flavored beverages, the biggest source of added sugar in the diet, may lead to extra pounds in an especially tricky way. Research has shown that the body doesn't compensate for calories taken in as liquid as it does for calories eaten as food (in other words, after gulping a 300-calorie supersize soda, you'll still eat the same-size dinner). Another pitfall of high-sugar diets that may lead to weight gain: People who eat larger amounts of sugar generally have worse diets.
Sugar Myth #3: White table sugar is the worst form.
Cookies sweetened with fruit juice may seem like a healthier option, but don't be fooled by this marketing trick. Whether you eat white table sugar or fruit juice, it all turns into glucose in your body. Despite certain diet-book claims that refined white sugar is "toxic," there's little difference between sweeteners (molasses does contain some calcium, but the quantity in an ordinary serving is too small to be significant). And even if a food is sweetened with fruit juice, the healthiest parts of the fruit--such as the fiber and disease-fighting phyto-chemicals--have been removed in the processing.
Sugar Myth #4: You can be addicted to sugar.
Wonder why sweet foods seem extra irresistible? Turns out we're born with an instinctive love of sweet foods--after all, in the hunting-and-gathering days, sweetness was a sign of a nourishing, high-calorie (not to mention nonpoisonous) food. If your desire for sugar seems especially uncontrollable, you may be hard-wired to desire sweet treats even more. Researchers recently located a gene that drives a preference for sweet foods. But a lust for candy and doughnuts is probably more bad habit than true addiction. You can adapt to a lower-sugar diet by cutting a candy bar into thirds, eating one piece and freezing the rest for later. It's all about portion control.
Sure, a healthy diet can still include reasonable amounts of your favorite sugary treats. But chances are, you're taking in a lot of extra sweet stuff without even realizing it. Here are some painless ways to shave calories from sneaky sugar sources;
* Pass up sweetened yogurts--which can contain as much as 7 teaspoons of added sugar--and go with no-sugar-added varieties. Or slice fresh fruit into plain varieties.
* Learn to spot sugar's aliases: If dextrose, fructose, maltose, malt syrup, sucrose or corn syrup appear first or second in the ingredient list, the food is high in added sugar.
* consider sugary sodas a treat--as you would dessert--and regularly opt for water, nonfat milk, 100 percent fruit juice, or seltzer flavored with lemon or lime instead.
* Buy breakfast cereals with no more than 8 grams of sugar per serving.
* Choose fresh fruit over canned varieties packed in syrup, which are full of added sugar.
* Split oversized restaurant desserts with several friends, or box up the rest for later in the week.
* When baking, cut the amount of sugar you use by one-fourth or one-third.
* Check labels of packaged food billed as "low fat" or "fat free": They may have as much sugar (or more!) as the full-fat version.

Thursday, September 16, 2010

Sistema inmune ocular

El sistema inmune ocular, o sistema inmunológico ocular, protege al ojo humano de infecciones y regula los procesos de sicatrización luego de una herida. El interior del ojo carece de vasos linfáticos pero está altamente vascularizado, y muchas células inmunes residen en la úvea, incluyendo macrófagos, células dendríticas, y mastocitos. Estas células del sistema inmunológico ocular combaten las infecciones e inflamaciones intraoculares que se pueden manifestar como consecuencia de una uveitis, iritis, o retinitis.

La córnea del ojo es un tejido inmunológicamente muy especial, ya que se encuentra expuesta en forma constante al mundo exterior. De modo que es vulnerable a una amplia gama de microorganismos al tiempo que su superficie de mucosa húmeda la hacen particularmente susceptible a los ataques. También carece de un sistema vascular que transporte glóbulos blancos. Es por ello que la defensa inmunológica es una tarea dificil. Sin embargo la repuesta inmune de la córnea viene de los tejidos vascularizados que la rodean, como los procesos ciliares, como así también de células de repuesta inmunológica que residen dentro de la córnea como los queratocitos, que son fibroblástos de la córnea. Otro componente del sistema inmune ocular de la córnea son las lágrimas que limpia su superficie cuando ésta es atacada por micropartículas.

Wednesday, September 15, 2010

Genes de la miopía

Dos estudios internacionales, que fueron publicados esta semana en la revista Nature Genetics, examinaron el ADN de miles de voluntarios y descubrieron dos regiones de genes cuyas funciones están relacionadas con la retina y que presentan variaciones asociadas con la miopía y otros errores de refracción del ojo, tales como la hipermetromía o el astigmatismo.

Según publicó el diario El Mundo, los autores admiten que debe haber más variables genéticas involucradas, pero confían en que sus resultados sirvan para conocer mejor los mecanismos de la miopía y demás enfermedades relacionadas. En un futuro, aventuran, podría someterse a los niños a pruebas para determinar si están predispuestos a tener problemas de visión. Además, conocer los genes involucrados podría ayudar a crear nuevas medicinas y tratamientos que detengan el avance de la dolencia.

El mismo número de Nature Genetics destacó que un tercer estudio encontró una variable genética relacionada con el glaucoma, una de las mayores causas de ceguera a nivel mundial, que provoca daños en el nervio óptico y causa ceguera progresiva. El científico australiano Stuart MacGregor, participó desde el Instituto de Investigación Médica Queensland, en Australia del estudio y reveló que descubrieron ” un nuevo gen para la miopía, otros que afectan al glaucoma, y uno que causa hipoplasia (desarrollo incompleto) del nervio óptico”.

“Análisis genéticos a gran escala, como éstos, pueden aumentar nuestra comprensión de muchas enfermedades”, comentó MacGregor. Estas investigaciones, conocidas como GWAS (siglas en inglés de Amplios Estudios de Asociación Genética), desataron una “gran euforia” hace unos años, según explicó el doctor José Miguel García Sagredo, jefe de servicio de Genética del Hospital Universitario Ramón y Cajal.

Si bien según este experto, no cumplieron todas las expectativas que despertaron hace una década, en plena ‘fiebre’ del genoma, lo cierto es que aún pueden ser muy útiles: “Si vemos qué genes están relacionados con una enfermedad, podremos saber cómo se desarrolla y tendremos nuevas dianas terapéuticas, algo sobre lo que actuar para curar, paliar, prevenir o estar sobre aviso”.

Uno de los problemas puede ser que los resultados obtenidos en una población determinada no sean replicables en otras. En este caso, los estudios sobre la miopía contaron con más de 5 mil voluntarios en Holanda e Inglaterra, mientras que en el del glaucoma participaron más de 40 mil personas.

Tuesday, September 14, 2010

Ora serrata

La ora serrata es la porción más anterior de la retina donde se continúa con el cuerpo ciliar. Posee un borde dentellado formado por unas cincuenta prominencias a modo de dientes que apuntan hacia delante, entre las cuales se encuentran otros tantos valles, recordando por lo tanto su forma a la de una sierra vista de perfil.

La ora serrata es la parte más periférica de la retina, ubicandose en el extremo anterior a la porción central y sensible de la misma que se llama mácula. Esta zona de empalme o confluencia entre la retina y el cuerpo ciliar, conocida como ora serrata, marca la transición entre el área que no es fotosensitiva y la compleja región de varias capas sensibles a la luz.


Monday, September 13, 2010

History of Nursing Models

History of Nursing Models

There is no specific date and place nursing theory took place. The evolution of nursing is not a new process, it has been in occurrence since the most basic of medical interventions started to be practiced. Within the western model of nursing there is a clear progression of nursing from mothers, to nuns, to doctor "assistants", to finally being recognized as a separate, complementary role in the medical team. Presently nurses have more autonomy than ever, and on going theory development and an exploration of professional borders are essential for the continued growth of the professional.

Major Nursing Theorists :

* Helen Erickson
* Virginia Henderson
* Imogene King
* Madeleine Leininger
* Betty Neuman
* Dorothea Orem
* Ida Jean Orlando (Pelletier)
* Hildegard Peplau
* Rosemarie Rizzo-Parse
* Isabel Hampton Robb
* Martha E. Rogers
* Callista Roy
* Katharine Kolcaba
* Katie Eriksson
* Dr. Jean Watson
* Paterson & Zderad
* Boykin & Schoenhofer

According to nursing history the most famous of all nurses is Florence Nightingale. Nightingale never actually devised a nursing theory science but was recognized with same by others who considered her personal works and communications into a theoretical framework such as her well-known value of nursing which is Bedside Care Nursing.

en.wikipedia.org

Tropicamida

La tropicamida es un fármaco anticolinérgico utilizado en oftalmología como mediador medriático. Esto quiere decir que es una droga parasimpatolítica que provoca medriasis (dilatación pupilar) y ciclopegia (paralisis del músculo ciliar). La tropicamida es utilizada previamente a una exploración de fondo de ojo y en ocasiones tras una intervención quirúrgica ocular. Las gotas cicloplégicas se emplean también en el tratamiento de la uveitis anterior por disminuir el riesgo de formación de sinequias e inflamación en la cámara anterior del ojose utiliza previamente a una exploración de fondo de ojo y en ocasiones tras una intervención quirúrgica ocular. Las gotas cicloplégicas se emplean también en el tratamiento de la uveitis anterior por disminuir el riesgo de formación de sinequias e inflamación en la cámara anterior del ojo.

El efecto de la tropicamida dura entre cuatro y seis horas. Puede utilizarce asociada a fármacos simpaticomiméticos que causan estimulación directa del músculo dilatador del iris, lo que aumenta su acción dilatadora sobre la pupila. En Estados Unidos la sustancia simpaticomimetica mas utilizada en asociación con la tropicamida en la fenilefrina.

Efectos colaterales

La tropicamida provoca un aumento leve y transitorio de la presión intraocular en la mayoría de las personas a las que se administra. También puede ocasionar ojo rojo, conjuntivitis y alteraciones en la capacidad visual durante un corto espacio de tiempo tras su administración, por lo que no se debe conducir antes de recuperar la visión normalLa tropicamida produce un aumento leve y transitorio de la presión intraocular en la mayoría de las personas a las que se administra. También puede ocasionar ojo rojo, conjuntivitis y alteraciones en la capacidad visual durante un corto espacio de tiempo tras su administración, por lo que no se debe conducir antes de recuperar la visión normal.

NANDA Approved Nursing Diagnosis 2009-2011

NANDA Nursing Diagnoses 2009-2011 : Definitions and Classification

NANDA Approved Nursing Diagnosis 2007-2008 contains 188 nursing diagnosis, latest NANDA-I Approved Nursing Diagnosis 2009-2011 contains an additional 21 new nursing diagnosis, 9 revisions diagnosis and some of diagnosis are not used again. Total nursing diagnosis at this time is 205 nursing diagnosis.

Nanda I usually revised every 2 years, but this time NANDA I publish a list of NANDA Nursing Diagnosis for period of three years.

for complete list of NANDA Approved Nursing Diagnosis 2009-2011, --> here <--

Saturday, September 11, 2010

Núcleo geniculado lateral

El núcleo geniculado lateral es el centro de procesamiento primario de la información visual que llega de la retina del ojo humano. El núcleo geniculado lateral se encuentra ubicado dentro del tálamo, en la base del cerebro, y, por lo tanto es parte del sistema nervioso central. Consta de varias capas de células nerviosas y de sostén, alternadas con capas de neuropilos.

El núcleo geniculado lateral recibe la información directamente desde las células ganglionares retinales ascendentes, a través del tracto óptico y del sistema reticular activador. Las neuronas de este centro de información visual envían sus axones, a través de la radiación óptica, hacia la corteza visual primaria, que rodea a la cisura calcarina, ubicado en lóbulo occipital.

El núcleo geniculado lateral también tiene conexiones desde la corteza visual primaria. En los seres humanos las dos vías más fuertes que unen la retina con el cerebro son aquellas que se proyectan hacia la parte dorsal del núcleo geniculado lateral del tálamo y hacia el colículo superior. Hay un núcleo genicualdo lateral en cada hemisferio cerebral.