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Ongoing support is an essential component of mastering goals and healthcare providers should advocate this type of support in conjunction with regular check-ups and in addition to support from family generic cefpodoxime 100 mg free shipping infection rate of ebola, friends and care providers purchase cefpodoxime 200 mg without prescription antibiotic chart. Implementation intentions and goal achievement: A meta-analysis of effects and processes order cefpodoxime 100 mg on-line infection bladder. We would like to gather information about your diabetes buy cefpodoxime 100mg lowest price antibiotics to treat staph, how it affects your life, how you self- manage your condition and whether or not you use a support group in doing so. To gather information, we are asking adults with type 2 diabetes to answer a survey. Right now, the study is at the preliminary stage and your responses to the survey will be useful in creating a survey that will be distributed to a larger patient population. There is no charge to you or your health insurance for completing the questionnaire. Like the information in your medical record, your responses to these questions will remain confidential; names and identifying information are not present on the questionnaire. While you will be asked to sign this form, this form will not be linked to your survey responses and you will not be identified in any reports on this study. The records of your responses will be kept confidential to the extent provided by federal, state and local law. The results of this study may result in your health care provider recommending that you seek support from other patients with diabetes if you should need it. As a token of our appreciation for your 272 participation in this study, you will receive a gift certificate valued up to $10 for a local grocery or pharmacy to be used as you desire. If you have any questions regarding the questionnaire or you feel confused by the questions, please either write down your comments on the questionnaire, or talk to me directly about your concerns. If you have questions or concerns about this study or feel that the study has caused you any harm, please contact Angela Hagan, at the Department of Clinical, Social and Administrative Sciences, 734- 615-8676 or Dr. I have discussed this study, its risks and potential benefits, and my other choices with. I understand that if I have more questions or concerns about the study or my participation as a research subject, I may contact one of the people listed above. I understand that I will receive a copy of this form at the time I sign it and later upon request. I understand that if my ability to consent for myself changes, either I or my legal representative may be asked to re‐consent prior to my continued participation in this study. For each item, please tell us how strongly the item describes how you feel about having diabetes. On a scale of 1: does not describe me at all 3: describes me moderatly well 5: describes me very well I believe there is nothing wrong with me I am certain that my diabetes will be cured I feel hopeful despite my diabetes I believe that my diabetes will go away by itself I feel that there is nothing I can do to help myself My diabetes must be a punishment for something I did in the past I am embarrassed or ashamed about having diabetes When I look at other people in good health, I get envious I blame myself for having diabetes I am worried about my diabetes I am angry about my diabetes I feel that nothing will ever be the same again My diabetes makes me feel lonely at times, even when I am with others 275 For each of the following questions, please tell us how strongly the item describes how you feel about the impact of diabetes on your life. I realize that diabetes is a part of me, but I do not let it interfere with my life. For each of the following items that mention things that are associated with diabetes, please indicate to what degree you agree or disagree. On a scale of 1: not at all 2: a very little bit 3: somewhat 4: moderately 5: quite a bit 6: very much 7: totally To what extent do you believe that diabetes can be controlled by monitoring blood glucose levels? To what extent do you believe that diabetes can be controlled by eating healthy foods? To what extent do you believe that diabetes can be controlled by avoiding certain foods? To what extent do you believe that diabetes can be controlled by physical exercise? How much does your family and friends accept you as a person with type 2 diabetes? For each of the following individuals, please rate the extent to which each individual assists you in caring for your diabetes. On a scale of 1: does not apply 2: not at all 4: moderately 6: considerably Spouse or significant other Children Other family Friends Paid helper Doctor Nurse Pharmacist Other person Other person (Please specify) 277 For the following individuals, please rate the extent to which your type 2 diabetes affects your relationships with each individual. On a scale of 1: does not apply 2: not at all 4: moderately 6: considerably Spouse or significant other Children Other family Care providers (doctor, nurse, pharmacist, etc. On a scale of 1:not at all 3: moderately 5: considerably Meeting work responsibilities Meeting household responsibilities Traveling as much as you want Being as active as you desire Having good relationships with people that are important to you Keeping a schedule you desire] Spending time with your family and friends Having enough alone time Do you wear or carry some kind of diabetes identification? Considering all these people and yourself as a group, please tell us to what extent each of the following applies to you personally. On a scale from 1: not at all 3: moderately 5: considerably To what extent do you think of yourself as a member of the group of all people with type 2 diabetes? How attached would you say you are to the group of all people with type 2 diabetes? How strong would you say your feelings of belongingness are towards the group of all people with type 2 diabetes? For the following questions, please rate the degree to which you agree with the statement about yourself as a person in general. On a scale of 1: strongly disagree 3: neither agree nor disagree 5: strongly agree On the whole, I am satisfied with myself. On a scale of 1: does not provide any care 2: provided care once 3: provides care every once and awhile 4: provides care regularly 5: provides all care General family physician Nurse Physician Assistant Diabetes Specialist (Endocrinologist) Pharmacist Other provider Other provider (please specify) During the past 3 months, please select the number of visits you made to each health care provider. On a scale of 1: no visits 2: one visit 3: two visits 4: three or more visits General family physician Nurse Physician Assistant Diabetes Specialist (Endocrinologist) Pharmacist Other provider Other (please specify what type of provider) At any of these visits, did that health care provider discuss setting goals to manage your diabetes? General family physician Nurse Physician Assistant Diabetes Specialist (Endocrinologist) Pharmacist Other provider Other (please specify what type of provider) For the following items, please rate the extent to which each item is a personal goal you have. On a scale of 1: not a goal at all for me 3: a moderate goal for me 5: a strong goal for me To monitor blood glucose levels regularly To eat healthy foods everyday To avoid eating certain foods everyday To engage in physical activity regularly To conduct foot exams regularly To take my diabetes medications as prescribed 280 Other goal and rating (1-5) For each of the following goals, please rate your degree of confidence in achieving the goal. On a scale of 1: not at all confident 3: moderately confident 5: very confident To monitor blood glucose levels regularly To eat healthy foods everyday To avoid eating certain foods everyday To engage in physical activity regularly To conduct foot exams regularly To take my diabetes medications as prescribed Other goal and rating (1-5) Mark the days during the last week that you achieved the following goals. On a scale of 1: have never done this 2: almost never 4: moderately often 6: very often Participate in support forums and chat rooms Read blogs or topics posted by others Post my own blog or topic Respond to blogs or topics posted by others Search for diabetes-related information on treatment (medications) Search for diabetes-related information on nutrition (diet tips, recipes) Set a diabetes-related goal and monitor my progress toward goal Please rate how often the following occurs in your online support group. On a scale of 1: this has never happened 2: happens sometimes 3: happens regularly 4: happens often 5: happens a lot Another member shows empathy toward you Another member consoles you Another member provides encouragement to you Another member pays you a compliment Another member reassures you Another member confides in you Please rate how often the following occurs in your online support group. On a scale of 1: this has never happened 2: happens sometimes 3: happens regularly 4: happens often 5: happens a lot You see yourself in the experiences other members post You feel as though you are not the only one You are a role model to other members You share your illness experience with other members You are looked upon to offer guidance and support 284 Please answer the following questions about the online diabetes support group you belong to. On a scale of 1: don’t identify at all 3: identify moderately with 5: identify very much with To what extent does your own self-image overlap with the image of those in your online diabetes support group? On a scale of 1: no overlap at all 3: moderate overlap 5: nearly total overlap How involved are you with your online diabetes support group? On a scale of 1: not involved at all 3: moderately involved 5: very much involved How attached are you to your online diabetes support group? On a scale of 1: not attached at all 3: moderately attached 5: very much attached How strong would you say your feelings of belongingness are with your online diabetes support group? On a scale of 1: not strong at all 3: moderately strong 5: very strong How committed are you to your online diabetes support group? On a scale of 1: not committed at all 3: moderately committed 5: very much committed To what degree does your membership in your online diabetes support group give you feelings of respect from others? On a scale of 1: very little respect 3: moderate respect 5: a lot of respect To what degree does your membership in your online diabetes support group give you feelings of admiration by others?
Hence if resistance is suspected in an area purchase cefpodoxime antibiotic 3 day, the preferred treatment would be with quinolones cheap cefpodoxime 200 mg with visa antibiotics for acne, azithromycin or third generation cephalosporins 21 Internal Medicine • Early use of antibiotics is associated with high rate of relapse (up to 20%) as compared to untreated cases (where the relapse rate is 5 - 10%) buy 200mg cefpodoxime infection in stomach. This is due to inhibition of adequate development of immune response by early therapy generic cefpodoxime 100 mg with amex antibiotic resistance arises due to quizlet. Co-trimexazole (160/800mg twice a day) plus Rifampicin 600mg orally/d for 6 weeks.. Identify the different features of the two types of borrelia and their clinical manifestations 7. Design appropriate methods of prevention and control of relapsing fever Definition Relapsing fever is an acute febrile illness caused by Borrelia species, presenting with recurrence of characteristic febrile periods lasting for days alternating with afebrile periods. Borrelia demonstrates remarkable antigenic variation and strain heterogeneity which help the parasite to escape the immune response of the host and result in recurrence of febrile episodes. In Ethiopia the diseases affects mostly homeless men living crowded together in very unhygienic circumstances especially during rainy seasons. Pathophysiology In humans, borreliae after entering the body multiply in the blood and circulate in great number during febrile periods. They are also found in the spleen, liver, central nervous system, bone marrow, and may be sequestered in these organs during periods of remission. Severity is related to spirocheatal density in blood but systemic manifestations are related to release of various cytokines. The disease is characterized by sub capsular and parenchymal hemorrhage with infarcts of spleen, liver, heart and brain is seen. Thus, patients will have enlarged spleen and liver with variable edema and swelling of brain, lung and kidneys. Complications:- Life threatening complications are unusual in otherwise healthy persons if the disease is diagnosed and treated early. Epistaxis, blood streaked sputum other bleeding tendencies Neurologic manifestations like iridocyclitis, meningitis, coma, isolated cranial nerve palsies, Pneumonitis, Myocarditis Spleenic rupture of spleen etc. Without treatment, symptoms intensify over 2-7 days period and subside with spontaneous crisis during which borrelia disappear from the circulation. Such cycles of febrile periods alternating with afebrile periods may recur several times. Define rickettsial diseases with Special Emphasis on Epidemic and Endemic Typhus 2. Identify the clinical manifestations of the different types of rickettsial diseases 8. Describe the most commonly used tests for the diagnosis of rickettsial diseases 10. Refer complicated cases of rickettsial diseases to hospitals for better management 12. Design appropriate methods of prevention and control of rickettsial diseases Definition: Rickettisiae are small intracellular bacteria that are spread to man by arthropod vectors, namely human body lice, fleas, ticks & larval mites. The organisms inhabit the gastrointestinal tract of these arthropods & spread to human host by the direct bite of the vector or the inoculation of the organism contained in the feces of the vector by bite induced body itching. These infections are characterized by persistence in the body, widespread vasculitis (invading endothelial cells of small blood vessels) & multi-system involvement. Except in louse borne typhus humans are accidental hosts in most rickettisial diseases. Classification Rickettsial diseases are classified into five general groups • Tick and mite borne spotted fever group • Flea and louse borne typhus group • Chigger borne scrub typhus • Ehrlichiosis • Q-fever 29 Internal Medicine Etiology and Epidemiology of Epidemic and Endemic Typhus : Epidemic Typhus (Louse born ): is caused by R. Lice acquire the rickettsia while ingesting a blood meal from an infected patient, the rickettsia multiply in the midgut epithelial cells of the louse and are excreted via louse faeces. The infected louse defecates during a blood meal and the patient autoinoculates the organisms by scratching. Humans and rats are infected when rickettsia –laden fleas are scratched in to pruritic bite lesions. Pathophysiology In man rickettsia multiply in the endothelial cells of capillaries causing lesions in the skin, brain, lung, heart, kidneys and skeletal muscles. Endothelial proliferation coupled with peri-vascular reaction causes thromboses and small hemorrhages. However, tissue and organ injury is commonly due to increased vascular permeability with resulting edema, hypovolemia and organ ischemia. This leads to multi-system involvement with complications such as non-cardiogenic pulmonary edema, cardiac dysrhythemia, encephalitis, renal and hepatic failure and bleeding. Clinical Features Signs and symptoms: • Incubation period of 1 week • Abrupt onset of illness with prostration, severe headache and rapidly rising fever of 38. Brill-Zinsser disease (recrudescent typhus): This is a mild form of epidemic typhus caused by reactivation of dormant R. Endemic typhus (Flea borne typhus) • Epidemic typhus (also known as murine typhus) is a relatively milder. Complications of Endemic and Epidemic Typhus Skin necrosis, gangrene of digits, Venous thrombosis Interstitial pneumonia in severe cases Myocarditis Oliguric renal failure Parotitis Diagnosis of rickettsial diseases is based on History, clinical course of the disease and epidemiologic of the disease may give a clue for diagnosis. Isolation of the organism by inoculation into laboratory animals is possible, it is time consuming and technically demanding. Delousing louse borne typhus Supportive Therapy Attention to fluid balance, prevention of bed sores, Treat agitation with diazepam Steroid treatment (prednisolone 20 mg daily for adults) in severe cases Prognosis: Untreated disease is fatal in 7 to 40 % of cases, depending on condition of host. In untreated survivors, renal insufficiency, multiorgan involvement and neurologic manifestations (12 %) are common. Prevention For flea borne typhus Elimination of fleas on clothing & bedding using insecticides like 1% Malathion powder Apply residual insecticide powder on the floor & bedding to kill hatching fleas. Protective wearing smeared with insect repellents is recommended for nurses and other attendants Chemoprophylaxis: Doxycycline 100mg weekly will protect those at risk. Helminthic Infections • Intestinal Nematodes • Tissue Nematodes • Filariasis and Related Infections • Schistosomiasis & Other Trematodes • Cestodes 3. Design appropriate methods of prevention and control of intestinal nematodes Nematodes are elongated, symmetric round worms. Some of the intestinal nematode species are Strongyloides stercoralis, Enterobius vermicularis, Trichuris trichuira, Ascaris lumbricoides, Necator americanus and Ancylostoma duodenale. More than a billion people worldwide are infected with one or more species of intestinal nematodes. They are most common in regions with poor sanitation, especially in developing countries. Epidemiology - Ascariasis has a worldwide distribution particularly in regions with poor sanitation. Development:- the adult live in the lumen of the small intestine, especially in the jejunum. After ingestion these eggs hatch in the 34 Internal Medicine intestine, liberating minute larvae that rapidly penetrate blood or lymph vessels in the intestinal wall. Some larvae reach the portal circulation & are carried to the liver; others pass through the thoracic duct. After increasing in size they migrate to the epiglottis and then down the esophagus to reach the intestine where mating takes place. Clinical Features: • During the lung phase patients may develop an irritating nonproductive cough and burning substantial discomfort.
Although a wide variety of infectious agents cause Nursing care diarrhoea trusted cefpodoxime 200 mg virus or bacteria, they are all transmitted through common Nursing care of the patient with infective diarrhoea pathways such as contaminated water purchase cefpodoxime 100mg on-line xanthomonas antibiotics, food 200 mg cefpodoxime antibiotics for sinus infection types, and requires: hands discount 200 mg cefpodoxime mastercard antibiotic lyme disease. Measures to interrupt the transmission • assessment and continuous observation of the should focus on the following pathways: clinical state; • supervision and administration of appropriate • giving only breast milk for the first 6 months of fluid and food; life; • maintenance of a fluid input and output chart; • avoiding the use of infant feeding bottles; • maintenance of a stool chart; • improving practices related to the preparation and • monitoring of temperature, pulse and blood storage of weaning fluids and feeds; pressure; • washing hands after defecation or handling faeces, • monitoring of weight, daily if the patient is a and before preparing food or eating; child; • minimizing microbial contamination and growth • encouraging a scrupulous personal hygiene of foods by preventing breaks in the food hygiene regime; and chain including: use of human excrement as • skin care to prevent excoriation. Rehabilitation may be more protracted • the importance of hand washing, safe disposal in individuals with serious underlying disorders. Giving a nutritious diet, appropriate for the child’s age, when the child is well is important. In addition, the hospital must determine the infecting organism and report it to the relevant public health authority; this is of primary importance in epidemic situations. Role of the community the community is responsible for ensuring the maintenance of good standards of food and water hygiene, educating about careful hand washing and other aspects of personal hygiene, and home Page 76 Module 3 Typhoid Definition approximately 600 000 deaths. Typhoid is Typhoid fever (also known as enteric fever) is a predominantly a disease of countries with poor severe systemic infection caused by the Gram sanitation and poor standards of personal and food negative bacterium Salmonella typhi. Multi-drug resistant strains have been a large number of organisms is usually necessary reported in Asia, the Middle East, and Latin America. The organisms are absorbed from the gut and Manifestations transported via the blood stream to the liver and • In the early stages fever, severe headache, spleen. They are released into the blood after 10 to constipation and a dry cough may be present. The • the fever rises in a “step ladder” pattern for 4 or 5 organisms localise in the lymphoid tissue of the days. This • Abdominal tenderness and an enlarged liver or is the main cause of death from typhoid fever. The • If untreated, complications can occur during the incubation period is from 10 to 21 days. Most patients who have typhoid will excrete • Other complications may affect any patient organisms at some stage of their illness. About because of the occurrence of septicaemia during 10% who have typhoid fever excrete the organisms the first week. These may include cholecystitis, for approximately three months after the acute stage pneumonia, myocarditis, arthritis, osteomyelitis of the illness and 2 to 5% of untreated patients and meningitis. Incidence of becoming • Bone and joint infection is seen, especially in a carrier increases with age, especially in females. Epidemiological summary Age groups affected the organism responsible for typhoid fever was Typhoid can affect any age. Typhoid fever affects Case-fatality rates of 10% can be reduced to less 17 million people in the world annually, with than 1% with appropriate antibiotic therapy. Module 3 Page 77 Diagnosis Treatment of carriers: this can often be very Blood culture is the most important method for difficult to implement, but spread through carriers diagnosis. Isolation of the organism from the stool is unusual if good personal hygiene is practised and is more common in the second and third weeks of stools are disposed of hygienically. In some cases, isolation of the bacteria in the urine can be used as a diagnostic method. Selective immunization of groups: during an epidemic in an endemic country, selective Methods of treatment immunization of groups such as school children, Four different antibiotics are often used for institutionalized people and healthcare workers is treatment: Ciprofloxacin, Co-trimoxazole, of great benefit. Effective treatment does not always prevent complications, Immunization against typhoid the disease recurring or the patient becoming a There are three types of typhoid vaccine: carrier. A chronic carrier may be treated for four weeks with aminoquinalones and in some cases it • Monovalent whole cell typhoid vaccine contains may be necessary to perform a cholecystectomy, in excess of 1000 million S. Two doses, given four to Prevention of spread is dependent upon: six weeks apart, give protection for three years, but • Clean water supply: protection and chlorination side effects include a painful reaction at the of public water supplies is necessary. It provides equally effective protection as the whole cell vaccine but with fewer Page 78 Module 3 febrile side effects, although it can cause irritation general examination for complications; at the vaccine site. Length Rehabilitation of protection may be less and vaccination may need Recovery may be complete after treatment, but may repeating after one year. The vaccine is unstable at also be delayed with recurrence of the symptoms room temperature and must be kept refrigerated. Recurrence is more It should be emphasized that whilst these vaccines likely to occur after inadequate treatment. Consequently strict food, water and personal Role of primary health care team hygiene protection continue to be of great • Education regarding food, water and personal importance. Blood • Awareness of the risks and management of patient cultures can provide early confirmation; the with carrier status organism can then be tested for antibiotic sensitivity. Stool and urine culture may also be Role of health education and health promotion performed from one week following confirmation • Heighten public awareness of the disease and of the disease. Water and food samples from its prevention suspected sources also need to be tested. The virus most commonly invades Paratyphoid usually has a shorter incubation period, the gastrointestinal tract and a viraemic illness may with diarrhoea from the onset, a more abundant develop. In some cases the virus invades and rash and less commonly develops intestinal destroys the anterior horn cells of the spinal cord. In the most severe cases, the virus attacks the motor neurons of the brainstem, causing difficulty in breathing, swallowing and speaking. Modes of transmission • the faecal-oral route, particularly in areas where there is poor food and water hygiene. Communicability Cases are most infectious from 7–10 days before and after onset of the illness, although the virus may be shed in the faeces for up to six weeks or even longer. Epidemiological summary It is thought that poliomyelitis first occurred nearly 6000 years ago in the time of the ancient Egyptians. Evidence for this theory lies in the withered and deformed limbs of some Egyptian mummies. Since the development of the polio vaccine in the mid- 1950s, cases of poliomyelitis have diminished dramatically. The disease was brought under control and practically eliminated as a public health problem in industrialized countries. Today the disease has been eradicated from large parts of the world; the key remaining reservoirs of Page 80 Module 3 virus transmission • the level of damage to the spinal cord determines are in South Asia the muscles affected. However, muscles of the lower and sub-Saharan limbs are more frequently paralyzed. However, • Contractures can occur, the most common being outbreaks still flexion contractures of the hip and knee, and equinus occur and in deformity of the ankle. Two billion children have now been fully in swallowing and speaking, and reduced immunized worldwide. In the meantime, countries free from poliomyelitis must continue to vaccinate in order Age groups affected to prevent the virus reestablishing itself if reintroduced Polio can affect any age and the illness is more severe from other countries. However, the virus most commonly affects children 3 years and under with Manifestations over 50% of all cases occurring in this age group. The disease can follow three pathways: • Asymptomatic illness, which produces Prognosis seroconversion and life long immunity to the virus. Although paralytic poliomyelitis is rare, two thirds Non-paralytic poliomyelitis, which produces mild flu- of those who develop severe symptoms will be left like illness with fever, pharyngitis and mild diarrhoea. Severe disability Sometimes viral meningitis with fever and headache is less common in children.
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