Pediatric Nursing 6

Luz Valerio-del Pilar, RN, MAN

 Rheumatic Fever
 Rheumatic fever is an inflammatory disease that may develop after an infection with group
Streptococcusbacteria (such as strep throat or scarlet fever).
 The disease can affect the heart, joints, skin, and brain.
 Affects children ages 5 -15
 Occurs approximately 14-28 days after strep throat or scarlet fever
 Symptoms
 Abdominal pain
 Fever
 Heart (cardiac) problems
 may not have symptoms, or may result in shortness of breath and chest pain
 Joint pain, arthritis
 mainly in the knees, elbows, ankles, and wrists
 Joint swelling; redness or warmth
 Nosebleeds
 Skin nodules
 Skin rash (erythema marginatum)
 Skin eruption on the trunk and upper part of the arms or legs
 Eruptions that look ring-shaped or snake-like
 Sydenham chorea
 emotional instability, muscle weakness and quick, uncoordinated jerky movements that
mainly affect the face, feet, and hands
 Tests
 Blood test for recurrent strep infection
 Complete blood count
 Electrocardiogram
 Sedimentation rate
The major criteria for diagnosis include:
 Arthritis in several large joints (polyarthritis)
 Heart inflammation (carditis)
 Nodules under the skin (subcutaneous skin nodules)
 Rapid, jerky movements (chorea, Sydenham chorea)
 Skin rash (erythema marginatum)
The minor criteria include:
 Fever
 High ESR
 Joint pain
 Abnormal EKG
 Treatment
 Antibiotics.
 Anti-inflammatory medications
 Low doses of antibiotics
 (such as penicillin, sulfadiazine, or erythromycin) over the long term to prevent
strep throat from returning.
  Outlook (Prognosis)
 If rheumatic fever returns, the doctor may recommend low-dose antibiotics continually,
especially during the first 3 -5 years after the first episode of the disease.
 Heart complications may be severe, particularly if the heart valves are involved.
 Possible Complications
 Arrhythmias
 Damage to heart valves
 (in particular, mitra stenosis and aortic stenosis)
 Endocarditis
 Heart failure
 Pericarditis
 Sydenham chorea
Prevention
 Quick treatment for strep throat and scarlet fever.
 Rheumatoid Arthritis
 a chronic (long-term) disease that causes pain, stiffness, swelling and limited motion and
function of many joints.
 can affect any joint
 the small joints in the hands and feet tend to be involved most often.
 Inflammation sometimes can affect organs:
 the eyes or lungs.
 Other signs and symptoms
 Loss of energy
 Low fevers
 Loss of appetite
 Dry eyes and mouth
 Firm lumps
 called rheumatoid nodules, which grow beneath the skin in places such as the elbow
and hands
 Causes
 RA is an autoimmune disease.
 certain cells of the immune system do not work properly and start attacking healthy
tissues — the joints
 In RA, the focus of the inflammation is in the synovium, the tissue that lines the joint.
 Immune cells release inflammation-causing chemicals. These chemicals can damage
cartilage (the tissue that cushions between joints) and bone.
 Genesthat affect the immune system may make some people more prone to getting RA.
 Diagnosis
 RA can be hard to detect because it may begin with subtle symptoms, such as achy joints or a
little stiffness in the morning.
 Some blood tests also can help confirm RA.
 Diagnosis of RA depends on the symptoms and results of a physical exam;
 warmth, swelling and pain in the joints. Some blood tests also can help confirm RA.
 Treatment
 There is no cure for RA.
 The goal of treatment is to lessen your symptoms and poor function.
 Doctors do this by starting proper medical therapy as soon as possible, before the joints
have lasting damage. No single treatment works for all patients.
  Many people with RA must change their treatment at least once during their lifetime.
 Good control of RA requires early diagnosis and, at times, aggressive treatment.
 Patients with a diagnosis of RA should begin their treatment with disease-modifying
antirheumatic drugs — referred to as DMARDs.
 Nonsteroidal anti-inflammatory drugs or NSAIDs and/or low-dose corticosteroids, to
lower swelling, pain and fever.
 Scabies
 a skin infestation caused by a tiny microscopic bug known as the human itch mite.
 Scabies mites can live on the skin for up to two months.
 A person with a scabies infestation usually will have between 10 and 15 mites.
 Scabies is easily spread.
 It just requires direct, extended skin-to-skin contact with someone who is infected.
 Signs and symptoms
 It can take four to six weeks before the symptoms start appearing
 Mites are most active at night and the most intense itching occurs at night.
 Continuous scratching of the infected area can create sores that become infected.
 In babies and young toddlers the commonly infected sites are:
 head
 face
 neck
 palms
 soles
Common sites for the rash in older children and adults include:
 wrist
 elbow
 armpit
 between fingers
 nipple
 penis
 waist
 beltline
 buttocks
 The rash itself can be pimply, made up of tiny blisters, and/or it can be scaly.
 In addition, the burrows of the mite can appear on the skin. They look like tiny, raised, dirty
white, or flesh-toned lines.
 Site of scabies infestation
 Diagnosis
 The rash and burrows are the main signs that doctors use to determine scabies infestation.
 Doctors will often try to confirm a visual diagnosis by removing a mite from a burrow
with a needle or skin scraping.
 The sample is examined under a microscope to confirm the presence of mites and/or
eggs.
 Treatment
 5 percent permethian cream
 25 percent benzyl benzoate lotion
 10 percent sulfur ointment
 10 percent crotamiton cream
 1 percent lindane lotion
  Steroid creams can also help with the swelling and itch.
 Pediculosis
 Caused by ectoparasites
 Patients usually present with itching.
 Head and pubic lice infestations are diagnosed by the visualization of insects or viable nits
(eggs).
 Primary treatment is topically administered 1 percent permethrin.
 Malathion is one alternative for treatment failures. The importance of environmental
measures to prevent infestation is a matter of controversy.
 The three lice species
 Pediculus humanus capitis—head louse
 Phthirus pubis —crab or pubic
 Pediculus humanus corpus—body louse.
 Treatment
 0.5 percent malathion lotion (Ovide)
 1 percent lindane shampoo
 Ivermectin (Stromectol), in an oral dose of 200 mcg per kg
 Impetigo contagiosa
 nonbullous impetigo
 most often begins as a red sore near the nose or mouth which soon breaks, leaking pus
or fluid, and forms a honey-colored scab, followed by a red mark which heals without
leaving a scar.
 Sores are not painful, but may be itchy.
 Lymph nodes in the affected area may be swollen, but fever is rare.
 Touching or scratching the sores may easily spread the infection to other parts of the body
 Bullous impetigo
 mainly seen in children younger than 2 years, involves painless, fluid-filled blisters,
mostly on the arms, legs and trunk, surrounded by red and itchy (but not sore) skin.
 The blisters may be large or small.
 After they break, they form yellow scabs
Ecthyma
 painful fluid- or pus-filled sores with redness of skin, usually on the arms and legs, become
ulcers that penetrate deeper into the dermis
 After they break open, they form hard, thick, gray-yellow scabs, which sometimes leave scars.
 Ecthyma may be accompanied by swollen lymph nodes in the affected area
 Causes
 It is primarily caused by Staphylococcus aureus and sometimes by Streptococcus pyogenes
 Both bullous and nonbullous are primarily caused by Staphylococcus aureus,
with Streptococcus also commonly being involved in the nonbullous form
Transmission
 Spread by direct contact with lesions or with nasal carriers.
 The incubation period is 1–3 days after exposure to Streptococcus and 4–10 days for
Staphylococcus
 Dried streptococci in the air are not infectious to intact skin.
 Scratching may spread the lesions.
 Diagnosis
 Impetigo generally appears as honey-colored scabs formed from dried serum, and is often found
on the arms, legs, or face
Treatment
 antiseptic gentian violet
 topical or oral antibiotics
 washing with soap and water and letting the impetigo dry in the air.
 Mild cases
 may be treated with bactericidal ointment
 Scoliosis
 is a lateral (toward the side) curvature in the normally straight vertical line of the spine.
 When viewed from the side, the spine should show a mild roundness in the upper back and
shows a degree of swayback (inward curvature) in the lower back.
 When a person with a normal spine is viewed from the front or back, the spine appears to be
straight.
 When a person with scoliosis is viewed from the front or back, the spine appears to be curved
 Scoliosis
 Congenital scoliosis
 Caused by a bone abnormality present at birth.
 Neuromuscular scoliosis.
 A result of abnormal muscles or nerves. Frequently seen in people with spina bifida or
cerebral palsy or in those with various conditions that are accompanied by, or result in,
paralysis.
 Degenerative scoliosis.
 This may result from traumatic (from an injury or illness) bone collapse, previous major
back surgery, or osteoporosis (thinning of the bones).
 Idiopathic scoliosis.
 The most common type of scoliosis, idiopathic scoliosis, has no specific identifiable
cause.
 Diagnosis
 careful bone exam
 X-ray to evaluate the magnitude of the curve
 Treatment
 Braces.
 Bracing is the usual treatment choice for adolescents who have a spinal curve between
25 degrees to 40 degrees -- particularly if their bones are still maturing and if they have
at least 2 years of growth remaining.
 The purpose of bracing is to halt progression of the curve. It may provide a temporary
correction, but usually the curve will assume its original magnitude when bracing is
eliminated.
 Treatment
 Surgery.
 Those who have curves beyond 40 degrees to 50 degrees are often considered for
scoliosis surgery. The goal is to make sure the curve does not get worse, but surgery
does not perfectly straighten the spine.
 Metallic implants are utilized to correct some of the curvature and hold it in the correct
position until a bone graft, placed at the time of surgery, consolidates and creates a rigid
fusion in the area of the curve.
 Scoliosis surgery usually involves joining the vertebrae together permanently-- called
spinal fusion.
  In young children, another technique that does not involve fusion may be used because
fusion stops growth of the fused part of the spine.
 In this case, a brace must always be worn after surgery.
 Bone tumors
 When cells divide abnormally and uncontrollably, they can form a mass or lump of tissue.
 As the tumor grows, abnormal tissue can displace healthy tissue.
 Classification:
 Benign, meaning they are not cancerous
 Malignant, meaning they are cancerous
 Benign tumors
 Osteochondromas
 develop in adolescents and teenagers.
 form near the ends of long bones, such as the arm or leg bones.
 tend to affect the lower end of the thighbone (femur), the upper end of the lower leg
bone (tibia) and the upper end of the upper arm bone (humerus).
 they are usually found at the actively growing ends of long bones.
 tumors are formed of a combination of bone and cartilage.
 considered to be an abnormality of growth.
 Non-Ossifying Fibroma Unicameral
 Non-ossifying fibroma unicameral is a simple solitary bone cyst.
 It is the only true cyst of bone.
 It is usually found in the leg and occurs most often in children and adolescents.
 Giant Cell Tumors
 Giant cell tumors grow aggressively.
 They occur in adults and in the rounded end of the bone, not in the growth plate.
 Enchondroma
 An enchondroma is a cartilage cyst that grows inside the bone marrow.
 When they occur, they begin in children and persist as adults.
 They tend to be part of syndromes called Ollier’s and Mafucci’s syndrome.
 Enchondromas occur in the hands and feet as well as the long bones of the arm and
thigh.
 Fibrous Dysplasia
 Fibrous dysplasia is a gene mutation that makes bones fibrous and vulnerable to
fracture.
 Aneurysmal Bone Cyst
 an abnormality of blood vessels that begins in the bone marrow. It can grow rapidly and
can be particularly destructive because it affects growth plates.
 Malignant Bone Tumors / Malignant Tumors
 Osteosarcoma
 occurs mostly in children and adolescents, is the second most common type of bone
cancer.
 usually develops around the hip, shoulder, or knee.
 fast growing and likely to spread to other parts of the body.
 The most common sites are the areas where the bones are most actively growing (the
growth plates), the lower end of the thighbone, and the upper end of the lower leg
bone.
 Osteosarcoma is also sometimes known asosteogenic sarcoma.
 Ewing sarcoma family of tumors (ESFTs)
  strikes adolescents and young adults, but can sometimes affect children as young as 5
years old.
 usually shows up in the legs (long bones), pelvis, backbone, ribs, and upper arms and in
the skull.
 It begins in the cavities of the bones where the bone marrow is produced(the medullary
cavities)
 an also grow in soft tissue, such as fat, muscle, and blood vessels.
 boys are more likely to be victims than girls.
 It is a rapidly growing and rapidly spreading tumor.
Chondrosarcoma
 Middle-aged people and seniors are more likely than other age groups to develop
chondrosarcoma.
 The hips, shoulders, and pelvis are the usual areas for this type of bone cancer.
Secondary Bone Cancer
 means that the cancer started somewhere else in the body and then spread to the bone.
 it usually affects older people.
 The types of cancer most likely to spread to the bones are:
 kidney
 breast
 prostate
 lung (particularly osteosarcoma)
 thyroid gland
 Cause of Bone Tumors
 The cause not known.
 possible causes are genetics
 radiation treatment
 injuries to the bones
 Signs and symptoms
 A dull ache in the affected bone is the most common symptom of bone cancer.
 The pain starts off as occasional and then becomes severe and constant. The pain may
be severe enough to wake up in the night.
 Sometimes, when people have an undiscovered bone tumor, what seems like an
insignificant injury breaks the already-weakened bone, leading to severe pain.
 This is known as apathologic fracture. Sometimes there may be swelling at the site of
the tumor.
 Tumors can cause night sweats or fevers
 People with benign tumors might not have any symptoms, and the tumor might not be detected
until an imaging scan reveals it while receiving other medical testing
 Diagnosis
 Physical examination
 check for tenderness in the bone and test the range of motion
 Blood and Urine Tests
 An alkaline phosphatase test is one common tool used in diagnosing bone tumors.
When the bone tissue is especially active in forming cells, large quantities of this enzyme
show up in the blood.
 Imaging Tests
 CT or CAT scan
 MRI, or magnetic resonance imaging
 PET scan, or positron emission tomography. The doctor injects a little radioactive sugar in the
vein.
 Angiogram
 Biopsies
 Needle
 Incisional
 Treatment for Benign Bone Tumors
 may or may not require action
 a higher likelihood of having their bone tumors disappear as they mature.
 Sometimes benign tumors spread or transform into malignant tumors.
 Since bone tumors can also lead to fractures, the doctor might want to surgically remove even a
benign tumor.
 Treatment for Malignant Bone Tumors
 depend on what type of bone cancer and whether it has spread.
 if the cancer cells are confined to the tumor and its immediate environs, this is called the
localized stage.
 in the metastatic stage, cancerous cells have already spread to other parts of the body
 surgery
 radiation
 chemotherapy
 cryosurgery
 Sexually transmitted diseases
 Sores or bumps on the genitals or in the oral or rectal area
 Painful or burning urination
 Discharge from the penis
 Unusual or odd-smelling vaginal discharge
 Unusual vaginal bleeding
 Pain during sex
 Sore, swollen lymph nodes, particularly in the groin but sometimes more widespread
 Lower abdominal pain
 Rash over the trunk, hands or feet
 Causes
 Bacteria (gonorrhea, syphilis, chlamydia)
 Parasites (trichomoniasis)
 Viruses (human papillomavirus, genital herpes, HIV)
 Transmission from mother to infant
 Direct contact or systemic
 gonorrhea, chlamydia, HIV and syphilis
 Complications
 Sores or bumps anywhere on the body
 Recurrent genital sores
 Generalized skin rash
 Scrotal pain, redness and swelling
 Pelvic pain
 Hair loss
 Pregnancy complications
 Eye inflammation
 Arthritis
 Pelvic inflammatory disease
 Certain cancers, such as HPV-associated cervical and rectal cancers
 Tests and diagnosis
 Blood tests
 Blood tests can confirm the diagnosis of HIV or later stages of syphilis.
 Urine samples
 Some STIs can be confirmed with a urine sample.
 Fluid samples.
 active genital sores, testing fluid and samples from the sores may be done to diagnose
the type of infection.
 Screening pregnant women
 Screening for HIV, hepatitis B, chlamydia and syphilis generally takes place at the first prenatal
visit for all pregnant women
 Gonorrhea and hepatitis C screening tests are recommended at least once during pregnancy for
women at high risk of these infections.
 Treatments and drugs
 Antibiotics
 Antiviral drugs.
 Problems of menstruation
 Amenorrhea
 Dysmenorrhea
 Obesity
 excess body fat has accumulated to the extent that it may have a negative effect on health,
leading to reduced life expectancy and/or increased health problems
 people are considered obese when their body mass index (BMI),a measurement obtained by
dividing a person's weight by the square of the person's height, exceeds30 kg/m2, with the range
25-30 kg/m2defined as overweight.
 Classification according to BMI
 Any BMI ≥ 35 or 40 kg/m2 is severe obesity
 A BMI of ≥ 35 kg/m2 and experiencing obesity-related health conditions or ≥40–
44.9 kg/m2 is morbid obesity
 A BMI of ≥ 45 or 50 kg/m2 is super obesity.
 Causes
 excessive food energy intake
 lack of physical activity
 genetic susceptibility
 endocrine disorders
 medications
 psychiatric illness
 Complication of obesity
 heart disease
 type 2 diabetes
 obstructive sleep apnea
 certain types of cancer and osteoarthritis
 Treatment
 Dieting
 Exercise
 Anti-obesity drugs
  may be taken to reduce appetite or decrease fat absorption.
 gastric balloon
 surgery may be performed to reduce stomach volume and/or
 Anorexia Nervosa
 A serious eating disorder that affects women and men of all ages
 a complex eating disorder with three key features:
 refusal to maintain a healthy body weight
 an intense fear of gaining weight
 a distorted body image
 Types of anorexia
 restricting type
 weight loss is achieved by restricting calories (following drastic diets, fasting,
and exercising to excess).
 purging type
 weight loss is achieved by vomiting or using laxatives and diuretics.
 Anorexic food behavior signs and symptoms
 Dieting despite being thin – Following a severely restricted diet. Eating only certain low-calorie
foods. Banning “bad” foods such as carbohydrates and fats.
 Obsession with calories, fat grams, and nutrition – Reading food labels, measuring and
weighing portions, keeping a food diary, reading diet books.
 Pretending to eat or lying about eating – Hiding, playing with, or throwing away food to avoid
eating. Making excuses to get out of meals (“I had a huge lunch” or “My stomach isn’t feeling
good.”).
 Preoccupation with food – Constantly thinking about food. Cooking for others, collecting
recipes, reading food magazines, or making meal plans while eating very little.
 Strange or secretive food rituals – Refusing to eat around others or in public places. Eating in
rigid, ritualistic ways (e.g. cutting food “just so”, chewing food and spitting it out, using a specific
plate).
 Anorexic appearance and body image signs and symptoms
 Dramatic weight loss – Rapid, drastic weight loss with no medical cause.
 Feeling fat, despite being underweight – Patient may feel overweight in general or just “too fat”
in certain places such as the stomach, hips, or thighs.
 Fixation on body image – Obsessed with weight, body shape, or clothing size. Frequent weigh-
ins and concern over tiny fluctuations in weight.
 Harshly critical of appearance – Spending a lot of time in front of the mirror checking for flaws.
There’s always something to criticize.
 Denial that you’re too thin – Patient may deny that her low body weight is a problem, while
trying to conceal it (drinking a lot of water before being weighed, wearing baggy or oversized
clothes).
 Purging signs and symptoms
 Using diet pills, laxatives, or diuretics – Abusing water pills, herbal appetite suppressants,
prescription stimulants, ipecac syrup, and other drugs for weight loss.
 Throwing up after eating – Frequently disappearing after meals or going to the bathroom. May
run the water to disguise sounds of vomiting or reappear smelling like mouthwash or mints.
 Compulsive exercising – Following a punishing exercise regimen aimed at burning calories.
Exercising through injuries, illness, and bad weather. Working out extra hard after bingeing or
eating something “bad.”
 Anorexia nervosa causes and risk factors
  Psychological
 People with anorexia are often perfectionists and overachievers
 Family and social pressures
 Biological causes of anorexia
 Genetics
 Brain chemistry also plays a significant role.
 People with anorexia tend to have high levels of cortisol, the brain hormone
most related to stress, and decreased levels of serotonin and norepinephrine,
which are associated with feelings of well-being.
 Major risk factors for anorexia nervosa
 Body dissatisfaction
 Strict dieting
 Low self-esteem
 Difficulty expressing feelings
 Perfectionism
 Troubled family relationships
 History of physical or sexual abuse
 Family history of eating disorders
 Some of the physical effects of anorexia include:
 Severe mood swings; depression
 Lack of energy and weakness
 Slowed thinking; poor memory
 Dry, yellowish skin and brittle nails
 Constipation and bloating
 Tooth decay and gum damage
 Dizziness, fainting, and headaches
 Growth of fine hair all over the body and face
 Effects of Anorexia
 Steps to anorexia recovery
What to advise the patient:
 Admit you have a problem
 Talk to someone
 Stay away from people, places, and activities that trigger your obsession with being thin
 Seek professional help
Treating anorexia involves three steps:
 Getting back to a healthy weight
 Starting to eat more food
 Changing how you think about yourself and food
 Substance abuse
 Marijuana (also known as grass, pot, weed, herb, cannabis sativa):
 pleasure, relaxation, and impaired coordination and memory
 Cocaine (also known as crack, coke, snow, rock)
 paranoia, constriction of blood vessels leading to heart damage or stroke, irregular
heartbeat, and death. Severe depression and reduced energy often accompany
withdrawal
 Methamphetamines (also known as meth, crank, ice, speed, crystal)
 heart attacks, dangerously high blood pressure, and stroke.
 Tobacco
  heart diseases lung cancer and emphysema peptic ulcer disease, and stroke
 Alcohol
 Heart enlargement and cancer of the esophagus, pancreas, and stomach
 Heroin (also known as smack, horse)
 drowsiness, pleasure, and slowed breathing. Withdrawal can be intense and can
include vomiting, abdominal cramps, diarrhea, confusion, aches, and sweating.
 Ecstasy (also called MDMA, Adam, STP)
 Long-term use may cause damage to the brain’s ability to regulate body temperature,
sleep, pain, memory, and emotions
 GHB (also called Liquid XTC, G, blue nitro)
 Effects range from mild relaxation to coma or death. GHB is often used as a date-rape
drug because it is tasteless, colorless, and acts as a powerful sedative.
 Rohypnol (also called roofies, roche)
 This is another sedative that can be used as a date-rape drug. Effects include low blood
pressure, dizziness, abdominal cramps, confusion, and impaired memory.
 Ketamine (also called Special K, K)
 This is an anesthetic that can be taken orally or injected.
 Ketamine (Ketalar) can impair memory and attention.
 Higher doses can cause amnesia, paranoia and hallucinations, depression, and difficulty
breathing.
 LSD (also called acid, microdot) and mushrooms (also called shrooms, magic mushrooms,
peyote, buttons)
 cause hallucinations, numbness, nausea, and increased heart rate. Long-term effects
include unwanted "flashbacks" and psychosis (hallucinations, delusions, paranoia, and
mood disturbances).
 PCP (al known as angel dust, hog, love boat)
 The anesthetic effects are so strong that a person can break his arm but not feel any
pain. Usually, tobacco or marijuana cigarettes are dipped into PCP and then smoked.
 Causes of substance abuse
 Factors within a family that influence a child's early development have been shown to be related
to increased risk of drug abuse.
 Chaotic home environment
 Genetic risks (drug or alcohol abuse sometimes can run in families)
 Lack of nurturing and parental attachment
 Factors related to a child’s socialization outside the family may also increase risk of drug abuse.
 Inappropriately aggressive or shy behavior in the classroom
 Poor social coping skills
 Poor school performance
 Association with a deviant peer group
 Perception of approval of drug use behavior
 Substance Abuse Symptoms
 Giving up past activities such as sports, homework, or hanging out with new friends
 Declining grades
 Aggressiveness and irritability
 Forgetfulness
 Disappearing money or valuables
 Feeling rundown, hopeless, depressed, or even suicidal
 Sounding selfish and not caring about others
 Use of room deodorizers and incense
 Paraphernalia such as baggies, small boxes, pipes, and rolling paper
 Getting drunk or high on drugs on a regular basis
 Lying, particularly about how much alcohol or other drugs he or she is using
 Avoiding friends or family in order to get drunk or high
 Planning drinking in advance, hiding alcohol, drinking or using other drugs alone
 Having to drink more to get the same high
 Believing that in order to have fun he needs to drink or use other drugs
 Frequent hangovers
 Pressuring others to drink or use other drugs
 Taking risks, including sexual risks
 Having "blackouts"-forgetting what he or she did the night before
 Constantly talking about drinking or using other drugs
 Getting in trouble with the law
 Drinking and driving
 Suspension from school or work for an alcohol or drug-related incident
 Red flags
 Mild tremors or an alcohol withdrawal seizure not accompanied by hallucinations or confusion
 Jaundice (yellow skin and eyes)
 Increasing abdominal girth
 Leg swelling
 Cough that won't go away
 Continuing feelings of sadness or depression
 Pain at an injection site
 Fever
 Thoughts of harming self or others
 Chest pain, rapid heartbeat, difficulty breathing, or lightheadedness
 Severe abdominal pain
 Confusion or ongoing hallucinations
 Severe tremors or recurrent seizures
 Difficulty speaking, numbness, weakness, severe headache, visual changes, or trouble keeping
balance
 Severe pain at an injection site (may be accompanied by redness, swelling, discharge, and fever)
 Dark, cola-colored urine
 Any suspicion that patient is sexually assaulted while under the influence
 Treatment
 Depends on the substance used and severity of the problem
 Suicide
 Most suicidal individuals give warning signs or signals of their intentions.
 The best way to prevent suicide is to recognize these warning signs and know how to respond if
you spot them
 Major warning signs for suicide include:
 talking about killing or harming oneself, talking or writing a lot about death or dying, and
seeking out things that could be used in a suicide attempt, such as weapons and drugs.
 These signals are even more dangerous if the person has a mood disorder :
 depression or bipolar disorder
 suffers from alcohol dependence
 has previously attempted suicide
  has a family history of suicide
 Remember!!!
 Take any suicidal talk or behavior seriously.
 It's not just a warning sign that the person is thinking about suicide—it's a cry for help.
 Suicide prevention tip
 Speak up if you’re worried
 Respond quickly in a crisis
 Offer help and support
 Risk factors
 Mental illness
 Alcoholism or drug abuse
 Previous suicide attempts
 Family history of suicide
 Terminal illness or chronic pain
 Recent loss or stressful life event
 Social isolation and loneliness
 History of trauma or abuse
 Other risk factors for teenage suicide include:
 Childhood abuse
 Recent traumatic event
 Lack of a support network
 Availability of a gun
 Hostile social or school environment
 Exposure to other teen suicides
 Additional warning signs that a teen may be considering suicide:
 Change in eating and sleeping habits
 Withdrawal from friends, family, and regular activities
 Violent or rebellious behavior, running away
 Drug and alcohol use
 Unusual neglect of personal appearance
 Persistent boredom, difficulty concentrating, or a decline in the quality of schoolwork
 Frequent complaints about physical symptoms, often related to emotions, such as
stomachaches, headaches, fatigue, etc.
 Not tolerating praise or rewards