FORTPOLIO

By Muhammad ARIF(R.NO 33)

Generic BSN

Submitted to Sir Mr. Amjad Shayan

MEDIX COLLEGE OF NURSING CHAKDARRA

 OBJECTIVES
1. Clinical concept map of different diseases
2. Nursing care plan for different diseases
3. Drug card for different diseases
4. Reflective log
 (i) Clinical concept map of Malaria
Definition: Malaria is a serious and sometimes fatal disease caused
by a parasite that commonly infects a certain type of mosquito which
feeds on humans. People who get malaria are typically very sick with
high fevers, shaking chills, and flu-like illness.
SIGNS AND SYMPTOMS: Symptoms of malaria include fever and
flu-like illness, including shaking chills, headache, muscle aches, and
tiredness. Nausea, vomiting, and diarrhea may also occur. Malaria
may cause anemia and jaundice (yellow coloring of the skin and eyes)
because of the loss of red blood cells. If not promptly treated, the
infection can become severe and may cause kidney failure, seizures,
mental confusion, coma, and death.
CAUSES: Malaria is an acute febrile illness caused
by Plasmodium parasites, which are spread to people through the
bites of infected female Anopheles mosquitoes. There are 5 parasite
species that cause malaria in humans, and 2 of these species – P.
falciparum and P. vivax – pose the greatest threat. P. falciparum is
the deadliest malaria parasite and the most prevalent on the African
continent. P. vivax is the dominant malaria parasite in most countries
outside of sub-Saharan Africa.
DIAGNOSE OF MALARIA: Malaria is to have a diagnostic test
where a drop of your blood is examined under the microscope for the
presence of malaria parasites. If you are sick and there is any
suspicion of malaria (for example, if you have recently traveled in a
country where malaria transmission occurs), the test should be
performed without delay.
MEDICAL MANAGEMENT: Malaria is treated with prescription
drugs to kill the parasite. The types of drugs and the length of treatment
will vary, depending on:
  Which type of malaria parasite you have
 The severity of your symptoms
 Your age
 Whether you're pregnant
Medications
The most common antimalarial drugs include:

 Chloroquine phosphate. Chloroquine is the preferred treatment for

any parasite that is sensitive to the drug. But in many parts of the
world, parasites are resistant to chloroquine, and the drug is no
longer an effective treatment.
 Artemisinin-based combination therapies (ACTs). ACT is a
combination of two or more drugs that work against the malaria
parasite in different ways. This is usually the preferred treatment for
chloroquine-resistant malaria. Examples include artemether-
lumefantrine (Coartem) and artesunate-mefloquine
NURSING MANAGEMENT: The Nursing goals for a patient with
malaria are

 Prevent infection.
 Reduce increase in and regain normal body temperature.
 Improve tissue perfusion.
 Improve fluid volume of the body.
 Gain information on malarial disease process, treatment, and
prognosis.
 (II) CLINICAL CONCEPT MAP OF DENGUE FEVER

 Definition: Dengue fever is an acute febrile disease caused by infection

with one of the serotypes of the dengue virus. It is a mosquito-borne disease
caused by the genus Aedes.
 Dengue is also known as Break bone Fever, Hemorrhagic Fever, Dandy
Fever, Infectious Thrombocytopenic Purpura.
 Dengue hemorrhagic fever is a fatal manifestation of the dengue virus that
manifests with bleeding diathesis and hypo volumic shock.
 These viruses are related to the viruses that cause the West Nile infection
and yellow fever.

 SIGNS AND SYMPTOMS: High fever. Sudden high fever occurs as a result

of the infection.
 Severe headaches. Severe headaches also torment the patient.
 Damage to lymph and blood vessels. As the virus slowly spreads, even the
lymph and blood vessels are affected.
 Bleeding. Bleeding from the nose and gums is a characteristic of DHF.
 Enlargement of the liver. The dengue virus could also penetrate the liver, causing
fatal damage.
 Circulatory system failure. The circulatory system ultimately fails eventually if
the disease is not treated promptly.

CAUSES: The etiologic agent and vector of dengue:

 Flavivirus. It is caused by infection of one of the four serotypes of dengue virus,
which is a Flavivirus, a genus of single-stranded nonsegmented RNA virus.
 Aedes aegypti. Dengue virus is transmitted by day-biting mosquitoes of the genus
Aedes that breed in stagnant water. It has white dots at the base of its wings, with
white bands on the legs.
 Incubation period. It has an incubation period of three to ten days.

DIAGNOSE OF DENGUE FEVER: Laboratory criteria for the diagnosis of dengue

virus may include 1 of the following:

 Dengue virus isolation. Isolation of the dengue virus from serum, plasma,

leukocytes, or autopsy samples.
 Immunoglobulin titers. Demonstration of a fourfold or greater change in
reciprocal immunoglobulin or IgM antibody titers to one or more dengue virus
antigens in paired serum samples.
  Immunohistochemistry. Demonstration of the dengue virus antigen in autopsy
tissue via immunohistochemistry or immunofluorescence.
 Polymerase chain reaction. Detection of viral genomic sequences in autopsy
tissue, serum, or Cerebrospinal samples via PCR.
 CBC. In DHF, there may be the presence of increases hematocrit level secondary
to plasma extravasation and/or third-space fluid loss.
 Decreased platelet count. This test confirms dengue.
 Guaiac test. Guaiac testing for occult blood in the stool should be performed on
all patients suspected of dengue virus infection.

MEDICAL MANAGEMENT: The management of DHF is actually simple as

long as it is detected early.

 Oral rehydration therapy. Oral rehydration therapy is recommended for

patients with moderate dehydration caused by high fever and vomiting.
 IV Fluids. IVF administration is indicated for patients with dehydration.
 Blood transfusion and blood products. Patients with internal or
gastrointestinal bleeding may require transfusion, and patients with
coagulopathy may require fresh frozen plasma.
 Oral fluids. Increase in oral fluids is also helpful.
 Avoid aspirins. Aspirin can thin the blood. Warn patients to avoid aspirins
and other NSAIDs as they increase the risk for hemorrhages.

NURSING MANAGEMENT:
 Evaluation of the patient’s heart rate, temperature, and blood pressure.
 Evaluation of capillary refill, skin color and pulse pressure.
 Assessment of evidence of bleeding in the skin and other sites.
 Assessment of increased capillary permeability.
 Measurement and assessment of the urine output.
CLINICAL CONCEPT MAP OF DIABETES
Definition The major sources of the glucose that circulates in the blood are through the
absorption of ingested food in the gastrointestinal tract and formation of glucose by the
liver from food substances.

 Diabetes mellitus is a group of metabolic diseases that occurs with increased

levels of glucose in the blood.
 Diabetes mellitus most often results in defects in insulin secretion, insulin action,
or even both.

SIGNS AND SYMPTOMS: Clinical manifestations depend on the level of the

patient’s hyperglycemia.

 Polyuria or increased urination. Polyuria occurs because the kidneys remove

excess sugar from the blood, resulting in a higher urine production.
 Polydipsia or increased thirst. Polydipsia is present because the body loses more
water as polyuria happens, triggering an increase in the patient’s thirst.
 Polyphagia or increased appetite. Although the patient may consume a lot of
food but glucose could not enter the cells because of insulin resistance or lack of
insulin production.
 Fatigue and weakness. The body does not receive enough energy from the food
that the patient is ingesting.
 Sudden vision changes. The body pulls away fluid from the eye in an attempt to
compensate the loss of fluid in the blood, resulting in trouble in focusing the
vision.

CAUSES: The exact cause of diabetes mellitus is actually unknown, yet there are factors
that contribute to the development of the disease.

Type 1 Diabetes Mellitus

 Genetics. Genetics may have played a role in the destruction of the beta cells in
type 1 DM.
 Environmental factors. Exposure to some environmental factors like viruses can
cause the destruction of the beta cells.
Type 2 Diabetes Mellitus

 Weight. Excessive weight or obesity is one of the factors that contribute to type 2

DM because it causes insulin resistance.
  Inactivity. Lack of exercise and a sedentary lifestyle can also cause insulin
resistance and impaired insulin secretion.
Gestational Diabetes Mellitus

 Weight. If you are overweight before pregnancy and added extra weight, it makes
it hard for the body to use insulin.
 Genetics. If you have a parent or a sibling who has type 2 DM, you are most
likely predisposed to GDM.
 DIAGNOSE: Serum glucose: Increased 200–1000 mg/dL or more.
 Serum acetone (ketones): Strongly positive.
 Fatty acids: Lipids, triglycerides, and cholesterol level elevated.
 Serum osmolality: Elevated but usually less than 330 mOsm/L.
 Glucagon: Elevated level is associated with conditions that produce (1) actual
hypoglycemia, (2) relative lack of glucose (e.g., trauma, infection), or (3) lack of
insulin. Therefore, glucagon may be elevated with severe DKA despite
hyperglycemia.
 Glycosylated hemoglobin (HbA1C): Evaluates glucose control during past 8–12
wk with the previous 2 wk most heavily weighted. Useful in differentiating
inadequate control versus incident-related DKA (e.g., current upper respiratory
infection [URI]). A result greater than 8% represents an average blood glucose of
200 mg/dL and signals a need for changes in treatment.
 Serum insulin: May be decreased/absent (type 1) or normal to high (type 2),
indicating insulin insufficiency/improper utilization (endogenous/exogenous).
Insulin resistance may develop secondary to formation of antibodies.

 MEDICAL MANAGEMENT: Normalize insulin activity. This is the main

goal of diabetes treatment — normalization of blood glucose levels to reduce the
development of vascular and neuropathic complications.
 Intensive treatment. Intensive treatment is three to four insulin injections per day
or continuous subcutaneous insulin infusion, insulin pump therapy plus frequent
blood glucose monitoring and weekly contacts with diabetes educators.
 Exercise caution with intensive treatment. Intensive therapy must be done with
caution and must be accompanied by thorough education of the patient and
family and by responsible behavior of patient.
 Diabetes management has five components and involves constant assessment and
modification of the treatment plan by healthcare professionals and daily
adjustments in therapy by the patient.
NURSING MANAGEMENT: The nurse should assess the following for patients
with Diabetes Mellitus:

 Assess the patient’s history. To determine if there is presence of diabetes,

assessment of history of symptoms related to the diagnosis of diabetes,
results of blood glucose monitoring, adherence to prescribed dietary,
pharmacologic, and exercise regimen, the patient’s lifestyle, cultural,
psychosocial, and economic factors, and effects of diabetes on functional
status should be performed.
 Assess physical condition. Assess the patient’s blood pressure while
sitting and standing to detect orthostatic changes.
 Assess the body mass index and visual acuity of the patient.
 Perform examination of foot, skin, nervous system and mouth.
 Laboratory examinations. HgbA1C,fasting blood glucose, lipid profile,
microalbuminuria test, serum creatinine level, urinalysis, and ECG must be
requested and performed.
CLINICAL CONCEPT MAP OF HYPERTENSION

Definition: Hypertension is one of the most common lifestyle

diseases to date. It affects people from all walks of life. Let us get to
know hypertension more by its definitions.

Hypertension is defined as a systolic blood pressure greater than 140 mmHg and

a diastolic pressure of more than 90 mmHg.
This is based on the average of two or more accurate blood pressure
measurements during two or more consultations with the healthcare provider.
The definition is taken from the Seventh Report of the Joint National Committee
on Prevention, Detection, Evaluation, and Treatment of High Blood Pressure.
SIGNS AND SYMPTOMS: Headache. The red blood cells carrying oxygen is having
a hard time reaching the brain because of constricted vessels, causing headache.
Dizziness occurs due to the low concentration of oxygen that reaches the brain.
Chest pain. Chest pain occurs also due to decreased oxygen levels.
Blurred vision. Blurred vision may occur later on because of too much constriction
in the blood vessels of the eye that red blood cells carrying oxygen cannot pass
through.
 CAUSES: Increased sympathetic synthetic nervous system activity.
Sympathetic nervous system activity increases because there
is dysfunction in the autonomic nervous system.
 Increase renal reabsorption. There is an increase reabsorption of sodium,
chloride, and water which is related to a genetic variation in the pathways by
which the kidneys handle sodium.
 Increased RAAS activity. The renin-angiotensin-aldosterone system
increases its activity leading to the expansion of extracellular fluid
volume and increased systemic vascular resistance.
 Decreased vasodilation of the arterioles. The vascular
endothelium is damaged because of the decrease in the vasodilation of the
arterioles.
  MEDICAL MANAGEMENT: The medications used for treating
hypertension decrease peripheral resistance, blood volume, or the strength
and rate of myocardial contraction.
 For uncomplicated hypertension, the initial medications recommended are
diuretics and beta blockers.
 Only low doses are given, but if blood pressure still exceeds 140/90 mmHg,
the dose is increased gradually.
 Thiazide diuretics decrease blood volume, renal blood flow, and cardiac
output.
 ARBs are competitive inhibitors of aldosterone binding.
 Beta blockers block the sympathetic nervous system to produce a slower
heart rate and a lower blood pressure.
 ACE Inhibitors inhibit the conversion of angiotensin I to angiotensin II and
lowers peripheral resistance.

NURSING MANAGEMENT: Nursing assessment must involve careful monitoring

of the blood pressure at frequent and routinely scheduled intervals.

 If patient is on antihypertensive medications, blood pressure is

assessed to determine the effectiveness and detect changes in the blood pressure.
 Complete history should be obtained to assess for signs and symptoms that
indicate target organ damage.
 Pay attention to the rate, rhythm, and character of the apical and peripheral pulses.
CLINICAL CONCEPT MAP OF MIGRAINE
Definition: A migraine is a headache that can cause severe throbbing pain or a
pulsing sensation, usually on one side of the head. It's often accompanied by
nausea, vomiting, and extreme sensitivity to light and sound. Migraine attacks can
last for hours to days, and the pain can be so severe that it interferes with your
daily activities.
SIGNS AND SYMPTOMS: One or two days before a migraine, you might notice
subtle changes that warn of an upcoming migraine, including:

 Constipation
 Mood changes, from depression to euphoria
 Food cravings
 Neck stiffness
 Increased urination
 Fluid retention
 Frequent yawning

 CAUSES: Hormonal changes in women. Fluctuations in estrogen, such as

before or during menstrual periods, pregnancy and menopause, seem to
trigger headaches in many women.
 Hormonal medications, such as oral contraceptives, also can worsen
migraines. Some women, however, find that their migraines occur less often
when taking these medications.
 Drinks. These include alcohol, especially wine, and too much caffeine, such
as coffee.
 Stress. Stress at work or home can cause migraines.
 Sensory stimuli. Bright or flashing lights can induce migraines, as can loud
sounds. Strong smells — such as perfume, paint thinner, secondhand smoke
and others — trigger migraines in some people.
 Sleep changes. Missing sleep or getting too much sleep can trigger
migraines in some people.
  Physical factors. Intense physical exertion, including sexual activity, might
provoke migraines.
 Weather changes. A change of weather or barometric pressure can prompt
a migraine.
 Medications. Oral contraceptives and vasodilators, such as nitroglycerin,
can aggravate migraines.
 Foods. Aged cheeses and salty and processed foods might trigger migraines.
So might skipping meals.
 Food additives. These include the sweetener aspartame and the preservative
monosodium glutamate (MSG), found in many foods.
DIAGNOSE OF MIGRAINE: If you have migraines or a family history of
migraines, a doctor trained in treating headaches (neurologist) will likely diagnose
migraines based on your medical history, symptoms, and a physical and
neurological examination.

If your condition is unusual, complex or suddenly becomes severe, tests to rule out
other causes for your pain might include:

 Magnetic resonance imaging (MRI). An MRI scan uses a powerful

magnetic field and radio waves to produce detailed images of the brain and
blood vessels. MRI scans help doctors diagnose tumors, strokes, bleeding in
the brain, infections, and other brain and nervous system (neurological)
conditions.
 Computerized tomography (CT) scan. A CT scan uses a series of X-rays to
create detailed cross-sectional images of the brain. This helps doctors
diagnose tumors, infections, brain damage, bleeding in the brain and other
possible medical problems that may be causing headaches.
MEDICAL MANAGEMENT: Migraine treatment is aimed at stopping
symptoms and preventing future attacks.

Many medications have been designed to treat migraines. Medications used to

combat migraines fall into two broad categories:
  Pain-relieving medications. Also known as acute or abortive treatment, these
types of drugs are taken during migraine attacks and are designed to stop
symptoms.
 Preventive medications. These types of drugs are taken regularly, often
daily, to reduce the severity or frequency of migraines.
Your treatment choices depend on the frequency and severity of your headaches,
whether you have nausea and vomiting with your headaches, how disabling your
headaches are, and other medical conditions you have.

NURSING MANAGEMENT: Headaches tend to range from mild to severe and

can be incapacitating to the patient. It is essential to identify the type of headache
the patient is experiencing. Nurses must take a detailed patient history of the
patient’s condition and determine if an underlying disease is contributing to the
condition. 
DRUG CARD OF LEVOTHROXIN