Definition of eschar: it is a pressure ulcer resulting from ischemic necrosis of an area of ​​skin for too long under pressure from the bone level and a hard surface.
· A pressure ulcer can occur in any subject that has lost the ability to perform transfers of support: Classic bedsore.
· "3:00 to constitute a pressure ulcer, three months to heal."
· It is a serious illness for in its impact, psychological, and the complications that can cause death in 10% of cases.
· It is a common pathology:
- 75% for paralyzed with the + frequent causes: traumatic paraplegia or SEP
- 30% in geriatric
- 3-5% in hospital
it is an economically heavy pathology (€ 20,000 to treat a significant eschar)

Pathophysiology:
The occurrence of pressure ulcers is never inevitable. Only prevention is effective + + +, and we need a better understanding of the pathophysiology, and educate caregivers, the patient and family.
The capillary pressure is 30 mm Hg. Supine pressure is 40 mmHg in the sacrum view 95 mmHg at the greater trochanter and the ischial 500 mmHg when sitting. It is thus understood ischemia resulting.

Movement Disorders Disturbed sensation







From mobility ↓



Ischemia
 


Slough

Evolutionary stages of pressure ulcers (Pathology):
· Consensus Conference 2001 (see illustrations attached)

- Stage I: skin erythema on an apparently intact skin does not disappear after the lifting of the pressure; in cases of pigmented skin: color change, induration, edema, heat are the indicators. Reversible stage.
- Stage II: tissue loss involving the epidermis and the dermis, in part, posing as a blister, abrasion or superficial ulceration. Due to lesions of endarteritis: irreversible stage.
- Stage III: defect involving the subcutaneous tissue with or without peeling device but not exceeding the fascia of the underlying muscles. Stage wet or dry necrosis.
- Stage IV: defect reaching and exceeding the fascia and may involve bones, joints, muscles tendon.

· Should enrich this classification of a stage 0: intact skin but bedsore risk.

· The infection of pressure ulcers is characterized as follows:
o 2 symptoms must be present: redness, tenderness or swelling of the wound edges
o and one of the following observations: bacteria isolated from the culture liquid obtained by aspiration or biopsy of the edge of the ulcer; organisms isolated from blood cultures. Infection is asserted beyond of 10 5 organisms / ml.


Risk factors for occurrence of pressure ulcers or bedsores etiologies:
the main risk factors of pressure ulcers are explanatory and can be classified into extrinsic and intrinsic factors or mechanical or clinical factor:
- Extrinsic factors:
· Still + + +
· Pressure, shear
· Maceration
· Rubbing cloth
· Plaster
- Intrinsic factors:
· General causes:
o nutritional deficiencies + + +: MPE hypoprotidemia Syndrome
o dehydration
o Anemia
o infection, acute disease
o severe chronic disease and terminal phases
o age (skin fragility)
o history of bedsores
o decrease in circulatory flow: vascular disease (arterial)
o urinary and fecal incontinence
o neurological disorder bordering on immobility

· Local trophic causes
o especially among the paraplegic + +: due to
§ loss sensibilitéÞ ↓ pain (motor paralysis has few eschar because the sensitivity is maintained),
§ and lower limb spasticity resulting in a vicious circle
§ and ↓ of tissue resistance to the pressure with micro thrombosis
o elective areas of support are well on risk areas:
§ supine: 30% sacrum, heels 30%, occiput (post surgery), scapula, elbow
§ lateral decubitus: 30% trochanter, lateral malleolus, inner knees, leg side face
§ sitting: ischium, sacrum buttocks, dorsal region lateralized
§ but all areas of the body can be affected (bedsores on nasal or urinary catheter, for example)
o the skin condition from (atrophic skin in the elderly)
We particularly note immobilization and undernutrition as a predictor of the risk of bedsores.
In some clinical situations, some factors are more specific:
- In neurology, orthopedics and traumatology three key risk factors:
· pressure
· Loss of mobility
· Neurological deficit with spasticity, incontinence, lack of patient cooperation. In case of reconstructive surgery, age, smoking, corticosteroid therapy, diabetes, disorders of microcirculation and coagulation are pejorative for healing.
- Geriatrics, the particular fragility of the skin and subcutaneous tissue and the protido-calorie insufficiency increase the risk of pressure ulcers in case of cardiovascular diseases, hypotension or hyperthermia
- In intensive care, the frequency of collapse, the severity of the initial state, fecal incontinence, anemia and length of stay are predictors of the risk of bedsores.



One can select three etiological circumstances bedsores:
- Eschar "accidental" related to a temporary condition of mobility and / or consciousness:
· Comas (metabolic, barbiturates, ethyl, traumatic ...)
- Eschar "neurological" consequence of a chronic pathology motor and / or sensory:
· Paraplegia
- Eschar "multifactorial" of the subject polypathologique, confined to bed and / or chair:
· The most frequent case of the elderly.


Differential diagnosis of pressure ulcers:
· The radiation injury: no notion of bed rest, immobilization. ATCD radiotherapy. Necrotizing vasculitis wider that the apparent damage. Appear 10-20 years after the biopsy because often radiothérapieÞ epitheliomatous evolution.
· The cytosteatonecrosis: Septic infarction fatty masses. very deep.
· Rhabdomyolysis or cytonécrose: after IM injection of toxic
· The original ulcers and various traumatic wounds

 Preventive treatment + + +. This is the real treatment of pressure ulcers:
1. assess risk
2. implement the general preventive measures
3. use appropriate media
4. inform and educate the patient and his family

· 1 Start by identifying risk factors in stage 0: from the very first contact with the patient. Caregivers should be trained in the recognition of risk factors and trained in the use of risk identification scale.
The risk scale reproducible and validated for use, combined with an initial clinical assessment, allows the development of prevention strategies adapted to the level of risk. The most common scales are those of increased Norton, Waterlow, and Braden (see annex), Amiens scale modified poplars.

                                          Norton scale
2 · Implement general preventive measures:
No decrease pressure: patient facility
o avoid prolonged support by mobilizing, setting the chair (30 ° 60 ° tilt hazard!), verticalization and the resumption of early works
o planned position changes every two to three hours
o avoid shear and friction phenomena installation and proper patient handling
o the oblique lateral decubitus position at 30 ° to the plane of the bed is preferable to reduce the risk of trochanteric pressure sores.


No other care nursing: + + +
o Observe the skin and areas at risk ++
o fight against contractures (physiotherapy)
o protection of bearing zones with landfilling of hazardous areas (studding)
o maintaining personal hygiene and good skin condition: Air and regular changes.
o Massage and friction, ice on areas at risk applications should be avoided since the average ↓ micro circulatory flow. Prefer strokes of support barehanded points of use corn oil or grape seed, (Sanyrene R). Proscribe products which dry the skin and clog the pores: alcohol, water pastes.
o Avoid maceration.

n ensure good nutritional balance. The severity of pressure ulcers is correlated with undernutrition. Eschar non curable if severe malnutrition. Criteria of malnutrition:
o ingestas <20 kcal / kg / day
o weight loss> 10% in six months
o lymphopenia <1200 / mm3
o albumin <35 g / l prealbumin <200mg / l
n rapidly process associated pathologies, including infectious states of hyper catabolism officials.
- 3 Use suitable media:
o mattress:
· Foam mattress waffle kind CLINIPLOT for weight 50-100 kg; ineffective in heels
· FOAM mattress viscoelastic "memory" which increases the contact surface
· Mattress UAE, 37 ° C, heavy, heat to maintain (survival blanket)
· Static or sophisticated mattress AIR kind Nimbus pressure sensors
· FLUID BED: Risk déshydratationà offset by 1 liter of fluid intake
o mattress:
· Air static self excel, excel has
· Alternating at alternate air swelling
· In silicone fiber
o the chair:
· Foam cushion
· Gel pad (RestonR)
· Static air cushion
· Slip nets
o Indications:

Static support
No bedsores or moderate risk of bedsores
Patient can move and <15h / day in bed
Static support
Dynamic +
Patient with bedsores or high risk of bedsores
or> 15h / day in bed
Unable to move one
Dynamic Mattress
Eschar carrier patient
or> 20 hours / day in bed
Unable to move one

- Inform and educate 4: promoting patient involvement and his entourage to the prevention of pressure ulcers: self-monitoring, self mobilization with lifting exercises stimulate and promote hydration and nutrition, and help ensure the toilet made in the rules.

Medical treatment consists of pressure ulcers:

- Requires a multidisciplinary team work for both local treatment is generally taking into account the individual and the wound.
- General treatment:
· Nutrition
o correcting deficiencies, anemia, electrolyte disturbances, fluid intake> 1.5 l / day (except one)
o protein supplementation 2xNsoit à2,5g 1.2 / kg / day (difficult if severe renal impairment)
o calorie 35-45 kcal / kg / day:> 2000kcal / day
o 55% carbohydrate intake 50A of the contribution
o Vitamin C 500mg to 1000mg Vit / d
o Zn 25-50mg / day
· Treatment of tissue anoxia factors (diabetes)
· Monitoring the cognitive state and vigilance
· Anti-tetanus vaccination
· Prevent thromboembolism
· Eschar infected: make repeated bacterial samples with antibiotic susceptibility testing but only if complications on infected pressure ulcers, osteomyelitis, arthritis, or systemic signs (hyperthermia, sepsis)
· Manage the control of feces:
o sometimes poses a colostomy bag to the anus if gluteal bedsore.
o Often diarrhea causing bedsores so superinfection control intestinal disorders (residue-free diet, parenteral nutrition, exceptionally colostomy discharge).
· Pain + + +:
o it does not correlate to the size of the ulcer
o assess its cause
· Cyclic acute pain (in the care, mobilization of nursing: choice of analgesic treatment, to alleviate Actiskenan ® 3 times before carefully with suitable dressing suitable support, good positioning analgesic
· Staples Acute pain in a greater care (debridement Mechanical debridement of necrotic): Effective use of topical anesthetics Emla® only 5mm deep, using O² / NO Kalinox® when dressing.
· Chronic pain in persistent permanently idle: choice of continuous treatment, relaxation, to ensure dosing schedule painkillers
o assess its intensity through VAS scales Doloplus
- Local treatment:
· Describe the eschar: use bedsore dressing monitoring forms (see appendix) with:
o Location on drawing,
o measurement of the surface and the depth,
o lesion appearance perished,
o describe the color black yellow red rose,
o pain assessment and nutrition
· General principles of treatment:
o treatment of redness: Stage I
· Release the pressure with a change of position every two hours
· If necessary use a semi-permeable or transparent hydrocolloid movie
· Effleurages
o cleaning of the wound and principles of its periphery: stage II or higher
· physiological serum
· No antiseptic (except betadine possible if surgery)
o treatment of blister: vent contents and maintain the roof of the blister, cover with a hydrocolloid dressing or fat dressing if hemorrhagic blister cut the roof of the blister
o treatment of pressure ulcers consists of:
· Debridement is necessary on necrotic wounds and / or fibrinous: mechanically or by excision around Alginate dressings or hydrogel. Detergent dressing Flammazine every other day by protecting the periphery with a paste with water.
· If debridement performed pro-inflammatory dressing for a budding: + tulle dressing liquid Betadine
· Use of modern dressings depending on the condition of the wound (see table)
· Is important to respect the bacterial ecosystem of the wound swab No systematic infection only if:
· Stage of debridement: Gram germ - and anaerobic (pyocyaniques) naturally colonize the surface of the eschar. These germs stimulates the arrival of macrophages and polymorphonuclear that will cleanse the wound
· At the stage of budding: Gram germs - are replaced by Gram + bacteria Staphylococcus Streptococcus
· In case of temporary local antiseptic but never superinfection local antibiotic therapy. Systemic antibiotic therapy on outcome of susceptibility testing.

Appearance of the wound
Therapeutic Alternatives
Black and dry necrosis Presence
Mechanical debridement
Hydrogel + / Scarifications
enzymes
Presence of a fibrin wound or slough
Mechanical debridement
Hydrogel so little exudative
Alginate and Hydrofiber if very exudative
Wound anfractuous
Alginate locks
Hydrofibres locks
hydrocolloid paste
Wound very exudative
At the stage of debridement
Alginate
Hydrofibres

At the stage of Budding
Hydrocellular
foam

Bleeding wound
Alginate
Burgeoning wound
Fat dressing
Hydrocellular
foam
Excessive granulation
Corticotulle
Silver nitrate
Wound nearing epidermization
Hydrocolloid
Tulgras
transparent polyurethane movie
Hydrocellular
foam
Smelly wound
Coal dressing
Infected wounds
Alginate
Coal dressing
Hydrofibres

3 Surgical treatment:
surgery is needed if:
· Significant tissue necrosis
· Exposure of neurovascular axes, tendons or joint capsules
· Exposing the bone and infection

surgery is against-indicated in the elderly if:
· Eschar multifactorial
· Lack of implementation or ineffectiveness of recurrence prevention measures
the surgical indication is retained if:
· Patient in good condition because heavy bleeding and response
· Rénutri sick without cardiovascular problem
· Carrying a clean eschar
in case of intervention:
· The surgical procedure must be framed by a medical preparation and particularly harsh treatment
· Problem installing the sick for intervention to prevent the emergence of new pressure ulcers for long procedures
· In intraoperative and postoperative antibiotics for 8 days off adapted to antibiograms performed preoperatively
· Capillaro-protective treatment
· Calorie diet without residues
· Redons let up until the drying up of flows, cultivation tubing
· Support forbidden on the operated area for one month minimum unless sick fluidized bed. And changing the position of every two hours. The patient must endure the prone position
· First dressing made removal of redons between the 5th and 8th day
· Surgical indication based on the type of pressure ulcer and its location:
o sacrum, heels: spontaneous healing in the prone position
o ischion: responsible pyoderma, furunculosis bursitis to be punctured in some cases
o trochanter: often complicated coxofemoral arthritis, subluxation, dislocation of the femoral head requiring resection of the head and neck. Make an X-ray systematically basin to search osteitis arthritis subluxation, dislocation.
· The techniques used:
o in a first step
§ excision of the eschar pocket
§ excision of bone ostéitique
o secondly cover the cavity excised by a flap
§ pure skin
§ pure muscle
Musculocutaneous §
§ cutaneous fascia.

4 Treatments eschar at the stage of palliative care: pressure ulcers end of life.
This support requires the most objective evaluation possible prognosis of the patient and the prognosis of the eschar frequently reassessed team.
Respect for the person must carefully guide treatment choices at different stages of evolution of the underlying disease and the patient's general condition.
There are several objectives in this context premiums or the overall approach and individualized patient:
· Locally treat eschar being attentive to patient comfort as well as pain relief:
o minimize the extension of the eschar avoid the uncomfortable symptoms Complications
o therefore not a priority debridement
o dressing chosen for less frequent renewal
odor management o (flagyl: dressing coal)
· On a general level:
o keep the patient clean up and reduce the physical discomfort
o and psychological: relational dimension of care.
o possibly prevent the occurrence of new pressure ulcers but nutritional status must take second place here

LES COURS DE Dr/ OUHSSAIN  : pancréatite, diabète, thyroïde
  POUR TÉLÉCHARGER CLIQUER ICI

la stérilisation des aides soignants

There are a lot of harmful substances to the body, which raises cholesterol levels and increase the probabilities of disease. The food they are useful, unfortunately, a few, but a few. "Health Center" German specialist site counted nine high interest for the body material, namely:

1. broccoli (or cauliflower or broccoli or broccoli), considered by some experts the best food item at all, and for the following reasons: broccoli contains a substance "Solforavan" natural anti-oxidant chemical. Broccoli and a strong stimulant enzymes repellents toxins, and reduces the risk of cancer and helps to produce enzymes that protect blood vessels in the body and reduce the risk of heart disease. And contains a substance "Gluckoravanin" which enhances the body's immunity against cancer.

It features a low thermal Bsarath, it contains one cup of cooked broccoli on about 40 calories. And provides broccoli body with large amounts of vitamins "C" vitamin "A" vitamin "Ki", as well as folic acid. And contains a high amount of potassium material, which helps to improve the nervous system of human health. It is also the perfect food to enhance the work of the functions of the brain. How to preparation and cooking: prefer to buy fresh types of it and washed with salt water, and then rinse with cold water. Preferably cooked with steam for a period of a few so as not to lose the useful articles. Preferably eat three meals a week of it.

2. hemp seeds (or seeds Alhamb): a lot of food and medical benefits, and most important: contains more than 20 kinds of amino acids, making it an integral protein of the body. And contain high levels of zinc, magnesium, calcium, phosphorus and iron. And contain a large number of useful body fat, and omega-6 linoleic acid. And working on the right balance of fatty acids (cholesterol) in the body, and is the only plant in the world that maintains the proper balance of saturated fat in the body.

It also eases the risk of heart attack and atherosclerosis. And reduce the risk of colorectal cancer because they contain a subject and insoluble different Dietary fiber. And sedative for insomnia, stress and help you relax. In addition to containing phenolic antioxidant compounds, which inhibit various types of cancers. How to be addressed: Hemp seeds can be added to milk or corn chips or vegetables. Can be used as seed flour in baking and pastry.

3. Shea seeds (or Alstaa or sage): similar to sesame seeds and grow in South America and Australia. The basic food for the Aztec and Mayan tribes in South America. The seeds contain omega-3 and omega-6 and Alcalaseyoum, magnesium, iron, potassium and protein. The most important benefits are the fight against aging and provide great food energy for the body enough for long hours and reduce blood pressure and risk of heart disease and help digestion and diet.

In addition to containing shea seeds Dietary fiber materials and anti-oxidants help to remove toxins, and reduce the risk of cancer and stroke. How to be addressed: the seeds powder can be added to Shea juices and cold drinks and drink at breakfast, and can be added to the authorities, vegetables and soup.

4. plant dandelion (also called dandelion or tarragon or teeth of a lion's wort): herb dandelion plant has many medicinal benefits and tremendous ability to heal gallbladder diseases and infections of the liver due to the presence of "Taraxakn" useful, in addition to its contribution in reducing the incidence of diseases of urinary and reduce blood pressure and treat low blood sugar level. These herbs once and preferably addressed cook and eat Soaúlha, as with the tea.

5. Coconut: Coconut oil is useful in saturated fats, which contain large amounts of fatty acids. And coconut makes metabolism works well, in addition to being low fat calories. According coconut also in the treatment of diseases and skin infections. It has a high dietary fiber and improves insulin secretion and the use of glucose in the blood. And contributes to anti-aging. And strengthens the body's immunity, and fights cancer.

6. plant nettles (or Napata Alenetlh) are herbal plants have thorns minutes, and medical herb used against anemia, hemorrhoids and calm the nerves and skin diseases, and strengthen the work of the joints. They are also used to treat internal bleeding and ulcers and gastrointestinal diseases. How to use it and eat: Works from the plant ointments private and can be eaten by drinking juice or mix it with vegetables or cooked by seeds.

7. Grain Quinoa: Quinoa is a grain found in the South American continent. Characterized by large food value because they contain a high percentage of protein, amino acids, and especially the basic amino acid lysine important in building tissue regeneration. And contain vitamin "B-2" who believes in the power of vital processes in the brain and muscle cells. Containing manganese antioxidant, and is appropriate for diet food. How to be addressed: You can cook the quinoa grain, as in cooked rice. It can boil water and eat, or mixed with vegetables and cooked.

8. algae Chlorella: A green algae live in fresh and salt water. To feature a high nutritional value and clear the body of toxins and increase the body's immunity and resistance. Made in the form of food grains and sold in pharmacies in special food shops.

3 steps to react to blood exposition

                                               EMERGENCY
1-  bite or injury (cut or otherwise): Wash immediately the area of skin witt a lot of water and
soap and disinfected

 2- projection in the mouth or nose,; flush Water immediately with plenty of tap

3- gets in your eyes, : flush Water immediately with plenty of tap (remove contact lenses)

Mr; xxxx                                                                                                                casa le 12.11.2014
quartier x  No 23
casablanca




                                               A monsieur le directeur général de l`hôpital,,,,,,,
                                                        S/C  de la voie hiérarchique


       

                               objet: demande de stage


                         j`ai l`honneur de vous demander de bien vouloir m`accorder un stage de fin de formation dans votre honorable établissement.

                      je tiens a informer que je suis une jeune marocaine , âgée de  21 ans titulaire d`un diplôme d`infirmière auxiliaire,
                     
                      Dans l`attente d`une réponse favorable ,veuiller accepter Monsieur le directeur  mes salutations les plus respectueuses.




                                                                                                  Mlle:XXXXXXXXX






                                                                                               Mr:ouzmi

        

                         

• - A la constatation d’une couleur anormale (rouge foncé ou jaunâtre) il faut saisir les

1. Pour les organes : il existe plusieurs maladies dont les plus importantes sont:- Les kystes hydatiques : Cette maladie se présente sous forme de kystes hydatiques au

• niveau des poumons et du foie et parfois au niveau du cœur.

o Si on observe un ou deux kystes dans un organe on peut enlever les kystes en
prenant les précautions pour ne pas les percer et consommer le reste de
l’organe.
o S’il y a une grande infection (plusieurs kystes étendus) il faut éliminer tout
l’organe.
- La larve de taenia : cette maladie parasitaire se présente sous forme de points blancs
au niveau du foie ou des kystes d’eau sur la face interne du foie ou sur la graisse
mésentérique.
-
o Si l’affection est légère dans un organe on peut enlever les points blancs ou les
kystes et consommer le reste de l’organe.

o S’il y a une grande infestation il faut éliminer tout l’organe.
- Distomatose : maladie parasitaire qui atteint le foie.

o Si l’infection est légère, il suffit d’un épluchage, sinon il faut détruire
l’organe en entier .

- Strongle des poumons : maladie parasitaire qui atteint le poumon se présentant sous
forme d’un grain de plomb au niveau de la partie inférieure de l’organe.

o En cas d’infestation, éliminer la partie atteinte.

- Contamination du poumon par le sang (écophrage) : Dans ce cas, il est nécessaire
d’éliminer la partie atteinte du poumon.

- Oestrose : la larve se localise le long des narines. Cette infection ne constitue pas un
danger pour la santé du consommateur, mais il convient d’éliminer cette larve.

AID EL KEBIR


RISKS AND DANGERS OF RED MEAT


The Feast of the red meat of choice, it is the day of Eid elkebir. Enjoy the holiday without harming his health: is it possible?


Beyond have fun, do not forget the religious character of the festival is the symbolic sacrifice of sheep first and then sharing the meat with the poor in a spirit of reverence and brotherhood; Based on this done, it is possible to consume in moderation red meat while following some diet and lifestyle without rules only if it could harm his health.


What could the people who will suddenly start eating red meat daily, noon and night? How will react metabolism?


The results of scientific studies do not go in the direction of a rehabilitation of red meat. Indeed, they show that the largest consumers of red meat see their risk of colon cancer increase. It is estimated that eating 100g of red meat every day increases the risk by 29%. Other studies also suggest an increased risk of cancer of the esophagus, pancreas, breast, lung, stomach, endometrium and prostate.


"Red meat promotes the risk of cardiovascular disease"


Not to mention that red meat bad reputation because rich in saturated fatty acids, which are known to promote cardiovascular disease by promoting atherosclerosis; by increasing the bad cholesterol (LDL); and give high blood pressure, coronary heart disease or stroke.


Who are the people who should not abuse of excessive consumption of mutton?


Anyone who presents a risk factor cardiovascular as dyslipidemia, diabetes, hypertension, smoking, and not forgetting the obese and patients suffering from gout.


What are the precautions to be taken by people who are not part of the population at risk, to avoid such hazards?


If eating red meat in large quantities can be harmful to health, do not eat it is so far beneficial? (Everyone is not going to become a vegetarian) What is the proper dosage?


The ideal would be not to abuse by favoring white meats like chicken, turkey and fish.


You need to consume up to three servings of meat per week is a ration of 500g per person per week; to choose the least fatty parts and rather prefer the steaming, oven and grill.


"You have to eat more than three servings of meat per week"


There are also tips on how to prevent the formation of carcinogenic substances as well trim the fat before cooking to avoid the smoke; Marinate meat well (lemon juice, balsamic vinegar, mustard, oregano and tin but not especially oil) and cook on a high heat or too much on the grill top, to limit the formation of heterocyclic amines responsible for the misdeeds red meat.


Keeping a whole sheep at home, it does not happen every day. Homes they have the necessary conditions to preserve meat sheep for a period long enough sometimes? How should people go about promoting the best possible hygiene?


Refrigerated sheep must be kept chilled, lasting three days do not exceed even one or two days if the meat is ground.


As against the freezer it can be stored in pieces and for eight to ten months; no more than two to three months for the ground meat................

1 - DEFINITION : This is an acute inflammation of the appendix

2 - ETIOLOGIES :
The infection begins in a point located between two mucosal lymphoid follicles. From this primary focus of infection causes the accumulation of pus in the appendiceal lumen , but tends to evolve through the thick wall to the serosa of the appendix, distended it promotes vascular thrombosis gangrene and perforation. In any case found in the appendiceal lumen calculation stercoral sometimes lymphoid hyperplasia or tumor, the causative organism is E. coli is associated with other germs.

3 - Clinical
Appendicitis is revealed in different forms:
A - Typical shape : crisis right iliac
· Abdominal pain with maximum defense at the right iliac fossa
· Fever 38 - 38.5 ° C
· Nausea or vomiting
· Constipation sometimes normal transit
· Tachycardia
· Tongue coated
· Pelvic Pain right ( DRE )
· NFS shows leukocytosis
· Changes in the absence of treatment is unpredictable
B - Form appendiceal
· Temperature 39 ° C
· Widespread pain
· Alteration of the general state
· Defense
C - Chest appendix : Agglutination of intestinal loops and adjacent organs
· Fever 39 °
· Defence at the right iliac fossa , and palpation of a mass at this
· Abdominal Pain
· Alteration of the general state
D - Peritonitis
· Maximum Abdominal Pain in the right iliac fossa
· Alteration of the general state
· Fever 40 ° C
· Abdominal Contraction
· At DRE : pelvic pain



4 - FORMS UNDER THE SEAT :
· Rétrocoecale Appendicitis
· Appendicitis mésocoeliaque
· Appendicitis in liver
· Pelvic Appendicitis

5 - Treatment:
Short resuscitation :
· Infusion of electrolytes + antibiotics
· Gastric tube
appendectomy
Wash warm serum abundance
Peritonitis or abscess drainage if
If Chest : Perfusion electrolytes + antibiotics for 9 days and appendectomy.


NURSE ROLE

1 -
Kindly welcome the patient and his companions help with administrative formalities by securing the health of their patient.

2 - Installation of the patient:

• · Choose a venous
• · Perform laboratory tests requested emergency and especially the white formula .

a- In case of surgery :

• · Secure the patient
• · The patient both physically and morally Reassure
• · Make the operative field
• · Make premedication if prescription
• · Accompany the patient to block with his record.

b- If it is an appendix mass

• · Reassure the patient
• · Put an ice pack to relieve pain
• · Apply the prescribed therapeutic
• · Inquire about the date and time of the transaction , pending thereof prepare physically and mentally ill
• · After his return from the block will be made ​​in care post operatively.

definition: This is to clean the oral cavity , to the maintenance of a denture or mouthwash. action

- Wash hands .

Bring :

• - A tougue depressor
• - Some gauzes
• - 2 glasses of water solution and rinse
• - Oral Solution " Givalex .. Sodium Bicarbonate .. "

If prosthesis : door dentures

• - Towel
• - kidney bassin
• - Gloves

1. - Prepare the solution
2. - Place the patient half sitting .
3. - Put the towel around his neck .
4. - Wrap the gauze around the tongue depressor at its end .
5. - Soak the compress wash solution.

Clean the oral cavity , proceeding from the bottom to the front of the mouth .
- Palace , teeth, gums, tongue, cheek , lips .
- Change compresses each faces.
- Rinse mouth if the person is using the kidney bassin as spittoon , if not done in the same technique.
- Moisturize lips.

Oral care is very important, if needed repeat 3-4 times / day for people whose function swallowing is impaired and do not feed or very bit orally.
                                                                                                                   alostad

Preparing the body of a died patient is a treatment in which the respect and dignity of the deceased will help to give an image more " bearable " to his family. After the death , the first contact between the family and their closest students can begin the " grieving " respecting the beliefs and values ​​of the deceased and their families We as caregivers give the deceased a nearest one to which his family can expect picture.
The toilet is a move that fits into the continuity of care
Toilet made ​​in a dental unit is to differentiate the toilet made ​​the death chamber that allows the convenient onsite various religious rites
 MATERIAL:

•  Disposable apron .
•  Gloves non sterile single use.
•  A garbage bag.
•  A box escape blunt objects .
•  Mild soap.
•  Washcloth disposable.
•  Towel disposable

 STAFF :
The toilet of the deceased is carried out by two people: one nurse and nurse assistante
 COURSE OF TREATMENT:

• The deceased patient is placed or kept in one room
•  Remove clothing, hearing aids, glasses ( make an inventory ) .
•  Close the eyes of the patient , if necessary, use a dry eye pad ( avoid putting tape ) .
•  Remove jewelry and safe deposit at the central hospital admissions (if the alliance can not be removed , it is best to let the body taking care to report on the plug connecting the mortuary )
•  Remove any invasive material: infusion catheter ...
•  Remove dressings, plasters ...
•  Perform a full closet with soap and water
•  clean and replace dentures to make the face its usual form ( note the plug for connection to the death chamber ) .
•  Perform a complete renovation of all dressings and strengthen occlusive dressings .
•  Suture ( doctor) if necessary open wounds
•  compress the puncture .
•  Changing ports pockets ( stoma urétérostomie )
•  establish a comprehensive single-use change ( "layer" ) to prevent leakage.
•  Proceed to the most suitable hairstyle.

 RECOMMENDATIONS :

• It is best not to shave the deceased patient ( this gesture is performed secondarily by caregivers using the mortuary ) .
• To comply with certain rites and customs, it is recommended that the patient's arms along the body .
•  Install the deceased without clothes in a clean cloth fabric .
•  Put an identification wrist band ( name, date of birth , date and time of death) .
•  Cover the body with a sheet which is then tied around the head and feet ( after the departure of the family).
•  Maintain the oral cavity closed by putting a cloth "rolled" under the chin and gently tilting the neck forward
•  if necessary put a gauze bandage around the jaw but only after the departure of families.
•  Remove highlight the identification form filled body on the sheet
•  fill in the form binding and whether the patient has an implantable chamber or a pacemaker .
• The deceased may remain in the unit within two to six hours before being taken to the mortuary ( this period may be extended up to a maximum of ten hours, depending on the case) Each situation must be assessed by caregivers in different situations , families and context.

 SOME INFORMATION ABOUT SOME RITUAL ...
In some denominations, the toilet can be performed at the mortuary by a family member of the same sex as the deceased or by the imam (Islamic religious ) The Israelite Consistory performs a ritual washing in the death chamber accompanied by a rabbi chaplain for prayers practice a blessing prayers with the family ( Catholic) pastor performs a reading of the Bible, a practice anointing oil to the deceased ( Protestant ) a monk performs various rites and prayers ( the deceased dressed seven outfits and a coin is placed in his mouth " passage into the afterlife " ( buddhism ) .

Anticoagulants used :
Doctors currently have three major classes of drugs: heparin , anti -vitamin K, slow but long-acting , and fibrinolytic .
Indications anticoagulants :
Anticoagulants are prescribed as a preventive or curative in the following conditions:
• coronary insufficiency and especially myocardial infarction
• Some heart failure
• The arteritis , phlebitis , thrombosis and embolism
• The cardiac rhythm before their regularization
• During the postoperative period in abdominal , pelvic and orthopedic surgery
This information will be tempered by cons -indications related field and in particular age or pregnancy
Cons -indications to anticoagulants :
Due to arterial status , especially the brain floor, the elderly , anticoagulants are cons -indicated after 75 years. These drugs are also cons - indicated in subjects with hemostasis is imperfect : cirrhosis with liver failure, thrombocytopenic patients , hemophiliacs, and in the patient with gasro ulcers . In pregnant women , anticoagulant therapy should be minimized; Under no circumstances should administer vitamin K. You should know that many common drugs can increase the action of anticoagulants. These are :
• Aspirin
• Corticosteroids
• Male hormones
• Thyroxine
• The sulfonamides
• Quinine
Finally beware of intramuscular injections in patients receiving anticoagulants, are a source of hematoma.
Accidents anticoagulants :
It is basically bleeding events , some of which are warning signs :
• hematuria
• gingival
• Epistaxis
• Bleeding
But any visceral bleeding may be due to a hemorrhagic lesion made ​​by hyper coagulability which reveals . These lesions should always be seeking Finally, you should know that the group of anticoagulants anti vitamin K are responsible for allergic cutaneous manifestation accidents , accidents of blood ( pancytopenia ) , kidney ( anuria ) and liver . Moreover, they are teratogenic and are shown against pregnant women .


Monitoring a patient on anticoagulants :
Two points are essential :
Always a patient group which we will administer anticoagulants so as to possibly transfuse quickly ;
Ensure the strict application of the requirements , especially the doses prescribed route and schedule of administration.
For the rest monitoring is twofold: clinical and laboratory .
Clinical monitoring :
This is especially the detection of bleeding events regarding nursing .
How ? The daily search for gingival hematoma to point injections intramuscular, blood in the stool or urine
Biological monitoring :
Day after day , hemostasis patient should be monitored using different tests that the nurse is the first to know the results. Biological monitoring varies anticoagulant used . The usual tests are:
Prothrombin time (PT), which tracks to follow the action of anti vitamins K. The result is given as a percentage of normal. In normal subjects , the prothrombin time was 100% . To be effective , the anticoagulant treatment must reduce between 20 and 30 %. Below 15% hemorrhagic stroke can occur ;
The international normalized ratio or INR is - to say " international normalized ratio . For a long time , the calculation of prothrombin time ( PT) was considered sufficient to monitor the anticoagulant effect, but it is being replaced by the INR . This new index is a calculation derived TP allows to standardize the results of all laboratories based reagents . The usual value of INR in the subject untreated is 1 . It is between 3 and 4 in case of hyper effective therapeutic clotting .

How to deal with an accident anticoagulants ?
In case of hemorrhagic stroke :
Of course, it is necessary to group the patient if it is not already, call your doctor immediately and decrease the anticoagulant dose. Then begins a clinical and biological monitoring as we have outlined above. In particular, pulse, blood pressure measured by the doctor prescribed rate will be recorded on a sheet of resuscitation. Such resuscitation allows detection of a collapse at the beginning stage . It must be continued for as long as the treatment of accident.
This treatment includes : before typing the patient or while waiting for the cover of blood , infusion of macromolecular solutes
After grouping the patient , blood transfusions iso group ABO and rhesus
In severe cases , it preferable to infuse blood fractions enriched in coagulation factors
Moreover, depending on the type of anticoagulant responsible for the accident treatment is completed by:
The administration of vitamin K1s'il is an accident by anti vitamin K. You should know that vitamin K1 act only 36 h
The injection of protamine sulfate in the case of an accident by the heparin . Ten milligrams of protamine sulfate neutralizes heparin ten milligrams .
If hemorrhagic incident .
Simply decrease the anticoagulant dose , determined by the physician, is generally sufficient. The same " tactics " will be adopted if , in the absence of bleeding , the patient is biologically clotting hypo too strong . This is the case for example when the prothrombin time is less than 15 % . We keep stopping treatment abruptly not increase the risk of thromboembolism . We must emphasize the importance of patient education in the prevention of risks related to anticoagulant therapy .
In case of non hemorrhagic stroke :
He noted symptomatic treatment and the choice of another anticoagulant drug.
Behavior in case of INR too high :
It is necessary to limit the risk of bleeding , but we must also avoid the use of high doses of vitamin K1 making it impossible equilibration treatment for several days with increased risk of thrombosis. The proposed lines are summarized in the table below.

Circumstances What to do
INR <5 , no bleeding , no planned surgery Delete the next dose , then reduce subsequent doses
INR between 5 and 9 , no or minimal bleeding Stop taken prescribe 1à2 mg vitamin K1 orally , daily INR resume AVK lower dose when the INR within the therapeutic range returns .
INR sup. 9 , no bleeding , understanding instructions 3A5 mg vitamin K1 orally (or 1-5 mg IV by slow infusion ) , 6 hours after INR ( INR renew vitamin K1si not sufficiently decreased) , resume AVK lower dose when the INR within the therapeutic range returns .
INR sup. 9 , hemorrhage or even minimal doubt on the ability to follow instructions Ditto + hospitalization.
Major bleeding or high INR Hospitalization, vitamin K1 10 mg slow IV , repeated if necessary every 6 hours depending on the degree of urgency, PFC infusion . After treatment with high doses of vitamin K1, will observe a period before returning to the effectiveness of VKA ; In this case, you must use heparin until VKA be effective, and especially avoid excessively increasing the dosage of these

Concepts of rights, health, illness and care .

Definition of a Man
In the holistic view of man is a bio-psycho- social being who is evolving with its environment. This is a unique being able to mobilize resources it can according to the different phases of his life. He is looking for a constant balance and maintaining a quality of life for himself and others.

According to Virginia Henderson , the man is a complete whole , with 14 independent basic needs. It is seen as a bio-psycho- social being who uses depending on its stage of growth and development means or ways of life of its own to meet its needs .

need
This is a requirement due to the nature and social life; Psychiatry is a craving and internal tension that accompanies deprivation .

Definition of Health ( according to WHO)
Health is a state of complete physical , mental and social , and not merely the absence of disease or infirmity.

According to Virginia Henderson, is the independence of the person in satisfaction of its 14 basic needs. It must be considered in a holistic vision of the human being , it is the result of a balance between the genetic material , biological, psycho , socio-cultural and spiritual . Health is a state variable fragile fluctuating depending on the different elements that constitute it. The person is always looking for balance, it aspires to wellness.



Definition of Disease ( according to WHO)
Dysfunction psychological, physical and / or social origin, which manifests itself in different forms.
 The perception of the disease is a subjective one ; Indeed , the disease will make you think for some people to the hospital, secondary benefits or otherwise to significant disorders, difficult to manage. Nevertheless, the disease is objective in nature when it comes to alterations functions highlighted by the scientific and technological research .
Person despite these alterations may be health or balance (eg diabetic) because it mobilizes resources to adapt to this new state. If the disease is witness to a disturbance in the body, it is also a sign of its responsiveness and adaptability , it must be viewed in a dynamic and not static vision.

Definition of care (according to Larousse)
The concept of care is take care of yourself, take care of others.
It is to realize common actions for the welfare and the lives of everyone ; this is a satisfactory response to the need for maintenance and continuity of a person's life, a family and a community. As long as the person is healthy, in equilibrium , it satisfies their needs to be autonomous .

The Anglo -Saxon use two distinct terms to describe care :
- CARE ( = take care of ), which means all acts relating to the care of maintenance of Life ( NURSING )
- CURE ( = give care ) that restores health, which repairs (eg, surgery , treatment, dressings, injections ... )

According to Virginia Henderson, is to help the individual patient or health maintenance and / or recovery of health ; or assist in his last moments of life by accomplishing tasks that would carry himself if he had the strength, will, or had the knowledge , and to perform its functions to the help to regain its independence as quickly as possible .

General:
Care planning is based on the concept of the individuality of each client, so she tries to make a plan of care'' custom'' that fits their specific needs. This individuality is respected in diagnostic procedures in the establishment of therapy and in all aspects of nursing. Individuality is more likely to be realized if written plans are collected in a continuous and systematic way. Care plans then become a valuable source of information on the problems of the patient.
Staff to prepare a plan of care must constantly assess the patient's condition, as and when the change occurs on the evolution of the disease. At the same time the nurse must be able to generate effective communication with both the patient with his family and with other team members.
We can therefore define the plan of care as a method and a working document for the health team to provide individual care to meet all the needs of the patient.

Definition:
Care planning is also called the nursing process: it is a systematic and organized approach that enables nurses to identify, analyze, plan, implement and evaluate nursing care for each patient.

Care planning can:
- The distribution in time of the actions provide care to all patients of a service;
- The collective organization of care for a given period;
- A means of precision, coordination and control activities.

It is displayed on a wall chart that allows any time to provide all professional information on the actions of caregiving for 24 hours.


This wall must include planning and distinguish the three nursing roles
The benefits of care planning:
- Provide organized and systematic care;
- Provide individualized care tailored to each patient;

- Sort care according to priority;
- Develop communication;
- Better distribute tasks among staff;
- Better supervise staff.

The goals of care planning:
- Ensure the continuity and coordination;
- Ensure greater security with a lower risk of being forgotten;
- Provide the means necessary for the implementation of care;
Estimate the workload and the equitable distribution
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I- Pre- operative care :
1 - psychological preparation
It starts with the quality of care within the service. Surgeon operated inform the purpose and progress of the operation
The nurse reassured by creating an atmosphere of calm and confidence
2 - Pre -operative assessment and correction of disorders
Take samples for laboratory tests
 rhesus Group
 Urea, glucose
 NFS , VS , hematocrit
 protidemia
Ionogram  blood and urine
Locate and note : proteinuria , glycosuria, ketonuria
Monitor and record constants ( pulse , blood pressure, weight, urine output )
Make appointments for lung radio and ECG
Achieve the requirements of intensivist physician ( transfusion , electrolyte balances hydro , antibiotics , etc ... ).

3 - preparing the future made ​​: depending on the type of intervention, outside the scope of the emergency

3-1 preparation bowel
Three to four days before the date of the intervention
To give enemas or purgatives as prescribed , raise intestinal disinfectants
Monitoring regime to be without residue, rich in calories, do call by the dietician
The respiratory physiotherapy : learn future made ​​to cough and spit effectively required to aerosol
3-2 local preparedness
The day before surgery , help the person to make a full careful toilet
To the surgical field : soaping , shaving pubic chest , brushing with antiseptic and cover with a sterile field (depending on service )
Leave fasting the day before surgery

4 - the morning of surgery

Reassure future surgery
Ensure it is Fasting
To urinate or ask a urinary catheter ( aseptically )
Check drape
Put boots, shirt , hat
Remove jewelry, dentures
Take constants , do the analyzes ( note on the sheet temperature )
Premedication three quarters of an hour before the procedure , note premedication on anesthesia record
Allow the patient lying flat calm
Check the folder ( biological assessment , radiological assessment , ECG)
To provide transportation to the operating room of the future accompanied by his record

5 - during the stay in the operating room
Make room cleaning , the air
Remaking the bed without a pillow or bolster , warm with an electric blanket to remove the back of the patient
Gather in the room all the equipment necessary for the care and supervision
II- post- operative care
1 - return to the operating room

 To inform the type and outcome of surgery
 Install operated flat on the side hypertension
 Connect :
- The digestive suction probe on the jar and adjust the pressure (40 to 70 cm of water)
- The bladder catheter to a collector
 To monitor the recovery of every quarter of an hour consciousness :
- The pulse , blood pressure , heat and the color of the integument
- The degree of awareness
- Ventilation ( rate, frequency , amplitude, color)
- Diuresis
- Nature and volume losses externalized by drainage
- The state of the dressing
Note all these parameters on the monitoring sheet and report any discrepancies immediately
2 - care and monitoring after waking
 upon regaining consciousness , put operated in a semi-sitting position
 strive to create an atmosphere of calm physical and moral
 digestive continuous suction
 inform the patient , family, staff of the ban on oral intake ( beverages, food) the duration of the digestive aspiration
 ensure the permeability of the probe , the probe needed to irrigate the syringe with 20ml of saline
 monitor the effectiveness of the vacuum system, change jars each day and fittings ( must be sterile )
 daily note on the balance sheet of the suction volume
 mobilize the probe and attach it to the cheekbone to prevent ulceration of the nose wing
 make oral care and frequent nose
 when tested clamping before removal , monitoring and reporting nausea, vomiting, bloating

Intravenous resuscitation :
 have constant concern to save the venous capital and maintain a permanent vascular access
 prepare , ask infusion bottles with a maximum aseptic
 respect infusion volumes , flow monitoring
 Monitor 2 times daily input and venous path item . The smallest inflammatory signs order to remove the infusion and possible cultivation of the catheter.
The balance of inputs and outputs: The set scrupulously at least once a day.
Hygiene and comfort:
To support the early days of personal hygiene care , rehabilitation bed
To preventive care bedsores , put a mattress alernating if necessary .
3 - Prevention of complications :
 Raise the operated as soon as possible, to help keeping the wound with a bandage body.
 Make mobilize frequently the lower limbs, monitoring calves.
 If the power is prescribed anti- coagulate , to inject the fixed hours.

4 - Local care. Asepsis + + +
 Make the dressing median to the 2nd or 3rd day, suture removal du10éme the 12th day on the advice of the surgeon.
 Dressing, exchange , removal of abdominal drainage

5 - monitoring :
The nurse must ensure a careful and prolonged ; note the parameters on the monitoring sheet and report any discrepancies .
* Clinical Supervision:
State of consciousness and alertness
ventilation State
Pulse, blood pressure , venous pressure
temperature
State of the abdomen and appearance of losses externalized peritonitis ,
surgical wound
Laxation + + +
Biomonitoring case basis on medical advice. :
Draw blood for urea , electrolytes , hematocrit, protein
A sample of 24-h urine for electrolytes , check pH of urine

6 - recharge :
Remove from gastric aspiration laxation (gas ) to 3rd, 4th
Make contact with the dietician who established. It will very gradually after the resumption of transit in conjunction with parenteral nutrition to ensure proper nutritional balance Monitor transit + + + +, frequency, appearance of stool
Supplies liquid , semi liquid , with progressive reintroduction of cooked cereal ; meat, raw butter, toast ...... etc. .

I - INTRODUCTION.DEF:

Is an epidemic and contagious disease that is caused by poly virus type 1 , 2.3 .

II - EPIDEMOLOGIE

- Man is the reservoir of germ
- The airborne transmission . human hands rooms is through the medium of water and contaminated food
- The virus enters the body through the digestive or nasopharyngeal it crosses the intestinal barrier and can bind to CNS or it causes destruction responsible for paralytic forms of the disease neurons.

III- CLINICAL

- Start by sudden fever 39-40 °
- Pharyngitis
- Digestive Disorder
- Headache
- Myalgia
- Meningeal syndrome with neck stiffness
- Paralysis begins abruptly
- Trouble sensitivity
- Paralysis of the respiratory muscles (pharynx and larynx paralysis )

IV TREATMENT

- Fighting against the pain analgesics
- Sports Physiotherapy
- In case of respiratory disorders hospitalized patient resuscitation
- Vaccination.

definition
pathophysiology
clinical signs
nursing


definition

    Deep vein thrombosis or phlebitis, is an inflammation of a vein ( atheroma ) most often deep , obliterated by the formation of a clot or thrombus. This clot completely or partially obstructs the light aveine .


pathophysiology

mechanism

The thrombus is formed at a valve, from platelets and white blood cells.
The thrombus can float in the bloodstream is called phlebothrombosis thrombosis, the risk of pulmonary embolism is high.
When the thrombus adheres to the wall , it is called thrombophlebitis .
predisposing factors

Venous stasis : slowing of blood flow to deep capital : plaster, right heart failure , varicose veins of the lower limbs , venous compression , prolonged sitting .
Parietal lesions during alterations of the venous wall , when the lesion is infected, there is inflammation and thus a poor venous return : catheter, infusion aging.
Changes in the blood coagulation abnormality biological , hereditary acquisition amended , taking progestin in women.
complications

Extension of thrombosis to proximal veins.
Pulmonary embolism by the migration of thrombus in the vena cava.
Postphlebitic disease .

clinical signs

initial stage

Dissociation pulse / temperature.
Pain in the lower limb.
Sign Homens : pain caused to dorsiflexion .
Pain along the venous route.
Gravity calf numbness .
Reduction of sloshing calf.
Red calf , hot, tense.
Pitting edema persistence of the trace of the finger.
Paresthesia .
Stage of thrombophlebitis confirmed

Pain all over the tenacious and intense member .
Functional impairment.

nursing

The prevention of phlebitis

Early rise.
Active and passive mobilization : regular and frequent contractions , massages, foot elevation .
Contention Members: increase venous return and thus reduce edema.
Anticoagulant for preventive medical prescription heparin subcutaneously .
treatment

The special care

Strict bed rest due to risk of pulmonary embolism.
Elevation feet.
The heparin treatment with curative intent

Before treatment, you must have a coagulation upstream : PT, APTT , platelet, blood group.
Administration : Early treatment with low molecular weight heparin (LMWH ) and relay with vitamin K antagonists (VKA ) .

Intravenous continuous electric pump .
Subcutaneous : 2-3 calciparine the injection 24 hours.
Subcutaneous : 2 fractionated heparin injection 24 h.
Surveillance:

Proper functioning of the SAP (hourly rate , flow) tubing and fittings .
Assess the risk of bleeding .
Heparinaemia : 0.3 to 0.6 IU / L.
Wafer twice weekly .
Patient Education

Prevent the risk of treatment: minor bleeding risk .
Properties of anti -vitamin K.
Importance of taking daily treatment.
Need for control examination .