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Medicine for Nurses
SN Chugh
CHAPTER 1:
Introduction to Clinical Medicine and Nursing
INTRODUCTION
Aims of Medicine and Nursing
The Nurse and the Patient
DIET
SMOKING
NURSING CARE OF THE ELDERLY PATIENTS
AN UNCONSCIOUS PATIENT
CLINICAL VITAL SIGNS AND THEIR MONITORING
The Pulse
Pathogenesis
Rate
Rhythm
Volume and Character
Blood Pressure (BP)
Method
Pulse Pressure
Neck Veins, Jugular Venous Pressure (JVP) and Central Venous Pressure (CVP)
Method
Measurement of CVP
Temperature
Method
Respiration
Intake and Output Chart
SAMPLE COLLECTION AND ANALYSIS
Urine
Urinary Constituent Abnormalities
Sugar (glucose)
Ketone Bodies (acetone)
Other Tests
The Stool
CHAPTER 2:
Major Aetiologies of the Disease
HEREDITY AND ITS DISORDERS
Chromosomal Disorders
Autosomal Disorders
DISORDER CAUSED BY PHYSICAL AND CHEMICAL AGENTS
Drugs
Drug Sensitivity
Adverse/Side effects/Unwanted Effects
Drug Overdosage/Intoxication
Accidental Poisoning/Overdosage
Self (deliberate) Overdosage
Management of Acute Poisoning/Drug Overdose
General Measures
Specific Measures
Other Measures
Common Poisons
SMOKING
ALCOHOL
Treatment of Alcoholism
Drug Dependence and Drug Addiction
EFFECTS OF EXTREMES OF HEAT
Heat Stroke
Clinical Features
Treatment
Heat Exhaustion
Clinical Features
Treatment
Heat Cramps
Malignant Hyperpyrexia
Neuroleptic Malignant Syndrome
Prickly Heat
EFFECTS OF COLD OR LOW TEMPERATURE
Hypothermia
Treatment
Frost-bite
ELECTRICAL INJURY
LIGHTNING INJURY
HIGH ALTITUDE DISORDERS
Chronic Mountain Sickness
POLLUTION DISORDERS
RADIATION INJURY / EFFECTS
DROWNING
MOTION SICKNESS
BITES AND STINGS
Snake Bite
Treatment
Prevention
Scorpion Sting
Treatment
TUMOUR/GROWTH FORMATION
Harmful Effects of Malignancy
Management of Malignancy
AUTOIMMUNITY AND AUTOIMMUNE DISEASES
Organ-specific Antibodies
Aetiology of Autoimmune Diseases
Immunodeficiency Disorders
Treatment of Autoimmune Disease
HLA SYSTEM AND ITS RELATED DISORDERS
Clinical Applications of HLA
CHAPTER 3:
Infection, Immunity and Chemotherapy
INFECTION
Nomenclature
Bacteria
COCCI
Gram-negative Cocci
Bacilli (Fig. 3.1)
Coccobacilli (Fig. 3.1)
Spirochaetes (Fig. 3.1)
Reservoir of Infection (From where the organisms come)
Modes of Transmission (How the bacteria enter the body?)
Pathogenic Mechanism of Infection (How bacteria cause disease?)
Clinical Effects of Infection
Healing/Repair
Allergic/Immunological Effects
Host Defense (The defense against infection)
IMMUNITY
Innate Natural Immunity
Acquired (adaptive) Immunity
Naturally Acquired Immunity
Artificially Acquired Immunity (Active and passive)
Vaccination (Immunization)
Clinical Utility of Vaccination/Immunization
Organ Transplantation and Graft vs Host Reaction
ALLERGY AND HYPERSENSITIVITY
Anaphylaxis
Serum Sickness
Hypersensitization/Idiosyncracy/Allergy
LABORATORY DIAGNOSIS OF INFECTION
Specimen Collection and Transport
I. Swabs
2. Sputum
3. Stool/Faeces
4. Urine
5. Blood
Fluids (pleural, pericardial, ascitic and cerebrospinal)
Identification of the Infecting Organisms and Serology
Staining of Smears
Culture Techniques
Serological Tests
Molecular Techniques
CHEMOTHERAPY FOR INFECTION
Sulphonamides
Side Effects
Antibiotics
Beta-lactam Antibiotics
Penicillins
Dosage and Administration (Table 3.7)
Cephalosporins
Doses and Adverse Reactions
Macrolides
Adverse Effects
Tetracyclines
Adverse Effects
Chloramphenicol
Adverse Effects
Aminoglycosides
Uses
Adverse Effects
Doses
Fluoroquinolones
Uses
Adverse Effects
Doses
Lincomycin, Clindamycin, Vancomycin
Adverse Reactions and Dose
Anaerobicidal Agents
Adverse Effects and Doses
Nalidixic Acid and Nitrofurantoin (Urinary tract antiseptic)
Antifungal Agents
Antiparasitic Agents
Antiviral Drugs
CHAPTER 4:
Diseases Caused by Infections
ACUTE INFECTIOUS FEVER
Terminology Used
Isolation and Period of Infectivity
Clinical Features of Acute Infectious Fever
Treatment and Prevention
Aims
Steps
DISEASES CAUSED BY BACTERIA
Staphylococcal Infections
Staphylococcal Toxic Shock Syndrome
Streptococcal Infections
Scarlet Fever
Symptoms and Signs
Types
Diagnosis
Treatment
Erysipelas
Symptoms and Signs
Treatment
Pneumococcal Infection
Gonococcal Infection
Meningococcal Infection
MENINGOCOCCAEMIA
Diphtheria
Pathogenesis and Pathology
Symptoms and Signs
Diagnosis
Treatment and Prevention
Tetanus
Pathogenesis and Pathology
Symptoms and Signs
Diagnosis
Treatment
Prophylaxis
Food Poisoning
Symptoms and Signs
Diagnosis
Treatment
Bacillary Dysentery (Shigellosis)
Symptoms and Signs
Diagnosis
Treatment
Anthrax
Symptoms and Signs
Diagnosis and Treatment
Legionnaires Disease (Legionella infection)
Whooping Cough (Pertussis)
Clinical Features (Symptoms and Signs)
Diagnosis
Complications
Treatment
Prevention
Cholera
Pathology
Clinical Features (Symptoms and Signs)
Diagnosis
Treatment
Prevention
Typhoid and Paratyphoid Fever
Pathology
Symptoms and Signs
Diagnosis
Complications (Box 4.5)
Treatment
Treatment of Carrier State
Prevention
Paratyphoid Fever
Plague
Symptoms and Signs
Diagnosis
Treatment
Prevention
Brucellosis (Malta or Undulant Fever)
Symptoms and Signs
Diagnosis
Treatment
Actinomycosis
Symptoms and Signs
Diagnosis and Treatment
Anaerobic Infections
Pathogenesis
Symptoms and Signs
Diagnosis
Treatment
DISEASES CAUSED BY VIRUSES
Chickenpox (Fig. 4.7)
Symptoms and Signs
Complications of Chickenpox (Box 4.7)
Treatment
Shingles (Herpes Zoster Infection)
Symptoms and Signs
Treatment
Smallpox
Symptoms and Signs
Infectious Mononucleosis (Glandular Fever)
Symptoms and Signs
Diagnosis
Treatment
Measles
Symptoms and Signs
Complications
Diagnosis
Treatment
Prevention
Rubella (German Measles)
Symptoms and Signs
Complications
Diagnosis and Treatment
Prevention and Immunization
Mumps
Symptoms and Signs
Complications (Box 4.9)
Diagnosis
Treatment and Prevention
Prevention
Dengue Fever
Classical Dengue (Fig. 4.12)
Symptoms and Signs
Diagnosis
Treatment
Prevention and Control (Fig. 4.13)
Influenza
Symptoms and Signs
Complications (Box 4.10)
Diagnosis
Treatment
Acute Viral Bronchiolitis
Symptoms and Signs
Treatment
Rabies
Symptoms and Signs
Diagnosis
Treatment
Prophylaxis
Acquired Immunodeficiency Syndrome and HIV
Spread and Prevalence
Symptoms and Signs
Opportunistic Infections
Diagnosis
Treatment
Prevention and Control
DISEASES CAUSED BY FUNGI
Predisposing Factors/Conditions for Fungal Infections
Candidiasis
Symptoms and Signs
Diagnosis
Treatment
Aspergillosis
Symptoms and Signs
Diagnosis and Investigations
Treatment
Cryptocomycosis
Histoplasmosis (Darling's Disease or Cave's Disease)
Symptoms and Signs
Investigations
Treatment
Mucormycosis
Clinical Features
Diagnosis
Treatment
RICKETTSIAL INFECTIONS
Typhus Fever and Spotted Fever
Spread
Symptoms and Signs
Treatment
SPIROCHAETAL INFECTIONS
Syphilis
Spread and Incidence
Symptoms and Signs
Diagnosis
Treatment
Leptospirosis
Spread and Incidence
Symptoms and Signs
Diagnosis
Treatment
INFECTIONS CAUSED BY PARASITES
Tropical Diseases
Life Cycle (Fig. 4.19)
Pathogenesis and Pathology
Clinical Features
Symptoms and Signs
Diagnosis
Treatment
Prevention
Malaria
Life Cycle (Fig. 4.22)
Symptoms and Signs
Diagnosis
Complications of Malaria (Box 4.13)
Treatment
Treatment of Cerebral Malaria
Prophylaxis
Kala-Azar (Leishmaniasis)
Life Cycle (Fig. 4.24A)
Clinical Features (Symptoms and Signs)
Diagnosis
Treatment
Giardiasis
Trichomoniasis
Symptoms and Signs
Diagnosis and Treatment
NEMATODE (HELMINTHIC) INFECTIONS
Filariasis
Life Cycle (Fig. 4.25)
Symptoms and Signs
Diagnosis
Treatment
Prevention
Intestinal Nematodes
Life Cycle (Fig. 4.27)
Clinical Features
Diagnosis
Treatment
TAPEWORMS (CESTODES) INFECTION
Taenia solium Infection and Cysticercosis
Life Cycle (Fig. 4.29)
Cysticercosis in Humans
Symptoms and Signs
Diagnosis
Treatment
Echinococcus Granulosus (Taenia Echinococcus) and Hydatid Disease
Clinical Features
Symptoms and Signs
Diagnosis and Treatment
CHAPTER 5:
The Skin and Sexually Transmitted Diseases
THE SKIN AND ITS DISORDERS
Terminology used in Skin Disorders
Pruritus
BACTERIAL INFECTION OF SKIN
Staphylococcal Infection
Streptococcal Skin Infections
Tuberculosis of the Skin
Leprosy (Hansen's disease)
Pathogenesis
Clinical Features
Diagnosis and Treatment
Prevention
HERPES INFECTION OF THE SKIN
FUNGAL INFECTIONS OF THE SKIN
Dermatophytosis (Ringworm Infection, Tinea Infection)
Symptoms and Signs
Diagnosis and Treatment
Pityriasis Versicolor (Tinea Versicolor)
PARASITIC INFECTION OF THE SKIN
Scabies (the itch)
Mode of Spread
Symptoms and Signs
Diagnosis
Treatment and Prevention
Pediculosis
Symptoms and Signs
Diagnosis
Treatment and Prevention
SKIN DISEASES
The Eczemas/Dermatitis
Types
Clinical Features
Treatment
Psoriasis
Aetiopathogenesis
Clinical Types and their Features
Complications
Diagnosis
Treatment
Acne Vulgaris
Aetiopathogenesis
Symptoms and Signs
Treatment
Bedsores/Pressure Sores/Decubitus Ulcer
Predisposing Factors
Prevention and Treatment
Pemphigus
Types
Symptoms and Signs
Diagnosis
Treatment
Vitiligo and Albinism
Treatment
Hyperpigmentation
Hirsutism
Treatment
Alopecia Areata
Clinical Features
Treatment
Urticaria
Causes
Symptoms and Signs
Treatment
SEXUALLY TRANSMITTED DISEASES (STD)
SYPHILIS
Chancroid (Soft Sore)
Symptoms and Signs
Diagnosis and Treatment
Lymphogranuloma Venereum
Symptoms and Signs
Diagnosis
Treatment
Gonorrhoea
Epidemiology
Symptomatology
Diagnosis
Complications
Treatment
Prophylaxis
Granuloma Inguinale (donovanosis)
Symptoms and Signs
Diagnosis
Treatment
Acquired Immunodeficiency Syndrome and HIV Infection
CHAPTER 6:
Diseases of the Respiratory System
ANATOMY AND PHYSIOLOGY
Bronchopulmonary Segments and Important Landmarks of Lungs
Mechanism of Respiration
Control of Respiration
COMMON RESPIRATORY SYMPTOMS
Haemoptysis
Difference between Haemoptysis and Haematemesis
Causes
Treatment
Cough
Sputum
Chest Pain
Characteristics of Pleuritic Pain
Causes
Differential Diagnosis of Chest Pain
Dyspnoea (Read Cardiovascular Disease also)
Characteristics of Respiratory Dyspnoea
Cyanosis
Clubbing of the Fingers and Toes
Causes (Table 6.4)
INVESTIGATIONS FOR RESPIRATORY DISEASES
Chest X-ray
Computed Tomography (CT Scan) and Magnetic Resonance Imaging (MRI)
Microbial and Histopathological Examination
Skin Tests
Serological Tests
Pulmonary Function Tests
Laryngoscopy, Bronchoscopy and Mediastinoscopy
Bronchoscopy
Mediastinoscopy
Pleural Aspiration (Thoracocentesis)
Ventilation/Perfusion Scans
Pleural and Lung Biopsy
Pulmonary Angiography
Blood Gas Analysis
DISEASES OF THE UPPER RESPIRATORY TRACT
Acute Coryza
Symptoms and Signs
Treatment
Sinusitis
Causes
Symptoms and Signs
Treatment
Acute Tonsillitis
Symptoms and Signs
Diagnosis
Differential Diagnosis
Treatment
Laryngitis
Acute Laryngitis
Symptoms and Signs
Diagnosis
Treatment
Chronic Laryngitis
Causes
Symptoms and Signs
Treatment
Hay Fever (Seasonal Rhinitis)
Symptoms and Signs
Treatment
Inhalation of the Foreign Body
DISEASES OF LOWER RESPIRATORY TRACT
Acute Bronchitis
Symptoms and Signs
Treatment
Pneumonia
Pathogenesis and Pathology
Predisposing Factors
Classification
Causative Organisms (Box 6.5)
PRIMARY PNEUMONIAS
Pneumococcal Pneumonia (Lobar Consolidation)
Symptoms and Signs
Staphylococcal Pneumonia
Klebsiella Pneumonia
Legionella Pneumonia
Pneumonia due to Mycoplasma and Viruses
Primary Atypical Pneumonia
Viral Pneumonia
Diagnosis of Primary Pneumonia
Investigations
Treatment
SECONDARY PNEUMONIA
Hospital Acquired Pneumonia (Nosocomial Pneumonia)
Pneumonia in Immunocompromised Patients
Complications of Pneumonia
LUNG SUPPURATION
Bronchiectasis
Causes
Symptoms and Signs
Diagnosis
Investigations
Complications
Treatment
Lung Abscess
Causes
Symptoms and Signs
Diagnosis
Treatment
TUBERCULOSIS OF THE LUNG
Epidemiology
Pathogenesis and Pathology
Types of Tuberculosis of the Lung
Modes of Spread
Primary Tuberculosis
BCG Vaccination
Postprimary Tuberculosis
Symptoms and Signs
Diagnosis of Tuberculosis
Bacteriology
Serology
Blood Test
Radiology
Pleural Aspiration and Pleural Biopsy
Skin Test (Mantoux Test or Heaf Test Box 6.6)
Treatment
Drug Therapy
Regimens of Tuberculosis and Duration of Treatment
Social Aspects of Treatment
INTERSTITIAL LUNG DISEASE
Sarcoidosis
Symptoms and Signs
Investigations
Treatment
Cryptogenic Fibrosing Alveolitis
Symptoms and Signs
Diagnosis
Treatment
Extrinsic Allergic Alveolitis
Clinical Features
Investigations
Treatment
Pneumoconiosis
Symptoms and Signs
Treatment
OBSTRUCTIVE DISEASES OF THE LUNG
Bronchial Asthma
Precipitating Factors
Extrinsic versus Intrinsic Asthma
Clinical Features
Acute Severe Asthma (Status Asthmaticus)
Management of Asthma
Treatment of Acute Severe Asthma (Status Asthmaticus)
CHRONIC OBSTRUCTIVE PULMONARY DISEASE
Chronic Bronchitis
Causes
Clinical Features (Symptoms and Signs)
Signs
Diagnosis and Investigations
Complications
Treatment
Emphysema
Causes
Clinical Features (Table 6.9)
Treatment
Respiratory Failure
Causes
Symptoms and Signs
Treatment
LUNG CANCER (BRONCHOGENIC CARCINOMA)
Atelectasis (Collapse of the Lung)
Causes
Symptoms and Signs
Treatment
Prevention
Pulmonary Embolism
Causes
Symptoms and Signs
Diagnosis and Investigations
Prevention
Treatment
DISEASES OF PLEURA
Pleurisy
Causes
Symptoms and Signs
Treatment
Pleural Effusion
Causes
Clinical Features
Diagnosis
Treatment
Empyema Thoracis
Causes
Symptoms and Signs
Diagnosis and Investigations
Treatment
Nursing Care of Water-seal Drainage
Pneumothorax
Types
Causes
Clinical Features
Diagnosis
Treatment
Haemothorax
Hydropneumothorax
CHAPTER 7:
Disorders of Cardiovascular System
APPLIED ANATOMY AND PHYSIOLOGY
Circulation (Figs 7.1A and B)
Cardiac Cycle
Conduction System
COMMON CARDIOVASCULAR SYMPTOMS AND SIGNS
Symptoms
Physical Signs
Examination of the Heart
Heart Sounds
Murmurs
CARDIAC INVESTIGATIONS
Electrocardiogram (ECG)
The Lead System of ECG
Stress ECG
Ambulatory ECG (Holter's monitoring)
Chest X-ray (PA view)
Specialised Investigations
Echocardiogram (Fig. 7.10)
Radionuclide Scanning
Cardiac Catheterisation
Angiocardiography
Coronary Angiography
DISORDERS OF HEART RATE, RHYTHM AND CONDUCTION
Disturbance of Heart Rate
Bradycardia and Tachycardia
Sinus Arrhythmias
Types of Abnormal Tachycardias
Supraventricular Tachycardias
Ventricular Tachycardia
Paroxysmal Supraventricular Tachycardia (PSVT)
Symptoms and Signs
Treatment
Arrhythmias
Atrial Arrhythmias
Atrial Tachycardia
Atrial Flutter and Atrial Fibrillation
Ventricular Arrhythmias
Ventricular Ectopics/Premature Contractions (VPCs)
Ventricular Tachycardia (VT)
Cardiac Arrest
Conduction Disturbance (Heart Blocks)
Types
Causes (Box 7.8)
Symptoms and Signs
Stokes-Adams Syndrome
Treatment
HEART FAILURE
Left Ventricular Failure (LVF)
Causes (Box 7.9)
Symptoms and Signs
Investigations
Treatment
Right Heart Failure
Causes
Symptoms and Signs
Congestive Heart Failure (CHF)
Causes
Symptoms and Signs
Treatment
Surgical Treatment
Convalescence
CONGENITAL HEART DISEASE
Classification of Congenital Heart Diseases
Symptoms and Signs
Diagnosis
Complications
Acyanotic Heart Diseases with Left to Right Shunt
Atrial Septal Defect (Fig. 7.23A)
Ventricular Septal Defect (Fig. 7.23B)
Patient Ductus Arteriosus (Fig. 7.23C)
Fallot's Tetralogy (Fig. 7.23D)
Aortic and Pulmonary Stenosis
Coarctation of Aorta
Treatment of Congenital Heart Diseases
RHEUMATIC HEART DISEASE
Acute Rheumatic Fever
Prevalence
Pathology
Symptoms and Signs
Treatment
Prophylaxis and Follow up
Chronic Rheumatic Heart Disease
Pathology
Symptoms and Signs (Table 7.7)
Complications of Chronic Rheumatic Heart Disease
Treatment
Prevention
PULMONARY VALVULAR DISEASES
Pulmonary Stenosis
Pulmonary Hypertension
Pulmonary Embolism
Cor Pulmonale
Symptoms and Signs
Treatment
SUBACUTE BACTERIAL ENDOCARDITIS (SABE)
Prevention
Summary of Course of Rheumatic Heart Disease
SYPHILITIC HEART DISEASE
THYROTOXIC HEART DISEASE
CORONARY ARTERY DISEASE
Coronary Circulation (Fig. 7.28)
Atherosclerosis and Coronary Artery Disease (CAD)
Risk Factors (Fig. 7.30)
Clinical Presentations
Angina Pectoris
Symptoms and Signs
Precipitating Factors for Angina
Diagnosis
Treatment
Coronary Thrombosis and Myocardial Infarction
Predisposing Conditions
Symptoms and Signs
Diagnosis
Management
Course and Complications
Arrhythmias in Myocardial Infarction
Coronary Care Units (CCU)
Late Management and follow up of Myocardial Infarction
Prevention of Coronary Thrombosis
SYSTEMIC HYPERTENSION
ACUTE CIRCULATORY FAILURE/SHOCK
Causes
Symptoms and Signs
Complications
Treatment
PERICARDITIS
Causes
Symptoms and Signs
Treatment
Chronic Constrictive Pericarditis
Symptoms and Signs
Causes
Treatment
Pericardial Effusion and Cardiac Tamponade
Causes
Symptoms and Signs
Diagnosis and Treatment
DISEASES OF THE BLOOD VESSELS
Arteriosclerosis/Atherosclerosis
Causes
Pathology
Symptoms and Signs
Diagnosis
Treatment
Arterial Thrombosis
Symptoms and Signs
Arterial Embolism
Predisposing Factors
Symptoms and Signs
Treatment
Thromboangitis Obliterans (Buerger's disease)
Symptoms and Signs
Treatment
Raynaud's Disease
Symptoms and Signs
Treatment
Diseases of the Veins
Superficial Thrombophlebitis
Causes
Symptoms and Signs
Treatment
Deep Vein Thrombosis (DVT)
Causes
Symptoms and Signs
Treatment and Prevention
CHAPTER 8:
Diseases of Alimentary System
APPLIED ANATOMY AND PHYSIOLOGY
Ingestion
Digestion
Absorption
Defense Mechanisms
Immune System and Immune Response
INVESTIGATIONS OF ALIMENTARY SYSTEM
Plain X-ray of Abdomen
Barium Studies
Computed Tomography (CT) and Magnetic Resonance Imaging (MRI)
Ultrasound
Endoscopy
Upper GI Endoscopy
Oesophagoscopy and Gastroscopy
Endoscopic Retrograde Cholangiopancreatography (ERCP)
Lower GI Endoscopy
Biopsy of Small Intestine
Secretory Studies
Malabsorption Tests
Biochemical Tests
Examination of Stool
Occult Blood in Stool
DISEASES OF MOUTH AND OESOPHAGUS
Stomatitis
Causes
Symptoms and Signs
Treatment
Glossitis (Fig. 8.3)
Diseases of Salivary Glands
Dysphagia
Causes
Clinical Features
Diagnosis
Treatment
DISEASES OF STOMACH AND DUODENUM
Dyspepsia
Causes of Dyspepsia
Vomiting
Causes
Haematemesis and Malena
Causes
Congenital Pyloric Stenosis
Clinical Features
Treatment
Gastritis
Causes
Symptoms and Signs
Treatment
Chronic Gastritis
Types
Symptoms and Signs
Treatment
Peptic Ulcer
Causes
Clinical Features
Diagnosis
Treatment
Complications of Peptic Ulcer
Management of Bleeding Ulcer
Gastric Carcinoma (Malignancy Stomach)
Clinical Features
Diagnosis and Investigations
Treatment
Hiatus Hernia
Types and Features
Diagnosis
Prevention and Treatment
DISEASES OF INTESTINES
Constipation
Causes
Treatment
Diarrhoea
Causes and Classification
Acute Gastroenteritis
Symptoms and Signs
Treatment
Malabsorption Syndrome
Causes
Symptoms and Signs
Diagnosis
Treatment
Intestinal Obstruction
Symptoms and Signs
Diagnosis
Treatment
Acute Appendicitis
Causes (Fig. 8.13A)
Symptoms and Signs
Physical Signs
Complications (Fig. 8.13A)
Diagnosis
Treatment
Abdominal Tuberculosis
Intestinal (ileocaecal) Tuberculosis
Types
Clinical Features
Diagnosis
Complications
Treatment
INFLAMMATORY BOWEL DISEASE
Ulcerative Colitis and Crohn's Colitis
Aetiology
Clinical Features
Diagnosis and Investigations
Complications of Ulcerative Colitis and Crohn's Colitis
Treatment
Irritable Bowel Syndrome (IBS)
Causes
Symptoms and Signs
Diagnosis
Treatment
Diverticulosis
Cause and Pathogenesis
Symptoms and Signs
Diagnosis
Complications
Treatment
Carcinoma Colon and Rectum (Colorectal Cancer)
Causes
Clinical Features
Diagnosis and Investigations
Treatment
Prevention
Acute Intussusception
Symptoms and Signs
Diagnosis
Treatment
Megacolon
Hirschsprung's Disease (Aganglionic Megacolon)
Intestinal Worms
Giardiasis
Symptoms and Signs
Diagnosis
Treatment
DISEASES OF PERITONEUM
Peritonitis
Acute Peritonitis
Chronic (Tubercular) Peritonitis
Ascites
Causes
Clinical Features
Diagnosis
Investigations
Differential Diagnosis of Ascites
Treatment
Chylous Ascites
Causes
DISEASES OF THE PANCREAS
Anatomy and Physiology
Common Diseases of the Pancreas
Acute Pancreatitis
Causes
Symptoms and Signs
Complications
Diagnosis and Investigations
Treatment
Chronic Pancreatitis
Treatment
Carcinoma of Pancreas
Symptoms and Signs
Diagnosis
Investigations
Treatment
CHAPTER 9:
Diseases of the Liver and Gallbladder
ANTATOMY (Figs 9.1A and B) OF THE LIVER
APPLIED PHYSIOLOGY
INVESTIGATIONS FOR A PATIENT WITH LIVER DISEASE
Blood Tests
Serum Bilirubin
Serum Enzymes
Alkaline Phosphatase
Gamma-glutamyl transferase (γ-GT)
Serum Albumin
Globulins
Albumin and Globulins Ratio
Prothrombin Time and Index (%)
Urine Tests
Radiology
Abdominal Paracentesis (Removal of Ascitic Fluid)
Liver Biopsy
Liver Aspiration
Portal Pressure
JAUNDICE
Bilirubin Synthesis, Metabolism and Excretion
Classification of Jaundice
Haemolytic Jaundice (Fig. 9.2A)
Obstructive Jaundice (Fig. 9.2B)
Causes of Jaundice
Symptoms and Signs associated with Jaundice
DISEASES OF THE LIVER
Hepatitis
Causes
Acute Viral Hepatitis
Causes
Hepatitis A
Treatment
Prophylaxis
Hepatitis B
Hepatitis C (Non A–Non B)
Hepatitis D
Hepatitis E
Alcoholic Liver Disease
Symptoms and Signs
Treatment
Chronic Hepatitis
Types
Symptoms and Signs
Treatment
Cirrhosis of the Liver
Causes
Clinical Features
Diagnosis and Investigations
Complications
Treatment
Portal Hypertension (PH)
Causes
Clinical Features
Diagnosis
Treatment
Hepatic Failure/Hepatic Coma
Causes
Symptoms and Signs (Figs 9.9A to C)
Diagnosis and Investigations
Treatment
Tumour of the Liver
Hepatomegaly
DISEASES OF GALLBLADDER
Gallstones
Types of Gallstones
Pathogenesis
Sites of the Gallstones (Fig. 9.11)
Clinical Features
Diagnosis and Investigations
Treatment
Acute Cholecystitis
CHAPTER 10:
Diseases of Kidneys and Urinary Tract
APPLIED ANATOMY AND PHYSIOLOGY
Renal Functions and Renal Function Tests
URINARY CONSTITUENT ABNORMALITIES
Proteinuria
Tests for Proteinuria
Asymptomatic Proteinuria
Orthostatic (Postural) Proteinuria
Microalbuminuria
Bence Jones Proteinuria
Haematuria
Pyuria
Causes
Casts
Glucose
COMMON URINARY SYMPTOMS
Polyuria
Dysuria
Urgency of Micturition
Incontinence
Enuresis
Oliguria
Anuria
INVESTIGATION OF A CASE WITH RENAL DISORDER
Urine Examination
Blood Biochemistry
Renal Clearance or Glomerular Filtration
Radiology and Renal Imaging
Ultrasonography
Intravenous Pyelography
Micturating Cystogram
Renal Angiogram
CT (Computed Tomography) Scan
Radionuclide Studies
Renal Biopsy
GLOMERULONEPHRITIS (GN)
Acute Nephritic Syndrome
Causes
Clinical Features
Treatment
Nephrotic Syndrome
Causes
Symptoms and Signs
Diagnosis
Treatment
RENAL FAILURE
Acute Renal Failure
Causes
Symptoms and Signs of ARF
Treatment
Prevention
Curative
Types of Dialysis
Method
Complications
Chronic Renal Failure
Causes
Symptoms and Signs
Treatment
Dialysis and Renal Transplantation
HYPERTENSIVE RENAL DISEASE
URINARY TRACT INFECTION (UTI)
Acute Pyelonephritis
Symptoms and Signs
Diagnosis
Treatment
Reflux Nephropathy and Chronic Pyelonephritis
Symptoms and Signs
Diagnosis and Investigations
Treatment
URINARY TRACT OBSTRUCTION (OBSTRUCTIVE UROPATHY)
Urinary Calculous Disease
Causes and Predisposing Factors
Symptoms and Signs
Diagnosis and Investigations
Treatment
Prevention (Box 10.7)
HEREDOFAMILIAL DISEASE OF KIDNEYS
Polycystic Kidney Disease
Clinical Features
Diagnosis
Treatment
TUMOURS OF KIDNEY AND URINARY TRACT
Bladder Cancer
Symptoms and Signs
Diagnosis
Treatment
Prostatic Enlargement (Benign Hypertrophy of the Prostate)
Symptoms and Signs
Diagnosis
Treatment
CHAPTER 11:
Diseases of Blood and Lymphoid System
APPLIED ANATOMY AND PHYSIOLOGY
The Plasma and its Constituents
Cells
Haematopoiesis
Erythropoiesis
Factors Governing the Erythropoiesis
Haemoglobin (Hb)
Red Cell Destruction
INVESTIGATIONS FOR A CASE WITH BLOOD DISORDER
Erythrocyte Sedimentation Rate (ESR)
C-reactive protein (CRP)
DISEASES OF RBCS
Anaemia
Clinical Features
Signs
Classification of Anaemia
Morphological Classification of Anaemia
Causes of Anaemia (Box 11.4)
Iron Deficiency Anaemia
Causes
Symptoms and Signs
Investigations
Treatment
Anaemia due to Blood Loss (Haemorrhagic Anaemias)
Causes
Symptoms and Signs
Treatment
Megaloblastic Anaemias including Pernicious Anaemia
Causes
Symptoms and Signs
Investigations
Treatment
Pernicious Anaemia
Clinical Features
Diagnosis and Investigations
Treatment
Anaemia of Pregnancy
Birth Defects and Folate Deficiency in Pregnancy
Nutritional Anaemia in Infants
Anaemia due to Gastrointestinal Diseases
Aplastic or Hypoplastic Anaemia
Causes
Clinical Features
Diagnosis and Investigations
Management
Haemolytic Anaemias
Causes
Clinical Features
Investigations of Haemolytic Anaemia
Treatment
Congenital Haemolytic Anaemia (Acholuric Jaundice)
Blood Transfusion Related Reactions
Precautions to be taken before Blood Transfusion
Indications of Blood Transfusion
Complications or Adverse Reactions to Blood Transfusion, their Diagnosis and Treatment
Acute Haemolytic Reactions
Anaphylactic Reaction
Haemolytic Diseases and Rhesus (Rh) Factor
Rhesus Haemolytic Disease of the Newborn (HDN)
Treatment
Prevention
HAEMORRHAGIC DISORDERS
Investigations for a Patient with Haemorrhagic Disorder (Table 11.18)
Classification of Haemorrhagic Disorders
Conditions Involving the Vessel Wall
Thrombocytopenic Purpura
Causes
Clinical Features
Idiopathic Thrombocytopenic Purpura (ITP)
Coagulation Disorders
Causes of Coagulation Disorders
Haemophilia A
Clinical Features
Treatment
Disseminated Intravascular Coagulation (DIC)
Causes
Symptoms and Signs
Diagnosis
Treatment
Bleeding due to Liver Disease (Vit. K Deficiency) and Obstructive Jaundice
Causes
Haemorrhagic Disease of the Newborn
Anticoagulant Induced Haemorrhage (Fig. 11.16)
Nursing Care of a Patient on Anticoagulant Therapy
Treatment
MALIGNANT DISORDERS OF RBCS
Polycythaemia
Types
Symptoms and Signs
Diagnosis and Treatment
DISEASES OF WHITE BLOOD CELLS
Leukaemia
Classification
Acute Leukaemias
Clinical Features
Investigations
Treatment
Chronic Myeloid Leukaemia (CML)
Symptoms and Signs
Diagnosis
Treatment
Chronic Lymphoid Leukaemia (CLL)
Agranulocytosis
Causes
Symptoms and Signs
Diagnosis
Treatment
Multiple Myeloma (Myelomatosis)
Treatment
THE SPLEEN AND LYMPH NODES
Splenomegaly
Lymphadenopathy
Causes
Lymphomas
Hodgkin's Lymphoma
Symptoms and Signs
Diagnosis and Differential Diagnosis
Treatment
Non-Hogdkin's Lymphoma
CHAPTER 12:
Nutrition and Vitamins
NUTRITION AND DIET
Classification of Nutrients
Energy Yielding Nutrients
Carbohydrates
Fats
Deficiency of Essential Fatty Acids
Proteins
Metabolism of Nutrients
Carbohydrate Metabolism
Fat Metabolism
Lipoproteins
Hyperlipidaemia
Causes
Symptoms and Signs
Treatment
Proteins
Structure of Protein and their Synthesis
Inborn Error of Amino Acid Metabolism
Protein Energy Malnutrition (PEM)
Classification and Clinical Features
Treatment of PEM
Prevention
UNICEF'S Inexpensive Measures to Prevent PEM
ELECTROLYTES AND MINERALS
Sodium (Na+)
Hyponatraemia
Symptoms and Signs
Treatment
Salt Depletion Syndrome
Hypernatraemia
Causes
Symptoms and Signs
Treatment
Potassium (K+)
Hypokalaemia
Causes
Clinical Features (Fig. 12.5)
Treatment
Hyperkalaemia
Causes
Clinical Features (Fig. 12.5)
Treatment
Iodine
Fluoride
Role of Fluoride in Prevention of Dental Caries
Water
Dehydration (Water deprivation)
Causes
Consequences of Dehydration
Symptoms and Signs
Treatment
Oedema
Pathogenesis
Identification of Oedema
Inflammatory Oedema
Balanced Diet
Composition of Normal (balanced) Diet
Catabolism and Catabolic States
NUTRITIONAL DEPLETION AND NUTRITION SUPPORT
Nutritional Support
Parenteral Nutrition
Indications
Complications
OBESITY
ANOREXIA NERVOSA
METABOLISM AND ACID-BASE DISTURBANCE
Regulation of Acid-base Balance
Acidosis
Alkalosis
Causes of Metabolic Alkalosis
VITAMINS
Functions
Name and Preparations (Table 12.8)
Causes of Vitamins Deficiency
Vitamin A (Retinol)
Clinical Features of Vitamin A Deficiency
Prevention
Treatment
Vitamin E
Clinical Deficiency
Treatment
Vitamin K
Clinical Deficiency
Treatment
Vitamin D
Diseases due to Vitamin D Deficiency
Rickets
Clinical Features
Investigations
Management
Osteomalacia
Aetiology
Clinical Features
Treatment
Vitamin C (Ascorbic acid)
Clinical Features of Deficiency
Prevention
Treatment
Vitamin B Complex
Thiamine (B1)
Clinical Deficiency
Diagnosis and Treatment
Niacin (Nicotinic Acid)
Aetiology
Clinical Features
Treatment
Riboflavin (B2)
Deficiency Signs (Box 12.9)
Folate and Vitamin B12
CHAPTER 13:
Rheumatology
APPLIED ANATOMY AND PHYSIOLOGY
Joint Structure and Function
Terminology used in Rheumatology
RHEUMATOID ARTHRITIS (RA)
Pathology
Symptoms and Signs
Diagnosis
Treatment
Goals of Therapy
General Measures
Local Measures
Drug Treatment
Surgery
Rehabilitation and Physiotherapy
ANKYLOSING SPONDYLITIS (AS)
Symptoms and Signs
Diagnosis and Differential Diagnosis
Treatment
OSTEOARTHRITIS (OA)
Pathogenesis and Pathology
Symptoms and Signs
Diagnosis and Differential Diagnosis
Treatment
GOUT AND PSEUDOGOUT
Clinical Features
Diagnosis
Treatment
PSEUDOGOUT (PYROPHOSPHATE ARTHOROPATHY)
Diagnosis
Treatment
OTHER TYPES OF ARTHRITIS
Traumatic Arthritis
Septic Arthritis
Tubercular Arthritis
Gonococcal Arthritis
Syphilitic Arthritis
Haemophilic Arthritis
DISEASES OF INTERVERTEBRAL DISC (LOW BACK PAIN)
Prolapsed Lumbar Disc
Diagnosis
Treatment
Prevention/Precautions
Prolapsed Cervical Disc
Treatment
NONARTICULAR (SOFT TISSUE) RHEUMATISM
FIBROMYALGIA (FIBROSITIS)
Symptoms and Signs
Treatment
CONNECTIVE TISSUE DISEASES/COLLAGEN VASCULAR DISORDERS
SYSTEMIC LUPUS ERYTHEMATOSUS (SLE)
Symptoms and Signs
Diagnosis
Treatment
SYSTEMIC SCLEROSIS (SCLERODERMA)
Symptoms and Signs
Treatment
VASCULITIS
POLYARTERITIS NODOSA (PAN)
Symptoms and Signs
Diagnosis
Treatment
TEMPORAL ARTERITIS
Symptoms and Signs
Diagnosis
Treatment
INHERITED RHEUMATIC DISORDERS
Marfan's Syndrome
Clinical Features
Diagnosis
Treatment
DISEASES OF BONES
OSTEOPOROSIS
Causes and Risk Factors
Symptoms and Signs
Diagnosis
Treatment
CHAPTER 14:
Disorders of Nervous System
APPLIED ANATOMY AND PHYSIOLOGY
Central Nervous System
HIGHER MENTAL FUNCTIONS
DISEASES OF THE CRANIAL NERVES
Common Diseases of Cranial Nerves
The Second (Optic) Nerve
The Ocular (3rd, 4th and 6th) Nerves
The Fifth (Trigeminal) Cranial Nerve
The Seventh (Facial) Nerve
Bell's Palsy
Symptoms and Signs
Treatment
The Eighth (Vestibulo-cochlear) Nerve
The Twelfth (hypoglossal) Nerve
THE MOTOR SYSTEM AND ITS PATHWAYS
WHAT IS UPPER MOTOR NEURON AND WHAT IS LOWER MOTOR NEURON?
ABNORMAL / INVOLUNTARY / EXTRA MOVEMENTS
Types
Ataxia and Gait Abnormalities
The Reflexes
THE SENSORY SYSTEM AND ITS PATHWAYS
Sensory Pathways
Terminology Related to Sensory System
Testing of the Sensations (Table 14.3)
Autonomic System
INFECTIVE DISORDERS OF NERVOUS SYSTEM
Encephalitis
Symptoms and Signs
Investigations and Treatment
Brain Abscess
Symptoms and Signs
Treatment
Meningitis
Types and Causes
Symptoms and Signs
Diagnosis and Investigations
Treatment
Poliomyelitis
Epidemiology and Spread of Infection
Clinical Features
Bulbar Poliomyelitis
Diagnosis and Investigations
Treatment
Course and Prognosis
Prophylaxis
Global Polio Eradication
Herpes Zoster Infection (Shingles)
Clinical Features
Treatment
Neurosyphilis
Meningovascular Syphilis
Tabes Dorsalis
Symptoms and Signs
Diagnosis
General Paralysis of Insane (GPI)
Symptoms and Signs
Diagnosis
Treatment of Neurosyphilis
AIDS Related Neurological Diseases
Headache
Common Causes
Migraine
Tension or Psychological Headache
Treatment
Syncope
Common Types and their Causes
Treatment
Prevention
Epilepsies
Causes of Convulsions/Fits
Classification of Epilepsy
Grand Mal (Tonic-clonic Seizures)
Petit Mal Seizures (Absence Fits)
Focal or Partial Seizures
Precipitants of Epilepsy (Box 14.9)
Diagnosis and Differential Diagnosis
Investigations
Treatment
First Aid Treatment of a Seizure
Treatment of Fits
Precautions
COMA (UNCONSCIOUSNESS)
Diagnosis
History
General Physical Examination
Investigations
Management of Coma
Nursing Care
Medical Treatment
VASCULAR DISEASES OF THE BRAIN
Cerebrovascular Disease (Stroke)
Causes
Risk Factors (Box 14.13)
Clinical Features
Cerebral Haemorrhage
Physical Signs
Investigations
Treatment
Nursing Management
Medical Treatment
Subarachnoid Haemorrhage and Intracranial Aneurysm
Causes
Symptoms and Signs
Diagnosis
Treatment
BRAIN TUMOUR OR SPACE OCCUPYING LESION
DEMYELINATING DISEASES
Multiple Sclerosis (MS)
Symptoms and Signs
Investigations
Treatment
Physical Rehabilitation
EXTRAPYRAMIDAL DISORDERS
Parkinsonism
Causes
Symptoms and Signs
Treatment
Chorea
Causes
Symptoms and Signs
Treatment
HEREDITARY ATAXIA (SPINOCEREBELLAR DEGENERATION)
Friedreich's Ataxia
Symptoms and Signs
Diagnosis and Treatment
DEGENERATIVE DISORDERS OF NERVOUS SYSTEM
Motor Neuron Disease (MND)
Types
Symptoms and Signs
Treatment
DISEASES OF SPINAL CORD
Subacute Combined Degeneration of Cord
Symptoms and Signs
Diagnosis and Treatment
Lathyrism
Symptoms and Signs
Treatment
Spinal Cord Compression
Causes
Symptoms and Signs
Investigations
Treatment
Specific Treatment
Transverse Myelitis
Causes
Symptoms and Signs
Diagnosis and Treatment
Syringomyelia
Symptoms and Signs
Diagnosis and Treatment
Fluorosis
Symptoms and Signs
Diagnosis and Treatment
Spondylosis
Symptoms and Signs
Diagnosis
Treatment
DISEASES OF PERIPHERAL NERVES
Peripheral Neuropathy
Causes
Clinical Features
Specific Polyneuropathy
Treatment
Sciatica
Symptoms and Signs
Treatment
Median Nerve Compression (Carpal Tunnel Syndrome)
Symptoms and Signs
Treatment
DISEASES OF THE MUSCLES AND MYONEURAL JUNCTIONS
Myopathy and Muscular Dystrophies
Duchenne's Muscular Dystrophy
Symptoms and Signs
Diagnosis and Treatment
Fascioscapulohumeral Myopathy
Myasthenia Gravis
Symptoms and Signs
Diagnosis
Treatment
CEREBRAL PALSY AND DEVELOPMENT DEFECTS
Cerebral Palsy (Spastic Paralysis in Children)
Causes
Symptoms and Signs
Hydrocephalus
Causes
Symptoms and Signs
Diagnosis
Treatment
Development Spinal Defects
BIRTH INJURIES
Brachial Plexus Injuries
Treatment
CHAPTER 15:
Diabetes Mellitus
DIABETES MELLITUS
Epidemiology
Classification (Box 15.1)
Aetiopathogenesis
Clinical Features
Diagnosis
Treatment
Aims of Treatment
Treatment of Type 1 Diabetes
Insulin
Types of Insulin
Indications of Insulin
Guidelines for Insulin Therapy
Routes of Administration
Complications of Insulin Therapy
Treatment of Type 2 Diabetes
Uses
Classification of OHA
Uses
Side Effects
Alpha-glucosidase Inhibitors
Parameters for Assessment of Control
Self Monitoring of Glucose and Urine
Complications of Diabetes
Diabetic Coma (Diabetic Ketoacidosis)
Symptoms and Signs (Table 15.9)
Diagnosis
Treatment
Hypoglycaemia
Symptoms and Signs (Box 15.4)
Treatment
Hyperosmolar Non-ketotic Diabetic Coma
Chronic/Late/Long-term Complication of Diabetes
Diabetic Retinopathy
Diabetic Nephropathy (Kimmelstiel-Wilson's syndrome)
Diabetic Neuropathy
Coronary Artery Disease
Peripheral Vascular Disease
Diabetic Foot
Infection
Diabetes and Pregnancy
CHAPTER 16:
Diseases of Endocrine System
APPLIED ANATOMY AND PHYSIOLOGY
The Hypothalamus
The Pituitary
DISORDERS OF PITUITARY
Gigantism and Acromegaly
Clinical Features (Figs 16.2 and 16.3)
Diagnosis
Treatment
Prolactin Secreting Tumour (Prolactinoma)
Hypopituitarism (Simmond's Disease)
Causes
Symptoms and Signs
Diagnosis
Treatment
Dwarfism
Causes
Diagnosis
Treatment
DISORDERS OF POSTERIOR PITUITARY
Diabetes Insipidus
Causes
Symptoms and Signs
Diagnosis
Treatment
Thyroid Gland
Disorders of Thyroid Gland
Goitre
Types
Simple Nontoxic Goitre (Endemic Goitre, Puberty Goitre, Iodine Deficiency Goitre)
Prevention
Hyperthyroidism
Causes
Grave's Disease
Symptoms and Signs
Diagnosis
Treatment
Nodular Toxic Goitre
Malignant Goitre (Thyroid Carcinoma)
Hypothyroidism (Myxoedema)
Causes
Symptoms and Signs
Diagnosis
Treatment
Parathyroid Glands
Anatomy and Physiology
Regulation of Calcium Balance (Calcium Homeostasis) (Fig. 16.13)
Disorders of Parathyroid
Hyperparathyroidism
Primary Hyperparathyroidism
Secondary Hyperparathyroidism
Symptoms and Signs
Diagnosis
Treatment
Hypoparathyroidism (Hypocalcaemia)
Clinical Features
Tetany
Causes
Symptoms and Signs
Hypocalcaemia
Causes
Symptoms and Signs
Treatment
ADRENAL GLANDS
Applied Anatomy and Physiology
Hormones of Adrenal Cortex
Hormones of Adrenal Medulla
Cushing's Syndrome
Causes
Clinical Features
Diagnosis
Treatment
Addison's Disease
Causes
Symptoms and Signs
Diagnosis
Treatment
Adrenal Crisis/Addisonian Crisis
Adrenogenital Syndrome (Virilism)
Symptoms and Signs
Diagnosis
Treatment
DISEASES OF ADRENAL MEDULLA
Phaeochromocytoma
Symptoms and Signs
Diagnosis
Treatment
THERAPEUTIC USES OF ADRENAL HORMONES
Corticosteroids
Local Uses
Side-effects of Steroids (Box 16.6)
Epinephrine (Adrenaline) and Norepinephrine (Noradrenaline)
Oestrogens
Appendix 1
STIMULATION/SUPPRESSION TESTS USED IN ENDOCRINOLOGY
General Considerations
Growth Axis
Procedure
Contraindications
Precautions
Prolactin
Gonadal Axis
LHRH Test
Thyroid Axis
TRH Test (Stimulation Test)
Adrenal Axis
Intravenous Synacthen Test
Short ACTH Stimulation Test
Dexamethasone Suppression Test
Insulin Tolerance Test for ACTH Reserve
Test for Posterior Pituitary
Water Deprivation Test
Interpretation
Appendix 2 Bedside Diagnostic—Therapeutic Procedures and Instruments Used
LUMBAR PUNCTURE (LP)
Uses
Diagnostic
Therapeutic
Contraindications
Papilloedema
Complications
Procedure
Site. L3-L4 Interspace
Dry Tap
BONE MARROW ASPIRATION
Indications
Contraindications
Complications
Procedure
Dry Tap
TISSUE BIOPSY NEEDLE
Liver Biopsy
Indications
Contraindications
Complications
Renal Biopsy
Indications
Contraindications
Complications
ASPIRATION (PARACENTESIS)
Indications
Paracentesis of Pleural Fluid
Paracentesis of Ascites (Ascitic Tap)
Paracentesis of Pericardial Fluid
Tapping of Liver Abscess
Indications
TRACHEOSTOMY
Indications
Complications
ENDOTRACHEAL INTUBATION
Indications
Complications
NASOGASTRIC INTUBATION (RYLE'S TUBE INTUBATION)
Indications
Complications
Immediate
Late (Prolonged Use)
URINARY CATHETERISATION
Indications or Uses
Contraindications
Complications
Precautions
OXYGEN DELIVERY DEVICES (Figs A2.9A to C)
Indications of Oxygen Therapy
Complications
NASOPHARYNGEAL SUCTION CATHETER
Indications for Suction
INTRAVENOUS LINE ACCESS (I.V. ACCESS)
Indications
Complications
INTRAVENOUS INFUSION SET
Indications
MOUTH GAG
Indications
STOMACH (GASTRIC) LAVAGE TUBE
Indications
Contraindications
INDEX
TOC
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