Potential causes of diabetes pregnancy

• Family history of diabetes may cause diabetes during pregnancy.
• Having a previous birth of an overweight baby of 4 kg or more may cause diabetes pregnancy.
• Previous still birth with pancreatic islet hyperplasia revealed on autopsy also causes diabetes pregnancy.
• Unexplained perinatal loss also causes diabetes pregnancy.
• Presence of polyhydramnios or recurrent birth canal candidiasis in present pregnancy may cause diabetes.
• Persistent glycosuria
• People aged over 30 are prone to get number of health disorders.
• Obesity is the main cause type 2 diabetes mellitus.
• Ethnic group: Some groups of people have risk to get pregnancy diabetes.
• All these risks may cause diabetes pregnancy.

Causes of Pregnancy Diabetes

When the pregnancy hormones are interfering with the utilization of the insulin from the cells; it leads to diabetes pregnancy. Or diabetes pregnancy is also caused with lack of production of insulin in the pancreas or due to peripheral resistance to the insulin.

Hazards or complications of pregnancy Diabetes

The diabetes pregnancy will cause more effects on the baby as well as on pregnant mother. These risks can be prevented by reducing the blood glucose level. The risks of diabetes pregnancy includes…

Congenital anomalies: The baby born for the mother with gestational diabetes will get more birth defects. The baby will get heart diseases and neural tube defects are spina bifida (a defect in the spinal cord), anencephaly, microcephaly (Small head of the baby), sacral agenesis, renal agenesis, hydronephrosis, ureteral duplication, duodenal atresia, anorectal atresia, single umbilical artery and other Congenital anomalies are the hazards of diabetes pregnancy.

Recurrent abortion: Due to increase in the blood glucose level the pregnant mother will have more chances of getting miscarriage, is may be caused by diabetes pregnancy.

Premature birth: The pregnancy diabetes or gestational diabetes will cause the premature birth of the baby, due to premature rupture of the membrane is common with diabetes pregnancy.

Macrosomia: Macrosomia is defined as the birth of the baby above 4 kg or more birth weight. The baby with macrosomia looks very big. Macrosomia happens due to the sugar from the mother will cross and reach the fetus. So it leads the fetus to produce extra insulin and it converts the sugar into the fat and cause the baby to become bigger in size. Macrosomia is the common complication of untreated diabetes pregnancy.

Stillbirth: The baby born dead after 37 weeks of gestation is called as still birth; may happen because of diabetes pregnancy.

Immediate complication of the new born baby: there is a respiratory problem and hypoglycemia and icterus.

Obesity: there is a chance of getting obesity in the baby born for the diabetic mother.

Pre-eclamsia: If the mother is having gestational diabetes will have more risk of getting pre-eclampsia that is increase in blood pressure of the mother. Pre-eclampsia may be associated with diabetes pregnancy.

Polyhydromnios: Polyhydromnios is another important major risk in diabetic mother. There will be increase in the amount of the amniotic fluid level more than 2500 ml is called polyhydromnios; the complication of diabetes pregnancy.

Cesarean delivery: Due to the large size of the baby the mother has to undergo cesarean section in some cases of diabetes pregnancy.

Diet for diabetes pregnancy

The mother during her pregnancy has to focus her attention on food; especially the mother who is having diabetes must have to take so much of care in her diet to prevent hyperglycemia. The mother has to take a planned amount of calories per day; it should consist of all the contents like vitamins and proteins, fat, and carbohydrates. Mother with diabetes pregnancy has to get nutritional counseling.

The calories for each day are calculated by the dietitians, the diet regimen is divided in to three meals, and three snacks.

Nearly 20 % of calories should obtain from proteins. The protein including items are lean meats, milk and milk products, fish, beans, cereals, eggs and nuts. And more about 30 to 40% from primarily unsaturated fats. The main source of fats are from plants and vegetables sources.

Main source of calories from carbohydrates nearly about 40 to 50 % from main complex foods such as  grains, whole-grain bread, fruits, cereal, pasta and, as well as rice and vegetables.

Precaution of sweets should be avoided by diabetes pregnancy mother.

Diagnosis of diabetes pregnancy

It is important to rule out the other pathological conditions during pregnancy so the mother must undergo the following diagnoses…

Ultrasound scanning: Ultrasound scanning is used to find the condition of the fetus, especially in the last trimester of pregnancy, to identify diabetes pregnancy.

Non stress test: This test is very essential to find out the heart rate of the mother and as well as the baby’s heart rate. It is repeated every weekly or more frequently.

Counting of the fetal movement: The pregnant mother has to take records over the fetal movement in one or two hours.

Management of diabetes pregnancy

The patient with diabetes pregnancy needs more frequent antenatal supervision with periodic check up of fasting blood glucose level which should be less than 95 mg%. The control of high blood glucose is done by restriction of sugar containing diet; exercise with or without insulin for mother with diabetes pregnancy. Human insulin should be started if fasting plasma glucose level exceeds 105 mg/dl and 2 hours postprandial value is greater than 130 mg/dl. Even on diet control. Diet 2000-2500 Kcal/day for normal weight diabetes pregnancy woman and restriction to 1200-1800 Kcal/day for overweight woman is recommended. Exercise program are safe in diabetes pregnancy and may obviate the need of insulin therapy.

Consultation with the physician or the diabetalogist is important to treat the gestational diabetes. Blood sugar control is important aim of gestational diabetes treatment. Frequent monitoring and medical supervision may assist in controlling geatational diabetes and getting health baby as a result of pregnancy.

Obstetric management of women with good glycemic or blood sugar control and who do not require insulin may wait for spontaneous onset of labor. However, elective delivery is considered in patients requiring insulin or with complications at around 38 weeks of pregnancy.

Follow up: Nearly 50% of women with gestational diabetes would develop overt diabetes over a follow up period of 5-20 years. Women with fasting hyperglycemia have got worse prognosis to develop type-2 diabetes and cardiovascular complications. Recurrence risk in subsequent pregnancy is more than 50%.

The contagious, bacterial, streptococcal infection of throat is called strep throat. The symptoms of strep throat are fever, redness, swelling of throat and tonsils. The inflammation makes the tonsils to become red and swollen with irritation. The symptoms of strep throat range from mild to severe symptoms.

Strep throat- Facts

The strep throat is commonly seen in children, even though the young and adults get the strep throat. The school children get an infection throat due to stay in an enclosed area, where the air has infecting droplets as sneezing, coughing, laughing etc. When the normal child inhales these infected droplets through breath, child will get strep throat.

Through coughing, and sneezing the infected person can spread the infection to other people. The bacterium in the air causes infection in children who have less immunity.

Contacting an object infected with strep throat causing bacteria such as books, table, pen, pencil, and shake hand can cause strep throat.

Strep throat is also caused by viruses. The viral strep throat symptoms are runny nose, coughing, hoarseness of voice etc. No need of treatment for viral strep throat infection.

Causes of strep throat are

Group A streptococci is the main cause of strep throat. Streptococcus pyogen, the group A streptococcal bacteria causes strep throat. The infection spreads from one to another person through contact and inhalation of infected droplets. These bacteria also cause damage to red blood cells. A beta hemolytic streptococcus causes strep throat.

A viral infection also causes strep throat. The viral infection stays for more than 3 days.

Smoke, allergic pollutants, contaminated air, and an injury to throat can cause strep throat.

The bacteria may infect both tonsils and throat simultaneously.

Symptoms of strep throat

A child with strep throat may have the symptoms such as:

• Red and white patches in the Pharynx or throat on visualization,
• Difficulty in swallowing is the main symptom of strep throat.
• Enlargement of lymph nodes in the neck region,
• Swelling of tonsils with redness,
• Abdominal pain in lower part,
• Mild fever and headache,
• Irritability and uneasiness,
• Loss of appetite and
• Nausea and vomiting,
• Skin rashes
• Are the main symptoms associated with strep throat.

The main function of kidney is to purify the blood, Water absorption, and maintaining biochemical levels in the body and also kidney regulates blood pressure through renin angiotensin system.

Urine is formed after filtration of blood and renal tubules helps in the absorption of different electrolytes and water.  The urine formed in the kidney is passed through ureters to the urinary bladder. From urinary bladder the urine is passed out with voluntary effort through urethra.

The infected bladder favors the environment for micro organisms to ascend into upper urinary tract and causes kidney infection. The infected kidney leads to kidney pain. Bacteria are the common micro organism causes kidney infection. Sever kidney infection causes pus formation and kidney pain.

Glomerulonephritis and Pyelonephritis are the common kidney infection troubles most of people across world. Untreated kidney infection may spread the bacterial infection to blood and causes bacterial sepsis or septicemia. Chronic renal failure may occur if the disease progress occurs. Acute renal failure may also develop with this kidney infection.

Diagnosis of Kidney infection

Diagnosis of kidney infection is made by urine test. The protein urea, passing pus cells or epithelial cells in the urine, confirms the kidney infection or urinary tract infection. Antibiotics are used to treat kidney infection and analgesics to relieve kidney pain. Ultrasound scan shows any enlargement of kidney due to severe kidney infection.

Causes of kidney infection and kidney pain

The untreated lower urinary tract infection is the main cause of kidney infection. The untreated kidney infection leads to improper kidney function and even leads to kidney failure also.

• Causes of kidney pain may of different origin.
• An abdominal surgery also causes kidney infection, if proper asepsis is not maintained.
• Storage of urine in the bladder due to anatomical obstruction also causes kidney infection or urinary tract infection.
• Urinary catheterization has more risk of causing kidney infection.
• Kidney biopsy also causes kidney pain after the procedure.
• Untreated kidney infection may cause kidney pain,
• An external injury to kidney also causes kidney pain,
• Cystoscopy and other procedures to visualize the bladder may cause infection.
• Presence of kidney stones leads to kidney pain. The kidney pain may be radiating and felt in the lower back region.

Symptoms of kidney infection

• · Continued urge to urinate is the main symptom of kidney infection.
• · Burning sensation or pain while passing urine,
• · Lower abdominal pain with mild fever,
• · Urine is Cloudy in nature with strong odor with kidney disease.
• · Pus or red blood cells in your urine (hematuria)
• · Urinary retention, usually occur in older adults.
• · Nocturia, passing urine during night
• · Low Back pain, (kidney pain) or groin pain
• · Fatigue, nausea and vomiting etc are the main symptoms of kidney infection or kidney disease or urinary tract infection.

Treatment of kidney infection and kidney pain

Treatment of kidney infection is given with antibiotics.

Give plenty of water to kidney infection person.

To relieve kidney pain, analgesics are administered.

The kidney pain is very complicated and immediate diagnosis and treatment is needed with hospitalization.

Surgical treatment is needed to correct any anatomical defect in the urinary tract.

Adequate fluid and electrolyte management is a necessary treatment for kidney patients.

Most of the elderly depressions are not identified easily in nursing homes and general hospitals. A mental health center is the right place to diagnose elderly depression and to provide appropriate mental health care. Hospitalization and different psychotherapies helps in reducing depression and restoration of mental health.

Somatic complaints and cognitive impairments are main symptoms usually associated with elderly depression. Antidepressant medications  are given to treat depression in elders and the dosage fixing and checking for drug tolerance is very important.

Causes of elderly depression are

• Normal aging process makes the individual weak, both mentally and physically. The feeling weak and the fear of death is the main cause of Elderly depression.
• Loss of spouse or loved one causes depression in most of the aged person.
• Loneliness tends the person to become depressed.
• Lack of mental support from the family members may cause depression in old age people.
• Loss of independence may affect psychologically.
• Feeling of being neglected form young ones also causes Elderly depression in old age people.
• Fear of death or dying,
• Feelings of purposelessness,
• Chronic medical illnesses such as psychological disorders, chronic disorders such as diabetes, uncontrolled hypertension, paralysis, stroke, limb fractures, immobility and other disorders causes Elderly depression of old age.
• Nutritional deficiency,
• Prolonged drug therapy and adverse drug reactions cause may cause depression.
• Psychosocial factors and
• Mental health problem are the major causes of Elderly depression of old age.
• Feelings of purposelessness and loss of hope, loss of career, loss in the business cause  depression.
• Loss of mobility due to joint deformity
• Remittent during the past, are the main causes of Elderly depression.

Symptoms of Elderly depression are

• The depressed elder one likes to be alone; always.
• Refuses to take food very weak interest towards food.
• Loss of appetite and weight loss,
• Loss of self-worth is the main symptom of Elderly depression.
• Deficit sleep is complained by most of old age one.
• Sadness with poor facial expression is seen in depression patient.
• Anxiety, irritability and worries are expressed by depression and psychological disorder.
• Neglects personal care is seen especially with psychological disordered depression patients.
• Loss of memory is common symptom of old age depression.
• Most of Elderly depression patients are not interested in mingling with family members,
• Social withdrawal and isolation is also a symptom of Elderly depression.
• Likes to stay in a dark room without lights and without ventilation.
• Fixation on death and likes to die; prays the god to grant death.
• Attempt to suicide is also considered as the symptom of old age depression or Elderly depression.
• Some old age or elderly depressed patients becomes alcoholics and drug abused.

Treatment of Elderly depression

Antideprssant therapy: Antidepressant medications lessen the symptoms of elderly depression. Care should be taken to lessen the side effects of drugs which occur in elders. Treating underlying cause of elderly depression is very important. Neuroleptic medications are also beneficial in some elderly depression individuals. Monoamine oxidase inhibitors (MAOIs) are the Antidepressant medications used in some patients.

Psychological counseling: is very beneficial in relieving symptoms of depression. Counseling should facilitate to make off loneliness and should be according to the need and life situation of elder ones. Watching for suicide accident and proper counseling regarding  prevention or removing suicide thought is important.

Music therapy: Listening to musical songs, devotional songs also helps in treating elderly depression. ECT electro convulsive therapy can be given to some individuals.

Play Therapy: Play is an important activity makes an individual to come out of depression. The physical activity stimulates to produce the hormones, which keeps the body active. Engagement in activity relieves the mental stress. Regular walk, swimming, physical exercise, painting, playing with children and any activity stimulates physically or mentally is the good treatment for elderly depression. The play therapy is not applicable for all depression patients. Persons with physical mobility can engage in suitable and possible activities to come out of depression.

Emotional support: The family members should mingle with elders to remove loneliness. Make the elders to play with small kids. Take a regular walk and advice to love the environment. Make them feel some one is caring and loving the elders. Advice to recall and the care giver need to recall the happiest movements of their life to bring joy. Allow them to express their feelings and make the depressed elder to feel that he is important for us.

Cognitive behavioral therapy is given to improve positive thinking in depressed patients. Recovering from depression is possible with number of treatment options. Healthcaretips.psyhil.com wishes better recovery for depression patients.

Causes of Fibula fracture

• Football players are prone to have fibula fracture.
• Falls in children, players and old ages also causes fibula fracture.
• Most of fibula fractures are not identified easily and some individuals live with fibula fracture with mild pain for long time.
• Some individuals feel pain at fibula after some months of fibula fracture.
• Patients with fibula fracture can walk with minor discomfort as the fibula bone bears less body weight.
• Orthopedic surgeon should assess the fibula fracture carefully to know the severity of fibula fracture.
• Hairline crack in the fibula or small fracture in fibula is caused because of stress and is called as stress fibula fracture.
• Muscles traction and twisting forces placed on the fibula bone from the surrounding muscles causes stress fibula fracture.
• Fibula fracture may be associated with tibia fracture or ankle fracture.
• These are the main causes of fibula fracture.

Signs and symptoms of Fibula fracture

• Pain in the injured lower leg is the main symptom of fibula fracture.
• Tenderness and swelling in the area below knee, near calf muscle,
• Bleeding and bruising at fractured site, especially with compound fracture.
• Difficulty  to bear weight on  fibula injured leg,
• Visible bone fragments  are seen along with damage to skin in case of complete or compound fracture,
• Numbness of lower leg if the blood supply and nerve damage occurred during fracture.
• Coldness of the affected leg and distal end of fracture site, as the blood supply is altered. These are the main signs and symptoms of fibula fracture.

Treatment of Fibula fracture and Management

Treatment is given on the nature of fracture and severity of fibula fracture. Elevation of fractured leg is the Initial treatment for fibula fracture, and ice packs are applied to relieve pain and reduce swelling of injured area. Reduce further dislocation of injured bone. Immobilization of affected victim is important.

If the bone is broken, plaster cast is applied to enhance healing of fibula fracture and the duration of cast application is up to 8 weeks. When the fibula fracture is compound, surgery is done to correct the deformity and a rod, plate or screws are fixed at fibula fracture site as per need. Walking with crutches is suggested during recovery period. A plastic stirrup-type brace, cast or walking boot is often recommended to treat fibula fracture.

Exercises should be done after the fibula fracture is healed. Exercises such as stretching and strengthening of injured leg, etc are done and exercises should enhance blood supply to the area. Physiotherapy is very helpful in restoring leg function after treating fibula fracture.

RICE principle is used to reduce swelling, pain and inflammation in case of acute fractures.

• Rest: Adequate rest is needed to correct the deformity, and walk should be assisted with crutches to lessen the weight on injured leg and to enhance better healing.
• Ice: Ice pack is applied every two to three hours of 15 to 20 minutes during the first 72 hours of fibula fracture.
• Compression: Use an ace wrap on the leg. Start at the bottom of the toes and wrap up to the upper end of knee.
• Elevation: Ankle of fibula injured leg should be elevated above the level of victims heart while sitting or lying down to enhance venous return to heart from lower extremity.

Causes of Frequent urination

Frequent and urgent urination may occur together and the inflammation of urinary tract reduces the urinary bladder’s capacity to store urine and even a small amount of collected urine causes bladder discomfort.

Diabetes- Due to excess urine formation in the body and polyurea is the main symptoms of the diabetes, diabetes patients suffer from frequent urination.

Pregnancy – changed anatomical position of the uterus produces pressure on the urinary bladder and causes frequent urination.

Prostate enlargement compresses the urethra and causes frequent urination.

Main causes of frequent urination

• Medicines like diuretics used to treat some other diseases causes frequent urination.
• Interstitial cystitis also causes frequent urination.
• Overactive bladder syndrome is the main cause of frequent urination.
• Inflammation of prostate gland in males,
• Stroke and neurological diseases affects urinary bladder,
• Urinary incontinence, etc causes Frequent urination.
• Urinary bladder cancer,
• Radiation therapy,
• Bladder dysfunction, etc causes frequent urination.

Causes of Nocturia with frequent urination are

• Excess water drinking at bedtime may cause nocturia.
• Enlarged prostate gland also causes frequent urination.

Home Care given to treat frequent urination are

Follow the medical advice properly.
Modify the diet as per the health care providers advice.
Note the amount of urine passed and urinary frequency.
If you have nocturia, follow the tips given below to avoid frequent urination.

If you have the following symptoms, seek the medical help

• Fever, back or lower abdominal pain, vomiting or chills with frequent urination.
• Increased thirst or Increased appetite, tiredness or unknown weight loss along with frequent urination.
• Frequent urination or urgency, along with new medication intake or systemic diseases,
• Urinary incontinence developed later with frequent urination,
• Frequent urination associated with hematuria or red blood cells in urine,
• Dehydration caused because of frequent urination and

All these medical disorders need immediate medical help and treatment.

Diagnostic tests for frequent urination are

• Analysis of urine for any urine infection or urinary tract disorder.
• Urine culture and sensitivity tests
• Cystometry (measuring the pressure within urinary bladder)
• Cystoscopy (visualization of urinary bladder)
• Neurological assessment
• Ultrasonography and other diagnostic tests are done to diagnose frequent urination.

Treatment of frequent urination

Treatment is determined by the cause of the urgency and frequency. Antibiotics and medicine may be prescribed to lessen the discomfort, if needed. Treating the underlying cause helps to treat frequent urination. In some individuals, the frequent urination may not be treated completely and the symptomatic relief is possible with appropriate medications.

Prevention of frequent urination

To avoid frequent urination during night time, drink less fluid before bed time.

Discontinue the drugs with cause more urination or urinary frequency.

The fluids need to be avoided during night time are water, coffee, fruit juice and other beverages and alcohol.

Avoid urinary tract infections by maintaining hygiene.

Get health care givers advice when you have a minor problem.

One must visit the physician, if the frequent urination persists for long time.

The pregnancy food should be adequate to provide the following

1. The pregnancy food should maintain the maternal health.
2. The pregnant food should fulfill the needs of the growing fetus.
3. The pregnancy food should provide strength and vitality required during labor.
4. The pregnancy food should result in Successful lactation.

During pregnancy, there is increased calorie requirement due to increased growth of the maternal tissues, fetus, placenta and increased basal metabolic rate. Pregnant mother should eat Pregnancy food adequately so as to gain the optimum weight.

The pregnancy food ideal should be light, nutritious, easily digestible and rich in protein, minerals and vitamins. The pregnancy food consist in addition to the principal food at least half liter or 1 liter of milk, green vegetables and fruits. The amount of salt should be of sufficient amount to make the food tasty. At least, half of the total protein should be first class protein containing all the amino-acids and majority of the fat should be animal type which contains vitamins A and vitamin D.

Diet advice should be given with due consideration to the socioeconomic condition, food habits and taste of the individual. Pregnant Woman with normal BMI should eat as to maintain the schedule weight gain in pregnancy. The instruction about diet should be reasonable and realistic to individual women. Pregnancy food places a major role in well development of baby.

Supplementary nutritional therapy: As previously mentioned, there is negative iron balance during pregnancy and the dietetic iron is not enough to meet the daily requirement especially in the second half of the pregnancy. Thus supplementary iron therapy is needed for all pregnant mothers from 16 weeks onwards. Above 10 gm% of hemoglobin, 1 tab of ferrous sulphate containing 60 mg of elemental iron is enough. The dose should be proportionately increased with lower hemoglobin level to 2-3 tablets a day. 3 tablets provide 45 mg of absorbable iron. As the essential vitamins are either lacking in the foods or are destroyed during cooking; supplementary vitamins are to be given daily from 20 week onwards. The pregnancy food should consist of iron and folic acid containing foods.

Vitamins, nutrients and food which includes minerals

Pregnancy food includes extra vitamins, minerals, and nutrients these will help the fetus to develop well.

Folate as pregnancy food

Folate is a B vitamin and is very important for the development of the fetus in early pregnancy. It helps in prevention of congenital anomalies like open spina-bifidas.  Minimum of 400 micrograms of folic acid is needed daily for a pregnant woman. The pregnancy foods rich in folic acid include breakfast cereals, fruit juices and nutritious drinks and green leaf vegetables.

Iodine as pregnancy food

Iodine is the mineral which is very essential to maintain the body metabolic state and also for the growth and development of the body. Iodine is very essential for the development of the fetal brain and is very important for growing children, if provided the sufficient amount. Iodine supplementation also helps to prevent the goiter. The foods containing iodine are milk and milk products, sea foods, eggs and fish, and by using iodized salt we can obtain the iodine.

Iron as pregnancy food

Iron is one of the very important mineral needed during pregnancy, because the iron helps in the formation of the hemoglobin which carries the oxygen through the blood. So iron is an important pregnancy food. During pregnancy extra amount of iron is needed because there is an increased need of the oxygen for the mother as well as for the fetus. Nearly 40 mg of iron is needed during pregnancy per day.

The diets rich in iron

• Green leafy vegetables such as cabbage, drumstick, and spinach

• Chicken

• Fish

• Some legumes such as lentils, kidney and lima beans

• Eggs

• And eating foods rich in vitamin C will also help in the absorption of the iron in the gut, for example drink orange juices

• And try to avoid drinks such as coffee and tea and cola drinks because they cause reduced absorption of the iron

Calcium as a pregnancy food

Calcium is one of the important mineral needed by the body for development of the skeletal system. The calcium helps in the strengthening of the bones and teeth. It helps to prevent osteoporosis. The daily recommendation of the calcium for the pregnant is about 1000 mg. The foods rich in calcium are milk and milk products, eggs, meat, vegetables etc. So calcium is a good pregnancy food.

Some of the safety guidelines for the maintenance of food hygiene

• Before eating the food the mother should have to wash her hands properly and pregnancy foods should be hygienic.

• Before cooking the food, the raw items should be washed thoroughly to prepare pregnancy food.

• The cooked food should be stored in a well manner that it should away from all insects in the home.

• The pregnancy food should be well cooked for the good softness, it should be easily digestible.

Stress urinary incontinence and Urge incontinence are the two main types of urinary incontinence. Leaking of urine and uncontrolled wetting of clothes is the main symptom of incontinent bladder. Incontinent bladder has become a embarrassing problem in most of old ages.

Stress urinary incontinence occurs at the time of laughing, sneezing, coughing, etc. Stress incontinence is usually temporary and is not recognized easily and is also not a major medical disorder. Retraining of urethral muscles is the main treatment option for urinary incontinence due to stress. Training of pelvic floor muscles by the Physical Therapist is a effective treatment for Stress urinary incontinent.

Urge incontinence is the sudden urge to urinate beyond the voluntary control of bladder muscles. The older adults or aged people experience urge incontinence commonly. Most of the women ignores this problem and seek medical help after the urinary incontinent becomes severe as they always have to go for toilet.

Weakened urinary muscle is the main cause of incontinent bladder. Also a over active urinary bladder leads to incontinent bladder.
When the bladder muscles or the muscles supports the bladder are weaken, the stress incontinent occurs during sneezing, coughing, laughing and other stressful activities. The overactive bladder induces a strong urge to urinate even though when urinary bladder is incompletely filled

Damage of the nerves which supply urinary bladder also causes incontinent bladder.
Prostate problems in males also causes urinary incontinent.
Removal of the prostate gland in males lead to this type of incontinence
some women’s experience urinary incontinent after childbirth or after menopause.

Symptoms of urinary incontinent

• Minor leakage of urine continuously from the bladder,
• Dribbling of urine,
• Wetting of clothes, which irritates more. In some incontinent, both loss of stools and urine occurs.
• Episodes of strong urinary urgency are the symptoms of urinary incontinent.

Types of urinary incontinence include

Stress incontinence : Loss of urine when pressure is exerted on urinary bladder. Stress on body is exerted during coughing, sneezing, laughing, exercising or lifting some weight, etc. psychological stress is not related to this stress incontinent but the physical stress is the main cause. Stress incontinent occurs due to weakened sphincter muscle at the neck of urinary bladder. Stress incontinent is experienced more when urinary bladder is full. Stress incontinent is the common type of incontinent bladder, and is commonly seen in women. Physical changes women due to pregnancy, childbirth and menopause leads to stress incontinent.

Mixed incontinence: when the person have symptoms of two or more type of urinary incontinence such as stress incontinent and urge incontinence together is called as mixed incontinence.

Functional incontinence: Many oldage people will have uncontrolled bladder, especially when stays on bed for long time with a chronic diseases. A physical or mental impairment such as partial paralysis, joint disability, makes oldage people unable to get up from bed and to void. This makes them to void on the bed itself ia called as functional incontinence.

Urge incontinence: This is a sudden, intense urge to urinate, followed by an involuntary loss of urine. Your bladder muscle contracts and may give you a warning of only a few seconds to a minute to reach a toilet. With urge incontinence, you may also need to urinate often. The need to urinate may even wake you up several times a night. Some people with urge incontinence have a strong desire to urinate when they hear water running or after they drink only a small amount of liquid. Simply going from sitting to standing may even cause you to leak urine. Urge incontinence may be caused by a urinary tract infection or by anything that irritates the bladder. It can also be caused by bowel problems or damage to the nervous system associated with multiple sclerosis, Parkinson’s disease, Alzheimer’s disease, stroke or injury. In urge incontinence, the bladder is said to be “overactive” —The bladder is contracting even when your bladder isn’t full. In fact, urge incontinence is often called an overactive bladder.

Overflow incontinence: If you frequently or constantly dribble urine, you may have overflow incontinence. This is an inability to empty your bladder, leading to overflow. With overflow incontinence, sometimes you may feel as if you never completely empty your bladder. When you try to urinate, you may produce only a weak stream of urine. This type of incontinence is common in people with a damaged bladder or blocked urethra and in men with prostate gland problems. Nerve damage from diabetes also can lead to overflow incontinence. Some medications can cause or increase the risk of developing overflow incontinence.

Gross total incontinence: This term is sometimes used to describe continuous leaking of urine, day and night, or periodic large volumes of urine and uncontrollable leaking. The bladder has no storage capacity. Some people have this type of incontinence because they were born with an anatomical defect. It can be caused by a spinal cord injury or by injury to the urinary system from surgery. An abnormal opening (fistula) between the bladder and an adjacent structure, such as the birth canal, also may cause this type of high-grade urinary incontinence.

Treatment of urinary incontinent includes

Treatment of urinary incontinence is given on the nature of cause, and need of medical help to correct the problem.
Exercises to strengthen the bladder muscles,
Medications to reduce the action of over active urinary bladder.

Don’t let urinary incontinent to trouble your daily activities and never hesitate to seek a medical help. In many situations, some urinary incontinent can be cured completely not some can be controlled. When urinary incontinent is not able to eliminate, some medical devices helps to relieve the problem of incontinent.

Definition of fever

Fever can be defined as an elevation of the body temperature more than normal by about 1-2 degree above the normal temperature of 98.6 degrees Fahrenheit (F) or 37 degrees Celsius (C). Fever is not a disease and is a symptom and it differs from hyperthermia.

Causes of fever

• Viral or bacterial Infections : Influenza, common cold, Human immunodeficiency virus, malaria, infectious mononucleosis, or gastroenteritis, strep throat, pneumonia, flu and chickenpox, Endocarditis, Encephalitis and Meningitis Gastroenteritis (Stomach Flu), Melioidosis, Staph Infection (Staphylococcus Aureus) , Respiratory Syncytial Virus, and other infections causes fever.
• Various skin inflammations: boils, pimples, acne, or abscess causes fever.
• Immunological diseases: Lupus erythematosus, sarcoidosis, inflammatory bowel diseases also causes fever.
• Tissue destruction: which can occur in hemolysis, surgery, infarction, crush syndrome, rhabdomyolysis, cerebral hemorrhage, etc causes fever.
• Drug fever: is directly caused by the drug, e.g. lamictal, progesterone, or chemotherapeutics causing tumor, necrosis.
• Fever is also a symptom of an adverse reaction to drugs, e.g. antibiotics or sulfa drugs.
• After drug discontinuation, e.g. heroin or fentanyl withdrawal may cause fever.
• Cancers: most commonly renal cancer and leukemia and lymphomas lead to fever as a first symptom.
• Metabolic disorders: gout or porphyria also causes fever.
• Thrombo-embolic processes : pulmonary embolism or deep venous thrombosis
• More or less all infections in the body cause fever as a first symptoms of an infection of inflammation.

Symptoms & Signs of fever

• Increase in body temperature more than 100.4 degrees F (38 degrees C) is main sign of fever.
• Presence of chills due to increase in temperature of the body than the external environment is associated with fever.
• Increase in heart rate and muscle tone is the main symptoms of fever.
• Shivering will be present in fever patients.
• In severe cases of fever sometimes there will be presence of delirium and convulsions. Delirium and convulsions are usually seen in children.
• When there is rise in body temperature the fever person feels warm. If fever becomes low the person may start to sweat.
• Severe cases of fever will be associated with the some other symptoms at that time the patient has to meet the doctor immediately to treat fever.

Measurement of fever temperature

The fever is measured using an instrument called thermometer. It contains mercury in it. The instrument is placed in different parts of the body and the temperature can be measured. There are varies types of thermometer are there. They are

• Oral thermometer,
• Axillary thermometer and
• Anal thermometer.

According to temperature measured in various sites of our body, some calculation should be done. For example,
If the temperature is taken in the anal region we have to subtract 1 degree from the total temperature because there is always high in temperature
If the temperature is measured in the oral region it is the normal there is no need of adding or subtraction.
When we are taking temperature in the axillary route we have to add 1 degree

Classification of the fever

The fever is classified according to the grade of the temperature, they are

• Low grade fever : Approximately varies from 100.4-102.2 degrees of F
• Moderate fever : Approximately varies from 102.2-104.0 degrees of F
• High grade fever : Approximately varies from104.0-107.6 degrees of F
• Hyperpyrexia : Is the maximum level that is more than the 107.6 degrees of F

Uses of fever

• According to some studies the fever is essential for the immune bodies to fight against the antigen of bacteria. There is speed up of certain immunological reactions are taken up by temperature.
• Fever may be sometimes very essential in some extents because it cause unbearable environment for the pathogens.
• Fever or increase in temperature is useful for the immunological bodies, it provides favorable environment for the white blood cells, so they will proliferate easily and can fight against the pathogens. There will be increased activity of the interferon during fever.

Treatment for fever

• Fever is not treated essentially because it is a essential reaction of our body. So the fever is needed only the symptomatic management. There will be so much of dehydration so the patient should be hydrated properly with intravenous fluids.
• During fever period the patient may be disoriented, so the patient needs psychological support to recover from fever, nurse should give psychological assurance that fever will be get reduced as soon as possible.
• The fever patient need complete bed rest, and room should be well ventilated and provide an environment to sleep well.
• Feed the fever patient only with small, frequent diet, because there will be alteration in the bowel pattern and indigestion may occur.
• The immediate cause of the fever should be ruled and proper steps to be taken to reduce the fever.
• There will be chances of hyponatremia, the patient is given sports drinks or intravenous administration of the electrolytes.
• If the fever is so high, cold bath or tepid sponge bath should be given.
• If the fever remains same the patient must take antipyretics like paracetamol or ibuprofen, Aspirin etc.
• The actual reason for fever should be find out and the cause should be treated immediately.

Cesarean delivery is the surgical procedure used to expel the baby from the mother’s womb when normal birth canal delivery is not possible. Cesarean section is the surgical form of child birth.

Cesarean section recovery takes some weeks. Effective post operative care of mother helps in easy recovery after cesarean section. Care after cesarean section includes immediate Care after cesarean section, and care given for a period of week.

Bleeding after cesarean section is the common complication and the health care provider place a major role in identifying bleeding after cesarean section. Effective measures need to be applied to prevent bleeding after cesarean section.

Indications for cesarean section or Cesarean delivery are

Cesarean section is indicated when normal delivery through birth canal might cause damage to the mother or baby. Reasons for cesarean delivery are as follows

• Cephalopelvic disproportions is the main cause of cesarean delivery,
• High Risk pregnancies need surgery for safe delivery of baby.
• Presence of pelvic mass,
• Prolonged labor requires cesarean delivery for saving life of baby and mother.
• Shoulder dystocia
• Apparent fetal distress
• Apparent maternal distress
• Pre eclampsia and hypertensive disorders,
• Pelvic contractions,
• Pelvic carcinoma,
• In case of multiple pregnancies, normal delivery is difficult and caesarean delivery or Cesarean section is the option for saving the life of baby.
• Mal presentation such has breech presentation
• Failed induction  of labor
• Macrosomia or large baby,
• Placenta previa, placenta abruptia,
• Umbilical cord abnormalities etc.
• Sexually transmitted disease like genital herpes may transfer infection to baby and Cesarean section is the option of treatment in these pregnant mothers.
• History of previous Cesarean section

These are the main indications of cesarean section or cesarean delivery

Care after cesarean section or Cesarean delivery

• Administration of intravenous fluid is important to restore the loss of fluids and electrolytes during surgery.
• Inject methargin 2 mg IM route to stop bleeding after surgery.
• Oxytocin drip may be administered to make the uterus to contract and stop bleeding.
• Monitoring vital signs is very important.
• The post surgical wound to be dressed regularly, until the wound heals.
• Administer sedatives such as Diazepam.
• Prescription of antibiotics is must for preventing the post operative infection in children.
• Special care to be taken by the nurses to assist the lactating mothers in feeding the baby born by Cesarean delivery.
• Most of the mothers get depression after surgery and the psychological counseling and assurance by the family members and health care providers is important.
• These are the measures used for care after cesarean section or Cesarean delivery.