Gout gives pain, just like you.

GOUT

DO YOU KNOW WHAT IS GOUT ?

An autoimmune disorder and a form of arthritis, joint inflammation which affect many joints in human body.

Joint that commonly involved is the first metatarsophalangeal joint (big toe) and called podogra.

WHY I POSSIBILY CAN SUFFERING GOUT ?

1. Diet

• Increase consumption of purine, examples: shellfish,red meat,organ meat 
• Drinking sweetened beverages with fruit sugar(fructose) that can increase level of uric acid
• Excessive consumption of alcohol drink
• Dehydrated

2. Obesity

• If you are overweight, body will produces more uric acid and kidney will have more difficulty eliminating uric acid

3. Medical condition

• There are certain diseases that can increase the risk of gout. For example, untreated high blood pressure, diabetes, kidney disease and the others.

4. Medication (Diuretics. Eg: Thiazide, aspirin)

• Diuretics increase urination, which reduces the amount of fluid in body. The remaining fluid is more concentrated, which can increase the risk of developing the crystals that cause gout. 

5. Family history of gout

• If you have any family members who had gout, it increased the risk of you to develop gout.

WHAT IS THE PATHOPHYSIOLOGY ?

HOW DO I KNOW THAT I POSSIBLY HAS GOUT ?

 Sudden onset of severe pain

• The pain is likely to be most severe within the first four to 12 hours after it begins .
• Usually attack joint at the big toe (first metatarsophalangeal joint)

Lingering discomfort

• After the most severe pain subsides, some joint discomfort may last from a few days to a few weeks.

Affected joint become swollen, redness and warmth 

• It is due to inflammatory response.

Hyperuricemia 

• serum urate concentration > 6.8mg/dl

More than one attack of acute arthritis 

• Which means more of joint inflammation, gout flare.

Limited range of motion 

• May not able to move joint as normally due to stiffness of joint and because of the pain.

WHAT ARE THE TESTS REQUIRED ?

Joint fluid test. 

Doctor may use a needle to draw fluid from your affected joint. 

Urate crystals may be visible when the fluid is examined under a microscope.

Blood test.

A blood test to measure the levels of uric acid and creatinine in your blood.

Some people have high uric acid levels, but never experience gout. 

And some people have signs and symptoms of gout, but don't have unusual levels of uric acid in their blood.

• X-ray imaging. 
• Joint X-rays can be helpful to rule out other causes of joint inflammation.

Ultrasound.

Musculoskeletal ultrasound can detect urate crystals in a joint or in a tophus. This  technique is more widely used in Europe than in the United States.

 

Dual energy CT scan. 

This type of imaging can detect the presence of urate crystals in a joint, even when it is not acutely inflamed. 

This test is not used routinely in clinical practice due to the expense and is not widely available.

IS THERE ANY MEDICAL TREATMENT?

• Treatment for gout usually involve medication. Medication given to the patient is based on patient current health status.

•  Gout medications can be used to treat acute attacks and prevent future attacks. Medications can also reduce your risk of complications from gout, such as the development of tophi from urate crystal deposits.

WHAT ARE THE MEDICATIONS ?

There are two types of medicines used in gout which is medicines for gout attack and medicines to prevent gout attacks and gout complications.

1. Medicines to treat gout attacks

a)        Nonsteroidal anti-inflammatory drugs (NSAIDs)

• Example; ibuprofen (Advil, Motrin IB) , naproxen sodium (Aleve), indomethacin (Indocin) or celecoxib (Celebrex)

Your doctor may prescribe a higher dose to stop an acute attack, followed by a lower daily dose to prevent future attacks. NSAIDs carry risks of stomach pain, bleeding and ulcers.

b)       Colchicine

• Example; Colcrys, Mitigare

A type of pain reliever that effectively reduces gout pain. Side effects such as nausea, vomiting and diarrhea can happen especially if taken in large doses.

c)        Corticosteroids

• Example; drug prednisone

This medication can control gout inflammation and pain. Corticosteroids are used only in people with gout who can not take either NSAIDs or colchicine. 

The side effects of corticosteroids may include mood changes, increased blood sugar levels and elevated blood pressure.

2. Medicines to prevent gout attacks and gout complications.

a)        Xanthine oxidase inhibitors (XOIs)

• Example; such as allopurinol (Aloprim, Lopurin, Zyloprim) and febuxostat (Uloric)

Medications that block uric acid production by limiting the amount of uric acid produced. 

Side effects of allopurinol include a rash and low blood counts. 

The side effects of Febuxostat include rash, nausea, reduced liver function and an increased risk of heart-related death.

b)       Uricosurics

• Example; probenecid (Probalan) and lesinurad (Zurampic).

Uricosuric is a medication that improves the uric acid removal. 

Uricosuric drugs improve the kidney’s ability to remove uric acid from the body by lowering the uric acid levels and reduce the risk of gout, but the level of uric acid in your urine is increased. 

Side effects include a rash, stomach pain and kidney stones. Lesinurad can be taken only along with an XOI.

ARE THERE ANY SURGICAL INTERVENTION?

1. Tophi Removal Surgery

The procedure done by making incision over the tophi to remove the tophi.

2. Joint Fusion Surgery (also called Arthrodesis)

This procedure fuses together the two bones that make up the aching joint.

It causes the bones to become one solid bone, make the joint more stable and help to bear more weight on it.

3. Joint Replacement Surgery

This surgery is done by removing the damaged or diseased parts of a joint and replaces them with new, man-made parts. 



CAN I HAVE A NURSING CARE PLAN FOR GOUT PATIENT THAT IN PAIN ?


Diagnosis

• Acute pain related to inflammation of joint and muscle spasm as evidence by patient verbalization and pain score is 4/10.

Goal

• Patient will verbalize reduce in pain and state that the pain score is 1/10.

Interventions

• Assess the severity of pain by asking the score of pain from 0 to 10 and assess patient facial expression. This is for proper management of the pain.

• Encourage adequate fluid intake to promote uric acid excretion in urine
  

• Encourage frequent changes of position. This is to prevent joint stiffness.
  


• Apply warm compress to the affected area. Warm compress promotes relaxation of muscle and reduces pain.

• Administer medication, like colchicine. This is to relieve pain. Colchicine can be given for acute pain specific to gout attack.

• Educate the patient to practice the non-pharmacological techniques to help decrease pain during gout attacks.

Evaluations 

• Patient verbalized the pain is reduced and stated the pain score is 1/10.

WHAT SHOULD NURSE EDUCATE PATIENT THAT SUFFERING GOUT ?

1 Dietary changes

• Reduce intake of food that contain high uric acid or purine. For example, spinach, cauliflower, seafood, and avoid alcoholic beverages. 
  

IS THERE ANY COMPLICATION THAT CAN ARISE AFTER ?

  

    Recurrent gout

(if left untreated, gout may cause destruction and erosion of the joint affected)

Advanced gout

(untreated acute gout causing deposition of urate crystals formed under skin nodules called Tophi which it can develop in several areas such as elbows, feet, hand, fingers, Achilles tendons along back of ankle – Tophi swollen and tender during gout attacks)

 Kidney stones

(elevated level of uric acid in blood causing formation of urate crystals in urinary tract of person with gout)

NURSING CONTRIBUTION

IN PAST

The contribution of nursing to professional nursing practice is the American Nurses Association (ANA) Board of Directors instituted the Nursing’s Safety & Quality Initiative in 1994 (ANA, 1999).  According to the study from Quigley (2003), “a coordinated and comprehensive system for patient safety has not existed”. So, this have drawn the attention of many organizations to the need for the development and support of an integrated and comprehensive system that identifies and manages medical errors and rewards health care systems for positive outcomes. Nursing’s Safety & Quality Initiative gave direction to the study of the impact of these changes on safety and quality of patient care as well as nursing. National Database of Nursing-Sensitive Quality Indicators (NDNQI) created where this is the indicators that capture care or its outcomes most affected by nursing. The purpose of the NDNQI was to promote and facilitate the standardization of information submitted by hospitals across the United States on nursing quality and patient outcomes. Regarding to the study about the importance of patient safety there has been a convergence of thought among professional, private, and governmental health care decision makers that agree that patient safety will be a top priority agenda item for health care providers now and in the future. All groups have validated the demand for improvement in patient safety. So, when the patient safety become the priority in nursing practice it has the potential to decrease the risk of malpractice.

In Malaysia, nursing contribution is in the nursing knowledge and skill required to sustain the quality of care. In the past, the nurses in Malaysia only have certificate in nursing. But then, when they realize the importance of knowledge in nursing, nursing education improved to degree, where they learn theory and not only skill in nursing. This is to improve their quality of care and can practice based on evidence-based practice.

IN PRESENT DAYS

NETWORK TOPOLOGY

NETWORK TOPOLOGY

Hello guys! It's me Isma here , i'm back again after 1 week break from updating my blog😂 I hope you guys have a nice and beautiful day ,don't be stress for those who have less than 1 month to facing the PSPM 😕

Okay!So today I am going to share about Network Topology 🔰 

What is the definition of Network Topology ?

A network topology refers to the layout of the computers and devices in a communication.  (easy to memorise right ? ) 😏

What are of Network Topology ?

1. Physical topology - The arrangement of cabling , including the devices, location and cable                                         installation.

      2.Logical Topology - The path that data travels between computers on a network explained how                                             data is actually transferred in a network as opposed to its physical design.

Time for video 😍 

Opps sorry , check it by yourself using the link provided 😈😉  

    

http://study.com/academy/lesson/physical-logical-topology-definition-characteristics.html

What are types of Network Topology ?

1)STAR TOPOLOGY

What is the definition ?

All the computers and other nodes on the network connect to a central device,thus forming a star.

How the data send and receive ?

•    Use a central device where are nodes are connected using cables
•    Data that travels from one node to another passes through the hub or switch until reach             destination nodes.

What are the advantages using Star Topology ?

• Easy to install and maintain.
• If one node fails,only that node is affected.The other nodes continue operate normally.
• Easy to troubleshoot.

What are the disadvantages using Star Topology ? 

• Requires more cable.
• More expensive.
• If one hub or switch fails,the entire network will be inoperable until the device is repaired.

NEXT . . .

2)BUS TOPOLOGY

What it's physical ?

1. Consists of a single central cable(backbone), to which all computers and other devices connect
2. Each devices is connected to the backbone through T-Connecter.

How do its's work ? 

A signals are send as electrical pulse that travel along the cable to all nodes and only recipient accept data.

What are the advantages using Bus Topology ?

• Inexpensive and easy to install.
• Failure of one node usually does not affect the rest of the bus network
• Can be attached and detached at any point on the bus without disturbing the rest of the network.

What are the disadvantages using Bus Topology ?

• Difficult to identify the problem if the entire network failed/shutdown.
• If the backbone fails,the entire bus network will be affected.

NEXT...VIDEO...😏

.........OKAY LETS MOVE TO ANOTHER TYPES OF NETWORK TOPOLOGY 😔😆...

no video hmmm

3)RING TOPOLOGY

Explanation ?

A cable forms a closed loop(ring) with all computers and devices arranged along the ring.

How do it's work ?

Data travels from one node to another node in one direction until it reaches its destination by using token passing.

What are the advantages of using Ring Topology ?

• The transmission of data is relatively simple as packets travel in one direction only.
• Cable faults are easily located,making trouble-shooting easier.
• The uses of token passing enables all nodes in a ring topology to share the network resources fairly.

What are the disadvantages of using Ring Topology ?

• A failure in any cable or device breaks the loop and can take down the entire network.
• Data packets(token) must pass through every computer therefore,it makes it slower.
• Adding or removing nodes bring down the network temporary. 

So , thats all I want to share for today blog.I hope you guys can read through it and learn something 💗 Thankyou ! And stay tuned to the following blogs 💁

INTERNET

INTERNET

Hello guys! It's me Isma here.This is my first time doing blog.So I hope you all will be able to enjoy and get something to learn from my blog.

Today I want to share about Internet.This topic is quite interesting to talk about , even during my matriculation computer science's lecture , I am very interested to study about Internet in Network's chapter.

As we all know that Internet is an technology that we cannot deny about its addiction towards we , so do I.Internet is worldwide that helps we to connect with others and there are so many interesting and important about Internet! Let'e explore it together !

WHAT IS THE INTERNET ?

Internet is a worldwide collection of networks that links millions of businesses,government agencies,educational institutions and individual.

ARE WE TO ADDICT TO INTERNET ?

Yes I am !I am rather with my smartphone and sit for a whole day and connected to Internet for a whole year !*okay I'm just kidding . - It's not like that "addict" 😍

Let me share an offline story from Martin Mihajlov's research : 

As for anecdotal offline stories I can share some from my research. During their 1 week offline, all of the participants kept a physical paper diary of their activities. It is interesting to observe that they are generally OK in the first couple of days after which they genuinely start to miss being online. On their last day they are actually ecstatic as they know that their offline endeavour is about to end.

In his everyday life, a male participant generally indulges in online sport content. He avoids the Internet by going out as much as possible. From day 2 he starts playing soccer with his friends and successfully attempts to repeat this activity two more times during the rest of the week. He buys a newspaper to keep up to date with current sport content, although it is obvious it is yesterday’s news. When he can’t play sports, he watches TV. He finds that watching TV is awkward as he can’t really select the actual content he wants to watch, but is limited to what is currently being offered.

A female participants wants to know the name of a song. She can find another way to obtain this information and decides to wait it out. She also wants to check the weather and has to ponder a while before she realizes the information can be found in a newspaper. Instead of being online she watches previously downloaded series or movies. She misses Facebook, especially since some of her friends start calling her to ask whether she is alive and well due to her online absence. While she deals with the many situations where she needs to resist her online cravings she starts to wonder whether this is how alcoholics feel when they have to say NO to a glass of whiskey.

-How about we ? Can we be able to do like what they did ? Let's try for a once 😨😨

WHAT ARE THE ADVANTAGES OF INTERNET ?

• Allow users to communicate with each other across distance instantly at anytime and anywhere easily,low cost and save time.
• Information resources using search engine to find information on the web such as sport,politics,economic,education etc.
• Students at any levels can find the information regarding to their studies.

WHAT ARE THE DISADVANTAGES OF INTERNET ?

• Internet security issues where anyone can access and share the information.
• People can addicted too much on Internet and will cause health and social problems.
• Students in every level can easily buy essay,articles or academic papers and pass them off as their own.