Encyclopedia of Family Medicine

Chapter 46 Prevention of Common Diseases (7)
General care for pyelonephritis includes:

1.Rest: Fatigue is a common cause of urinary tract infection. Patients with acute urinary tract infection should not get out of bed until their body temperature is normal, and a comfortable and quiet environment for rest should be created.

2.Diet: It is advisable to give foods rich in protein and vitamins to improve the body's disease resistance.

3.Drink plenty of water and urinate frequently.Encourage the patient to drink water and instruct the patient to urinate regularly (every two hours) to facilitate flushing of urinary tract bacteria and excretion of bacterial toxins.

4．保持外阴清洁。每天用温水或1：200新洁尔灭洗外阴部1~2次。

5.When renal function is impaired, a low-protein diet should be used; if edema and high blood pressure occur, water and salt intake should be limited, and skin care should be strengthened.

6.Accurately record the 24-hour intake and output, and measure blood pressure regularly to observe whether the patient has renal insufficiency such as polyuria, oliguria, and high blood pressure.

7.Avoid catheterization as much as possible to prevent new bacterial infections.

arteriosclerosis obliterans

This disease is a disease caused by chronic narrowing or occlusion of peripheral arteries due to atherosclerotic lesions.Mainly involving the large and medium-sized arteries of the lower extremities.

The common symptom of this disease is intermittent claudication, which is most common in the gastrocnemius muscle. There is pain when walking, and even causes spasm. It disappears after rest, and reappears when walking again.

Pain at rest is another important symptom, indicating increased ischemia in the lower extremities, resulting in insufficient blood supply to the skin.The pain is often aggravated when the limb is raised and relieved when the limb is lowered.The pain is more severe at night, and patients often sit with their feet hugged, and the pain is abnormal.

Other symptoms include coolness, numbness, paresthesias, and changes in skin color in the affected limb.

On physical examination, the arterial pulse distal to the occlusion can be found to be weakened or absent.Another important inspection is to auscultate the abdominal aorta and peripheral arteries. If there are systolic murmurs or continuous murmurs, it is helpful for the diagnosis of the disease and the determination of the stenosis.

Patients should quit smoking completely, exercise properly, exercise until pain occurs, and rest adequately after exercise until the pain completely disappears.Take care to protect the limbs, keep the skin clean, dry, moist, keep warm and prevent trauma.

Henoch-Schonlein purpura

The disease is a relatively common capillary wall allergic bleeding disease.The main lesion is increased permeability and fragility of small arteries and capillaries, causing spontaneous bleeding of skin and mucous membranes, often accompanied by varying degrees of gastrointestinal, joint and kidney involvement.

The disease is more common in children and adolescents, more males than females, and is more common in spring and autumn.The onset can be acute or slow, and there is often a history of upper respiratory tract infection 1 to 3 weeks before the onset.Early symptoms include fever, fatigue, general malaise and loss of appetite.Followed by skin purpura, a few may have gastrointestinal, joint or renal involvement performance.Depending on the location of the lesion, there may be different clinical manifestations, which are usually divided into five types:
1.Skin purpura type: the most common, manifested as skin petechiae, purpura and erythema of different sizes, especially on the outside of the lower limbs and near the joints.Symmetrical distribution, higher than the skin surface, some patients may be accompanied by urticaria, angioedema and erythema multiforme.

2.Abdominal type: It is more common in children. Before or after the appearance of purpura, it is episodic abdominal cramps, accompanied by nausea, vomiting, and blood in the stool, without abdominal muscle tension and rebound tenderness.Intestinal necrosis combined with intestinal perforation or rupture is rare.

3.Joint type: mostly occurs in the knee, ankle, elbow, wrist and other joints, and may have pain, swelling, and mobility impairment.It can be single or multiple, it can be migratory, and there is effusion.No sequelae after recovery.

4.Renal type: more common in children, with gross or microscopic hematuria, proteinuria, and casts.Often have edema, high blood pressure and other symptoms.

5.Mixed type: It has the characteristics of more than two types.

The general treatments for borderline purpura include:

1.Psychological care: Tell patients not to eat allergenic foods and avoid contact with suspicious related allergens.

2.When the patient has abdominal pain, blood in the stool, joint swelling and pain, or kidney damage, he should rest in bed to prevent internal and external trauma of the body from bleeding.Give a high-vitamin, low-salt, easy-to-digest diet. If there is blood in the stool, give a cold-flow juice diet. At the beginning of the disease, animal-based protein diets, such as milk, fish and shrimp, etc. should be temporarily prohibited; pay attention to clean skin, avoid wear and tear, and prevent pressure , The bed should be clean and smooth, and 1% gentian violet should be applied to the damaged herpes to prevent infection.

3.Pay attention to the changes in the location, quantity, and character of the patient's purpura, as well as the relationship with the type of diet and drugs.Pay attention to gastrointestinal symptoms, such as the location, nature, degree of abdominal pain and the presence or absence of abdominal distension, diarrhea, stool frequency, character, color, smell, etc., and pay attention to changes in urine color and urine volume.

Hyperthyroidism
This disease is a group of endocrine diseases caused by excessive secretion of thyroid hormone caused by various reasons.

The disease is more common in women.

Typical hyperthyroid patients have symptoms and signs such as palpitations, chest tightness, heat intolerance, sweating, hand tremors, insomnia, hyperphagia, weight loss, fatigue, diarrhea, goiter with vascular murmurs, tremors, and exophthalmos.

1.Psychological care: Patients with hyperthyroidism often have symptoms such as anxiety, impatience, and irritability. They should be considerate to the patient, have a kind attitude, and give spiritual comfort.

2.Life: Keep the environment quiet and ventilated, without strong light stimulation, avoid adverse environmental stimulation, pay attention to proper rest, avoid strenuous activities, avoid fatigue, mental tension and emotional agitation, and give sedatives such as diazepam if necessary.

3.Diet: Increase nutrition, choose a high-calorie, high-protein, high-vitamin diet, and prohibit stimulating drinks such as strong tea and coffee.

Hypoadrenal function

The disease is divided into acute and chronic categories.Clinically, there are a series of manifestations such as fatigue, weakness, pigmentation, low blood pressure, abnormal water and salt metabolism, and gastrointestinal dysfunction.

The onset is slow, more common in adults, and various clinical manifestations are mainly due to insufficient secretion of cortisol and aldosterone.

1.Pigmentation of the skin and mucous membranes: it is seen in most patients and is one of the early symptoms of the disease.

2.Fatigue and weight loss: Fatigue is one of the early symptoms of the disease, manifested as lack of concentration, lack of energy, lack of physical strength, fat loss, muscle wasting, weight loss, and mostly progressive aggravation.

3.Circulatory Symptoms: Characterized by low blood pressure, a very small heart, or circulatory collapse.Patients often have dizziness, vertigo, orthostatic syncope.

4.Hypoglycemia: patients with fasting blood sugar are often lower than normal, often before meals or after strenuous exercise, prone to hypoglycemia symptoms such as hunger, heart palpitations, cold sweat and fatigue, blurred vision, diplopia, mental disorders, and even coma in severe cases.

5.Gastrointestinal symptoms: due to decreased secretion of various digestive enzymes and digestive juices, loss of appetite, indigestion, often nausea and vomiting, occasional abdominal pain, and sometimes diarrhea or constipation.

6.Neuropsychiatric symptoms: mental atrophy, memory loss, dizziness, apathy, drowsiness, or irritability, insomnia, and even delirium or mental disorders.

7.Decreased renal function: increased nocturia, weakened ability to excrete water load, dilutional hyponatremia and polyuria may occur after drinking a lot of water.

8.Reproductive system symptoms: women may have menstrual disorders or amenorrhea, pubic hair, armpit hair loss, sparse.Male sexual dysfunction.

9.Decreased resistance: When encountering some kind of stress, such as infection, pain, fatigue, surgery, etc., it is prone to confusion, blood pressure drop, and acute adrenal insufficiency crisis induced in severe cases.

10.Adrenal crisis: It is manifested as a sharp exacerbation of the original symptoms of the disease, including high fever, vomiting, abdominal pain, diarrhea, dehydration, lower blood pressure, increased heart rate, weak pulse, and a state of peripheral circulatory failure; confusion and even coma.There may be hypoglycemia, hyponatremia, high, normal or low blood potassium, and timely rescue is required.

Diabetes mellitus

Diabetes is an absolute or relative lack of insulin in the blood, resulting in hyperglycemia and diabetes, which in turn causes fat and protein metabolism disorders, typically manifested as polyuria, polydipsia, polyphagia, weight loss, and fatigue.Severe cases are prone to acute complications such as ketoacidosis or chronic complications such as blood vessels and nerves.

Insulin-dependent type (type I, IDDM): This type is more common in childhood, with a more acute onset and a serious condition, and insulin therapy must be used. If insulin is not used or stopped, the condition progresses rapidly and is prone to ketoacidosis and other serious diseases. complication.

Non-insulin-dependent type (type II, NIDDM): This type is more common in adults, with slower onset and milder disease. Most patients only need diet control or oral hypoglycemic drugs.Few require insulin.

1.Psychological Nursing: Diabetes is a chronic disease that requires long-term treatment. It is necessary for patients to build confidence, treat the disease correctly, and actively cooperate with treatment.

2.Diet management should be implemented strictly and for a long time. The total calorie and nutrient content of the diet must meet the physiological needs, and the meals should be regular and quantitative to facilitate blood sugar control.

3.Learn to measure urine sugar. Generally speaking, the higher the blood sugar, the more urine output, and the more urine sugar.Diabetics have poor resistance and are prone to infection and skin damage. They should be treated in time and should be prevented and treated.

gout
Gout is a group of heterogeneous diseases caused by long-term purine metabolism disorders and increased blood uric acid causing tissue damage. The clinical features are: hyperuricemia, characteristic acute arthritis recurrent attacks, and sodium urate crystals can be found in the white blood cells of the synovial fluid of the joints. , Tophi is formed, and its severe cases can lead to joint movement disorders and deformities, renal uric acid stones and gouty renal parenchymal lesions.

Most of the onset of primary gout is over 40 years old, and there is often a family history.

1.Asymptomatic period: Only the blood uric acid continues to increase or fluctuates.

2.Acute arthritis stage: The patient often has a sudden onset at midnight and wakes up with a start every time due to pain.At the beginning, it was monoarticular inflammation, with the hallux and the first metatarsophalangeal joint being the most common, followed by other toe joints and tarsal ankle, heel, knee, wrist, finger, elbow and other joints, occasionally bilateral simultaneously or successively. Can develop polyarthritis.

The joints are red, swollen, hot and painful, and their activities are limited. When large joints are involved, there may be joint effusion.There may be fever, increased white blood cell count, and increased erythrocyte sedimentation rate.Generally, after 1 to 2 days, or up to a few weeks, it can be relieved naturally, and the joint function will recover.At this time, desquamation and itching may appear on the local skin of the affected joints, which are the unique symptoms of this disease.

3.Chronic arthritis stage: multiple joints are involved, the attacks are more frequent, the interval is shortened, the pain is getting worse day by day, even the pain is not completely relieved after the attack.Tophi is a common manifestation in this period. Generally, it is easy to see the helix, antihelix, metatarsophalangeal, interphalangeal and metacarpophalangeal of the outer ear. Joint deformity is manifested as joint swelling centered on bone defect, with no definite shape And asymmetrical.

4.Kidney stones: The incidence of kidney uric acid stones in gout patients is 10% to 25%.

5.Nephropathy: It is caused by the precipitation of urate in the renal interstitial tissue. The disease is chronic. The patient has intermittent proteinuria, hypertension, and elevated blood urea nitrogen. In the late stage, renal insufficiency develops.Some patients have nephropathy as the first clinical manifestation without arthritis symptoms.

General care for gout includes:

1.In the acute phase, absolute bed rest should be exercised, and the affected limb should be elevated to avoid weight bearing on the affected joint.

2.Adjust your diet to prevent obesity.It is encouraged to drink more water, and alkaline drugs should be taken, and drugs that inhibit the excretion of uric acid should not be used.

hypercortisolism
The disease, also known as Cushing's syndrome, is caused by excessive secretion of glucocorticoids (mainly cortisol) by the adrenal cortex.The main clinical manifestations are full moon face, sanguine appearance, central obesity, purple skin, acne, high blood pressure and osteoporosis.The cause may be excess adrenocorticotropic hormone (ACTH) or adrenal gland disease.

The clinical manifestations of this disease are mainly due to excessive secretion of cortisol, resulting in metabolic disorders and reduced resistance to infection.

1.Dyslipidemia: Facial and truncal obesity (central obesity) is characteristic of the disorder.The patient's face is like a full moon, and the fat in the chest, abdomen, neck, and back is very thick. In the late stage of the disease, the limbs appear relatively thin, which is in obvious contrast to the obesity of the face and trunk.

2.Disorders of protein metabolism: A large amount of cortisol promotes protein breakdown and inhibits protein synthesis.There are many clinical manifestations of excessive protein consumption: skin becomes thin, capillary fragility increases, and minor damage can cause ecchymosis.Patients with a long course of disease have muscle atrophy, osteoporosis, compression deformities of the spine, short stature, and sometimes rickets, prone to fractures, and often susceptible to infection, and the growth and development of children with patients is inhibited.

3.Glucose metabolism disorder: a large amount of cortisol inhibits sugar utilization and promotes hepatic gluconeogenesis.The patient's sugar content decreased, and some patients developed steroid diabetes.

4.Electrolyte disturbance: A large amount of cortisol can retain sodium and excrete potassium.

5.Hypertension: Long-term hypertension can be complicated by left ventricular hypertrophy, heart failure and cerebrovascular accident.

6.The resistance to infection is weakened, and the long-term increase in cortisol secretion weakens the immune function of the human body. After the patient suffers from infection, the inflammatory response is often not significant, the fever is not high, and it is easy to miss the diagnosis and cause serious consequences.

7.Changes in the hematopoietic system and blood. Cortisol stimulates the bone marrow, which increases the red blood cell count and hemoglobin content. In addition, the patient's skin becomes thinner, so the face is bloody.The total number of white blood cells and neutrophils increased.

8.Sexual dysfunction: Menstrual reduction, irregular or cessation of menstruation, mild hirsutism, common acne in women; rare in men, but if it occurs, be alert to adrenal cancer.Male libido can decrease, the penis shrinks, and the testicles soften.

9.Nervous and mental disorders: such as emotional instability, irritability, insomnia, severe psychosis, and individual paranoia.

10.Hyperpigmentation of the skin.

acute bacterial cystitis
The incidence of this disease in women is significantly higher than that in men. The female urethra is shorter and straight, the outer opening of the urethra is more wrinkled, and bacteria often exist. Sexual intercourse, use of diapers, and catheterization can easily lead to ascending infections.In men, the disease is often secondary to acute prostatitis, prostatic hypertrophy or urethral stricture, stones, and renal colic infection.

The onset of the disease is acute, with sudden frequent urination, and in severe cases, urination is usually every 10 minutes.There is obvious urgency and dysuria, burning pain in the urethra and bladder area when urinating, and still feel that the urine is not finished after emptying.There are varying degrees of hematuria and pyuria.There is tenderness in the bladder area.Systemic symptoms are not obvious.

Patients should generally drink plenty of water and take sodium bicarbonate orally to alkalize the urine and reduce irritation to the urinary tract.Use hot compresses on the bladder area, hot water sitz baths, etc. to relieve bladder spasms and relieve symptoms such as frequent urination, urgency, and painful urination.For antibacterial treatment, co-trimoxazole, norfloxacin, furantidine, ampicillin, etc. can be used.Even if the symptoms disappear, the drug should be continued for 7-14 days to avoid recurrence, or even protracted healing, forming chronic bacterial cystitis.

acute epididymitis
More secondary to prostatitis, seminal vesiculitis and posterior urethritis.Bacteria retrograde through the vas deferens to the epididymis.

Sudden pain in the scrotum, which radiates to the lower abdomen and perineum along the spermatic cord.The epididymis is enlarged, and the spermatic cord can be thickened at the same time.Have a high fever.Orchitis may be complicated by testicular enlargement, resulting in unclear boundary between testis and epididymis, and exacerbation of swelling and pain.May be accompanied by urinary tract irritation.

The patient rested in bed, held up the scrotum, and relieved the pain.Early cold compress, followed by hot compress, can be closed and antibiotic therapy at the same time.In severe cases, the formation of abscess should be incised and drained, and attention should be paid to maintaining smooth drainage.

Benign prostatic hyperplasia

A common disease in older men.

1.frequent urination.The early symptom of benign prostatic hyperplasia is frequent urination, which is more obvious at night.

2.Difficulty urinating.It is manifested as weak urination, slow urine flow, thinning urine line, dribbling after urination, and even filling incontinence.Suffering from cold, fatigue, drinking and other incentives can cause congestion and edema of the prostate and bladder neck, and the patient cannot urinate suddenly, resulting in acute urinary retention.This complication can occur at any stage of the disease.

In recent years, radio frequency or microwaves have been used to treat benign prostatic hyperplasia and have achieved certain results.In severe cases, acute urinary retention and renal dysfunction occur repeatedly, and surgery should be performed as soon as possible.

Joint dislocation
Joint dislocation (also known as dislocation) refers to the loss of the normal apposition of the articular surfaces of the bones that make up the joint, resulting in joint dysfunction. Common joints prone to dislocation: elbow joint, shoulder joint, hip joint, and mandibular joint.

Joint dislocation usually has a history of trauma, with local manifestations such as pain, swelling, ecchymosis, and loss of joint function.The characteristic signs of dislocation are deformity, elastic fixation, and hollow glenoid.

X-ray film examination can clarify the direction and degree of dislocation, and whether there are changes such as combined fractures.

1.The treatment of joint dislocation mainly involves reduction and fixation.Nursing should be carried out according to different stages. In the early stage, if the pain is obvious, anti-inflammatory painkillers should be applied locally, and joint activities should be strictly limited.

2.After the fixation is released, local hot compress, physical therapy, acupuncture, massage and massage should be applied to gradually increase joint activities to prevent soft tissue adhesion.

3.Strengthen joint function exercises to improve local blood circulation, eliminate swelling, prevent limb muscle atrophy and joint stiffness.Avoid pulling the wrench forcefully, which may cause joint damage.

Chronic injury of the locomotor system

1. Stenosing tenosynovitis
Due to the long-term repeated friction of the tendon in the sheath, the synovial membrane and fibrous sheath may have aseptic inflammation such as hyperemia, exudation, edema, and proliferation.Common sites are the radial styloid tendon sheath and the flexor digitorum tendon sheath.

Stenosing tenosynovitis of the radial styloid process is characterized by pain in the radial styloid process, which can radiate to the forearm and thumb, with local swelling and tenderness, and sometimes small nodules can be palpated.

Stenosing tenosynovitis of the finger flexor tendons of the hands is common in the thumb, middle, and ring fingers. The symptoms are soreness and snapping pain on the palm side of the finger joints, and ineffective flexion and extension of the fingers.

2.Ganglion cyst

The onset is related to chronic strain and mucous changes.

The disease is mostly female, and it occurs in the dorsum of the wrist, the dorsum of the foot, and the radial side of the palmar surface of the wrist. It is generally painless.The cyst is a hemispherical mass ranging from a pea to the head of the thumb, with a smooth, elastic surface, no adhesion to the skin, and a fixed base.

3. Bursitis

Bursitis can be caused by injury, chemical irritation, suppurative infection, tuberculosis, rheumatoid, gout and other diseases.

The local lesion was slightly distended and painful, and the pain was aggravated when squeezed, and the bursa was round to form an oval mass.

General care for chronic injuries of the locomotor system includes:

1.Care of chronic injuries of the motor system should first reduce local weight-bearing or compression.

2.Local hot compresses relieve pain.

Conjunctivopathy

1.Conjunctivitis
According to different etiologies, conjunctivitis is generally divided into four categories: bacterial, viral, allergic and trachoma.

(1) Bacterial conjunctivitis
The most common is acute catarrhal conjunctivitis, commonly known as pink eye.The most common bacteria were Koch-Weeks bacilli, pneumococci, and staphylococci.Acute onset, often involving both eyes, is contagious.Manifested as eye itching, foreign body sensation and burning sensation, without visual disturbance.Conjunctival hyperemia may have edema and hemorrhage points, mainly in the conjunctiva of the face and fornix.The secretion is mucopurulent, and the amount is large. It can stick to the eyelids and eyelashes at night, and the eyes cannot be opened in the morning.

The patient frequently drips antibiotic eye drops during the day, and applies antibiotic eye ointment before going to bed.Do not apply heat to the affected eye and do not cover it.

(End of this chapter)