What do you need to bear in mind if you have meningitis?

The risk of contracting meningitis increases if you come into close contact with someone who has it (if you sleep in the same room, live in the same house, kiss on the cheek, etc.), but there is no need to disinfect objects or areas because meningococcus bacteria do not live long outside of the human body.

The measures to prevent this illness are:

• Chemoprophylaxis (antibiotic treatment)
• Vaccination 

With meningitis, the appropriate measure is to administer antibiotics to the family and other people who live with the affected person.

If the illness was caused by meningococcal group B, the only preventive measure, and the most common in Spain,  is chemoprophylaxis, which aims to eliminate the microorganism from the pharynx. This stops it from spreading, in the space of a few days, between the people who have taken the medication.

If the illness was caused by meningococcal group C, as well as administering chemoprophylaxis, people close to the affected person will be vaccinated if they have not already been so.

If there is evidence that someone has had intimate contact with the patient in the ten days prior to the occurrence of the disease and they have not been administered chemoprophylaxis, healthcare staff must be informed.

What do you need to bear in mind if you take tuberculosis (TB) drugs or if you want to detect side effects early?

Currently, tuberculosis (TB) drugs are safe and effective, and the majority of people take them without any problems. In some cases side effects may appear, so it is important to follow the treatment plan under supervision and see a doctor in case of doubt.

Once treatment begins, and to make sure it has the desired result, follow the instructions below:

• Take medicine on an empty stomach (30 minutes before breakfast). 
• Do not take it alongside any antacids or gastric protectors. 
• If you are diabetic or have gout, tell your doctor. 
• The medication may cancel out the effect of hormonal contraceptives; where required, you will need to take other measures to avoid pregnancy. 
• Tell medical personnel about any other medication you may be taking. 
• Even if you feel better, continue treatment for the time indicated. If for any reason you are not able to take your medication, tell medical personnel beforehand. 
• The use of other medicines (cough medicine, antipyretics, natural remedies, etc.) may result in intolerances (digestive, kidney, etc.). It is important that you consult your doctor before taking any other medication. 
• Do not drink alcoholic drinks during treatment. 
• Use high factor sun cream when exposed to sunlight. 

Warnings 

Urine, faeces, sweat and tears may be red/orange in colour. This change is normal and will disappear when the treatment comes to an end.

Advise medical personnel if you have any of these symptoms

• Loss of appetite 
• Nausea 
• Diarrhoea 
• Abdominal pain 
• Gastric discomfort 
• Eyes or skin become pale 
• Joint pain or inflammation (knees, ankles, etc.) or significant
• skin outbreaks 
• Blurred vision or changes in perception of colours

What do you need to bear in mind if you have complex glomerular disease or you are caring for someone who does?

On the one hand, the function of the kidneys is to eliminate impurities from the body through the urine, and regulate the amount of liquid and chemical elements that we need, such as sodium, potassium, phosphorus or calcium. 

On the other hand, the kidneys also help in regulating blood pressure by activating vitamin D, which is required to maintain healthy bones, and producing erythropoietin, which is required to produce red blood cells in the bone marrow.

When the kidneys do not work properly, the impurities we generate and the water that the kidneys cannot eliminate accumulates in the blood and the tissues, and this causes major disruptions to the patient’s general health, fluid retention and hypertension. They are also unable to properly get rid of some medications we take, which can accumulated in the body, increasing the risk of side effects. 

As the kidneys are unable to help make vitamin D, or to retain phosphorous,  the bones are weakened. The kidneys are also unable to produce erythropoietin and therefore anaemia appears.

The main types of renal replacement therapy are:

• Haemodialysis
• Peritoneal dialysis
• Kidney transplant

Where patients will not benefit from renal replacement therapy,  conservative treatment will be carried out, aimed at controlling the different disorders and symptoms that appear during evolution of the illness.

The majority of cases of glomerulonephritis cannot be prevented, although a healthy lifestyle is advised, as promoted by the Spanish National Health System:

• Keep glycaemia levels (blood sugar) and blood pressure within normal range.
• Avoid toxic habits
• Do moderate physical exercise
• Avoid obesity

In addition, the application of dietary and pharmacological measures can help prevent or decrease the progression of the illness:

Dietary measures that should be taken

Maintain a balanced diet and limit:

• Salt. As substitutes, the following items can be used to eliminate or reduce consumption:
  • Use vegetables as seasoning: celery, garlic, leek, onion, tomato, carrot.
  • Add aromatic herbs and spices: if the herb is dry, it is better to add it towards the end of cooking, as this will make the most of its flavour.
  • Flavour oil.

• Potassium. Part of the potassium in food can be removed by:
  • Water: once peeled and cut, soak foods. The longer foods are soaked for and the smaller the pieces, the more potassium will be lost. They can also be washed several times, changing water.
  • Boiling: boiling foods removes potassium, as it stays in the water. You should therefore avoid consuming cooking water. It is better to change water after 10-15 minutes of boiling foods, adding clean boiling water.
  • Frozen foods: frozen vegetables and legumes have less potassium than fresh ones, although they retain many of their other properties.
  • Preserved food: when food is preserved in liquid, the potassium remains in the liquid and the food contains less. This liquid should be poured away.

• Proteins. Although proteins are required for repairing and creating cells and tissues, as well as for the proper functioning of the immune system:
  • Dried fruits and nuts are not recommended as they have a high potassium content.

• Fluids. Fluid intake should be adjusted to each particular case:
  • Reducing the sensation of thirst.
  • Drinking only when thirsty and drinking small amounts.
  • Not getting into the habit of drinking.
  • Taking medication with the liquids in meals and using the smallest amount possible.
  • Using citrus slices to stimulate salivation and moisten the mouth.
  • Adding a few drops of vinegar to water.
  • Chewing sugar free gum.
  • Adding a few drops of lemon juice to ice cubes before putting them in the freezer.
  • Freezing fruit pieces.
  • Reducing the intake of drinks such as coke, orange juice, etc., and replacing them with ice tea and homemade lemonade.
  • Avoiding alcohol.

Pharmacological measures that should be taken

• Patients many need to take the same medications as patients undergoing dialysis. Some drugs may include:
  • Hypotensors: drugs to reduce blood pressure (angiotension converting enzyme [ACE] inhibitors or angiotension receptor blockers [ACB]).
  • Corticosteroids: better known as steroids, these are anti-inflammatory medications.
  • Immunosuppressants: drugs that inhibit the immune system.

• Medication that helps patients to alleviate the symptoms,  such as itching, pain, etc., may also be taken.

• Other measures may also be adopted, such as:
  • Avoid consuming nonsteroidal anti-inflammatory drugs (NSAIDs).
  • Avoid contact with organic solvents and polluting substances, such as mercury.

Other related health information

• Looking after the peritoneal dialysis (PD) incision and catheter.
• Looking after a tunnelled central venous catheter (CVC)
• Looking after an arteriovenous fistula (AVF)
• Training and health education for patients and carers in PD treatment.
• Recommendations on discharge for patients with nephritic syndrome
• Advice for patients undergoing immunosuppressive therapy 

What should you bear in mind if you have lupus and you have been hospitalised?

Patients with lupus who have been hospitalised should bear in mind a series of indications when it comes to re-establishing their normal routine:

• Skin protection: it is advisable to protect your skin from exposure to sunlight, especially in summer, using high factor sun creams and hats to cover your head. If you have any skin lesions, you should let a doctor know.
• Joints: a level of physical activity suited to the physical ability of each patient should be maintained (walking, swimming, yoga, tai chi, etc.)
• Kidneys: follow a diet low in salt (reducing the amount of salt in meals as well as avoiding cured foods, tinned foods, salty snacks, etc.)
• Leisure activities: do activities that allow you to maintain an active social life and, if you find yourself getting tired, plan them so that they are spaced out a bit more.

You must always take medication as prescribed by medical personnel and see your doctor if you get any of the following symptoms:

• Fever (temperature > 38 ºC)
• Swollen legs or feet
• High blood pressure
• Increased heart rate when resting
• Difficulty breathing
• Joint pain
• Problems with your vision
• Depressed mood 

What do you need to bear in mind if you have resistant osteoarticular infections?

When the patient is discharged, nursing staff will give them all the support and information they need to be able to look after the wound themselves. Most patients will be fitted with an external fixator that needs daily care, so healthcare staff will emphasise the importance of hygiene in the affected area, which should be cleaned daily and the correct dressing applied.

If patients are not independent and do not have a relative or carer to look after them, the local health authority will be contacted (through the PREALT discharge preparation unit), so that they may be provided with nursing care. If patients are being treated with intravenous medication, the Hospital at Home Unit will be contacted to follow up and provide the relevant treatment.

It is also necessary to explain the importance of taking the medication prescribed. On being discharged, most patients will receive long-term oral antibiotics (prescribed by the Infectious Diseases Unit) and they are reminded of the importance of maintaining a fixed schedule and not forgetting to take their medication.

They are also reminded of the need to maintain healthy habits, such as:

• Being well hydrated
• Eating properly (protein-based diet)
• Stopping toxic habits (should they have any), such as alcohol and tobacco

What do you need to bear in mind to prevent Zika virus?

The advice to prevent infection with Zika virus is particularly aimed at pregnant women or those thinking of becoming pregnant in the short to medium term. The possibility of transmitting the infection to the foetus means that pregnant women are the most vulnerable group. For this reason, you are advised to:

• Avoid travelling to countries where there is a risk of being infected while you are pregnant.
• Inform a healthcare professional if you have already travelled to any the affected areas.
• Use a condom for the entire pregnancy if your sexual partner has travelled to countries affected by Zika virus.

Mosquito bite prevention

• Dress in clothes that cover most of your body and wear a hat all day to protect your skin as much as possible from exposure to mosquitoes.
• Use authorised repellents, following the manufacturer’s instructions for their use and reapplication indicated on the product.
• Avoid being outside unnecessarily during the most active times of day for mosquitoes (first thing in the morning and late afternoon).
• Sleep in air conditioned accommodation, as mosquitoes tend to avoid the cold, or place mosquito nets around the bed, doors and windows.

Mosquito proliferation prevention

Another way of preventing mosquito bites is to avoid proliferation of mosquitoes, which you can do by finding out and periodically checking the areas where these insects reproduce. Once breeding points are located, the measures should focus, as appropriate, on:

• Avoiding and/or draining any accumulation of water there may be in the subsoil of accommodation.
• Emptying or covering objects that may accumulate water.
• Emptying or refreshing water weekly in the case of fixed objects or containers that may accumulate water and covering, with a lid or mosquito screen, those that cannot be emptied.
• Keeping swimming pools, ponds and other bodies of water in correct hygiene conditions.

What do you need to bear in mind if you have acute bronchiolitis?

Acute bronchiolitis is a respiratory tract infection common in infants under two. This infection, caused by RSV, manifests itself in mild or moderate catarrhal symptoms, although if it is not treated, it may progress and cause serious bronchiolitis or pneumonia.

The symptoms of acute bronchiolitis may vary depending on the patient’s age:

• In adults and the majority of healthy infants: upper respiratory symptoms (rhinitis, mild cough, minor wheezing)
• In breastfeeding and premature babies: normally, lower respiratory symptoms (bronchiolitis, pneumonia)

This virus may be transmitted in two ways:

• Directly: through contact with secretions from an infected individual (wet mode)
• Indirectly: through contact with surfaces, such as furniture (for example, those that have been exposed to infectious secretions)

The preventive measures to avoid transmission of the virus are:

• Hand hygiene: hands should be washed before touching the child.
• Toys should be cleaned, especially after having been used by other infected children or adults.
• Personal utensils (plates and feeding bottles) should be washed properly and specific utensils used for the infant that are different to those used by adults.
• (Paper) disposable tissues should be used and immediately disposed of (not re-used).
• Physical contact with the infant should be avoided by people with respiratory symptoms or fever. Infection can be avoided if a distance of 1.8 m is maintained from the person with symptoms.
• Enclosed environments and crowds should be avoided.
• Avoid exposure to tobacco smoke.
• Breastfeeding should be encouraged, as it protects against infections.

Admission to hospital is more likely in infants belonging to high risk groups:

• Children born premature
• Children with chronic pulmonary illnesses
• Children with congenital heart disease

In the above cases, administering prophylaxis with palivizumab is recommended, as it is proven to reduce hospital admissions for RSV.

Palivizumab

• Palivizumab is a passive immunisation that prevents infections due to RSV (it is not a vaccine).
• It does not normally have adverse effects and it does not interfere with the vaccination schedule.
• Care must be taken to ensure that the doses are correctly given, since each dose last approximately 30 days.
• It must be administered by a healthcare professional in a hospital clinic (it cannot be administered in a primary care centre).
• The dose given will depend on the child’s weight, and will be administered once a month during an epidemic period (five doses in total) and by intramuscular injection to the face and/or outside thigh.

What do you need to bear in mind if you have sarcoma or other musculoskeletal tumours or you are caring for someone who does?

It is important to follow a series of advice related to lifestyle and treatment. The most important advice is:

• Diet and hydration: follow a healthy and balanced diet, ensuring it includes the necessary foods, proteins and calories.
• Control over passing urine and faeces: there is a tendency to constipation caused by pain medication (morphine or derivatives), which is why a diet rich in fibre is recommended.
• Unhealthy habits: avoid habits such as smoking, drinking or taking other toxins.
• Hydration and skin awareness: the skin normally becomes very delicate and deteriorates due to the effects of aggressive treatment.
• Control of post-surgical wounds: wash using less aggressive soaps and keep your skin well hydrated.
• Side effects (localised and systemic) of medication: watch for and avoid effects such as nausea, vomiting, diarrhoea, skin peeling, itchy skin, etc.).
• Education and keeping extremities mobile: sometimes there are cases of amputation and phantom limb syndrome.
• Maximum empowerment of the patient’s independence in the new situation and provide the necessary tools: crutches, walkers, wheelchairs, etc.
• Pain management: medication, relaxation techniques, breathing control, mobility techniques and energy saving.
• Education in injury and fall prevention: wearing appropriate footwear, adapting the home (removing barriers), walking safely, wearing comfortable clothing, etc.
• Infection control: keep an eye on temperature and symptoms. It is worth remembering that this is an immunosuppressant condition.
• Insistence on the importance of oral hygiene.
• Information and assessment of correctly taking medication.
• Vigilance and control of port-a-cath, if the patient has one.
• Sleeping at night and resting during the day to enable proper rest at night time.
• More direct professional support for the patient, their family or carer: necessary, adequate and understandable information should be provided about the illness and treatment. Support must be provided in paper format and other types of professionals can also give their support.
• Respect the patient’s independence and the decisions they make.
• Information about patient’s wishes.

Recommendations

To contribute to the welfare of patients with psoriasis, it is important that they are aware of a series of tips and recommendations:

• Correct application of treatments:

  • Topical, systemic and phototherapy.
  • It is important to follow the treatment prescribed.

• Treatment:

  • The patient should be aware that treatment might not always be effective and there are other alternatives, on an individual basis.

• Hygiene for patients with psoriasis:

  • Avoid aggressive gels or shampoos.  
  • Eliminate sponges from your personal hygiene routine.
  • Apply moisturisers as usual.  
  • Skin treatments should be used daily.

• Scalp treatment:

  • It is important to wet hair with warm water.
  • Shampoos with a pH between 4 and 4.5 are recommended.

• Factors that should be avoided:

  • To keep this illness under control and reduce symptoms:
    • Follow a balanced diet, rich in fresh food, keeping saturated animal fats in check and eating plenty of foods containing antioxidants.  
    • Avoid toxic products as much as possible (alcohol, tobacco and other drugs).
    • Avoid stress and learn to live with the illness: both of these are important factors in controlling psoriasis outbreaks.

• Infection control:

  • Any type of infection must be treated from the onset.

• Healthy habits:

  • Skin wounds or lesions reduce the body’s ability  to face external aggressions and worsen the symptoms of psoriasis.
  • You should be careful not to put on weight.
  • Traumas and injuries, along with aesthetic aggressions to the skin, may worsen the state of psoriasis plaques.
  • You should avoid wearing very tight clothes and rapid temperature changes.

• Exposure to sunlight:

  • A brief period of exposure to sunlight may be beneficial for psoriasis. However, always avoid burns and use adequate protection.
  • Avoid exposure to sunlight between 12 noon and 4 pm.

• Psychological effects:

  • Self-esteem and self perception should be dealt with on an individual basis with each patient.

• Evolution of the illness:

  • Concomitant and co-morbid illnesses (arterial hypertension, obesity and arthritis) are common. These will also need to be treated and the patient will need to know how to avoid them. 

What do you need to bear in mind to prevent Ebola virus?

Although there is currently no commercially available vaccine against the virus, the results of studies conducted so far show that the vaccine could be very effective. In Spain the risk of infection is very low, but: 

• Try not to travel to affected countries.
• Should you find yourself in one of these countries, avoid trips to affected areas. 

If you find yourself in an area affected by Ebola virus:

• Avoid direct contact with blood or bodily fluids from a patient or a corpse, and with objects that may be contaminated.
• Reduce contact with wild animals and do not eat raw meat.
• Wash your hands regularly.
• Avoid having unprotected sex.

If you travel to one of the affected areas and a few weeks after your return you notice the following symptoms, you need to seek medical attention urgently and tell the doctor about the trip:

• Fever
• Tiredness for an unknown reason
• Diarrhoea
• Other serious symptoms