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 

What do you need to bear in mind if you have diabetic foot?

The complications of diabetes mellitus with high blood sugar and/or poor metabolic control may end up causing injuries to small vessels, such as diabetic retinopathy and diabetic nephropathy, or large vessels, such as diabetic arteriopathy.

This affectation also extends to protective sensitivity to injuries, and causes signs of peripheral nerve damage. It may present as sensory, motor or autonomic nerve damage.

The most frequent form is sensory/motor and one of the serious complications is Charcot foot and ankle. The combination of nerve and artery damage with foot infection may be considered a serious complication.

Although it may start more severely, the main symptoms of diabetes are:

• Being very thirsty
• Being very hungry
• Needing to urinate a lot

And the symptoms that may indicate the beginning of diabetic foot are:

• Loss of feeling in the feet
• Pain at night
• Intolerance to bed sheet friction  
• Dry skin that may lead to cracking
• Changes in the points of support on the feet
• Appearance of hard skin and ulcers that may lead to amputation

Epidemiological data

Around 15% of patients diagnosed with diabetes get diabetic foot. Between 40% and 50% of diabetics will have an ulcer and 20% will need an amputation. More than 50% of non-traumatic leg amputations are performed in diabetics.

Diagnosis (normal general tests)

Clinical, analytical and screen for early detection.

Treatment (general)

Depending on symptoms and preventive.

Prevention

Prevention of diabetic foot includes good metabolic control alongside a healthy lifestyle and professional foot care

What do you need to bear in mind if you need periacetabular osteotomy surgery?

In the months running up to the operation patients are advised to follow an iron-rich diet. In addition, three doses of intravenous iron will be administered and, in some cases, a dose of erythropoietin glycoprotein to stimulate the production of red blood cells.

So that patients are able to be independent, they will be taught to walk with no pressure (without putting weight on the operated leg) and with partial pressure (only putting weight on the tips of their toes) using crutches so that they can walk on their own.

After the operation, patients will have their blood pressure, heart rate and temperature monitored, and they will have a finger prick done to check for anaemia.

Where possible, younger patients will not be given blood transfusions. By correctly tolerating low haemoglobin levels, this patient group is able to more easily trigger the body’s physiological mechanisms without complications to try to compensate for the blood lost during surgery. For this reason it is very important to rigorously monitor vital signs.

Once in the hospital, the person and their family should be informed about the exercises to be performed:

• Maintenance of the anti-rotation leg box, if required.
• Internal rotation exercises.
• Attempt to sit up on their own 24 hours after surgery.
• Doing mobility exercises with a pillow between their legs for the patient’s comfort.
• Training for the person’s family on how to carry out pumps, flexoextension, passive abduction and triple extension exercises so that they can help the patient.

Nursing staff and physiotherapists can teach the patient how to carry out deep breathing exercises, which:

• Prevent blood pressure from dropping, and help to oxygenate because rest reduces oxygenation of tissues
• Supply a large amount of oxygen to the lungs
• Ventilate and clean the lungs
• Activate the body’s relaxation response
• Stimulate the heart
• Promote bowel movements
• Massage the organs

Patients will move about and walk in the following three stages, depending on x-ray exams:

•  First four weeks: leaning on the tips of the toes so as not to lose balance
•  Partial pressure: from four weeks on
•  Total pressure: from six weeks on

Pain will be controlled using intravenous drugs for the first few days and, after that, oral medication. In order to alleviate pain, a cold compress will need to be applied on the area for twenty minutes three times a day.

To prevent thromboembolism, patients will be treated with subcutaneous heparin injections. The hospital admissions unit’s nursing staff will show them how to administer this.

Remember

• Exercises must always be assisted (by a family member).
• The patient will walk or move from their chair to the bed without putting their weight on the operated leg.
• If the articular capsule has been operated on, the leg should not be rotated towards the exterior.

Other related health information

Health education for paediatric patients with hip dysplasia.

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

Good prevention and early detection are fundamental to avoid complications. To reduce the symptoms of mucositis it is important to follow the following advice:

• Before receiving your first cancer treatment: have a dentist check-up to detect possible conditions and reduce the risk of complications during treatment. 

• During treatment:
  • Clean your teeth, tongue and gums after each meal with a soft brush and gentle fluoride toothpaste.
  • Rinse your mouth out with a thyme or chamomile infusion or even water with a small spoonful of bicarbonate of soda after oral hygiene. Do not use mouthwash containing alcohol.
  • Keep your lips well hydrated, with olive oil or lip balm.
  • Drink plenty of fluids
  • Avoid acidic, spicy, very salty or seasoned foods.
  • Avoid very hot foods.
  • Avoid substances that will irritate your mucous membranes, such as tobacco and alcohol.
  • If you wear false teeth, keep them clean and soak them every night in a glass of disinfectant water and rinse them well before you put them back in.

If you notice ulcers in your mouth or any other change (redness, burning sensation, white spots, etc.) that cause pain or stop you from eating properly, consult your nurse and/or day hospital.

If you have a fever which develops call the immediate care line or go to A&E.

Other related health information

• Information for treating xerostamia (dry mouth)

Modifiable risk factors

• Proper monitoring of tension lowers the chances of suffering a stroke and other cardiovascular diseases. Hypertension is, in fact, the main risk factor for stroke after age (it is estimated to be the cause in between 25 and 50% of cases). 
• Follow a healthy diet, limiting salt and fats, processed meats, and industrial pastries . The Mediterranean diet is a good choice because, as well as being balanced and providing the necessary nutrients, it has a low content of saturated fatty acids, is rich in antioxidants and reduces the possibility of obesity, bad cholesterol (a risk factor for stroke) and diabetes. It is also advisable to eat fish, legumes, fibre, fruit and vegetables on a regular basis.
• Doingsport on a regular basis helps avoid obesity and diabetes and prevents cardiovascular disease. Everyone is advised, where possible, to do 30-60 minutes of moderate (walking quickly) or intense (running) aerobic physical exercise five days a week.
• Proper monitoring and treatment of diseases such as diabetes may decrease the risk of stroke and other vascular diseases. While chronic microvascular complications involved in diabetes (retinopathy, nephropathy, and neuropathy) are associated with poor long-term glycaemic control, macrovascular complications (ischemic heart disease and stroke) are determined mainly by other cardiovascular risk factors. We also need to monitor weight and obesity, which promotes high blood pressure, dyslipidaemia and diabetes.
• Nicotine causes cholesterol plaques in the arteries and can cause them to clog, so it is recommended to give up smoking. 
• Excessive alcohol consumption is also harmful: it causes hypertension and cardiovascular disease. This is why you are also advised to limit alcoholic beverages.
• Controlling heart disease, specifically atrial fibrillation: changes in heart rate, as is the case in atrial fibrillation, may cause thromboembolism in the brain (a type of stroke) or in other organs.
• Take your pulse is a campaign run by the Department for Health of the Generalitat de Catalunya, la Fundació Ictus (Stroke Foundation) and the Consell de Col·legis de Farmacèutics de Catalunya (Council of Associations of Pharmacists of Catalonia). If you feel strong, rapid palpitations without having done any previous physical activity, you are recommended to go to the doctor.

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

One measure to prevent the appearance of new cases of this virus among people living near a sufferer is the disinfection of objects contaminated with nasopharyngeal secretions or skin lesions in patients with chicken pox. It is therefore important to wash your hands before and after coming into contact with infected people or objects.

To improve the itching and discomfort of this virus, apply:

• Cold and wet compresses on the affected skin
• Soothing ointments and lotions, such as colloidal oat creams.

It is easy for people with shingles to pass it on to others, so when skin wounds are open and pussy avoid any contact with people who have not had chicken pox, especially pregnant women, new born babies and immunodeficient people.

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

Flu is transmitted easily in three different ways:

• By small drops released when coughing or sneezing (airborne).
• Through skin or oral contact with people who have flu.
• By touching or sharing utensils (cutlery, glasses, etc.) and other objects that have not been cleaned properly.

There are a series of hygiene measures that help to prevent flu:

• Cover your mouth and nose with a disposable tissue when coughing or sneezing, and then throw it away.
• It is essential to wash your hands regularly with water and soap for 15-30 seconds and to dry them properly (especially after touching shared surfaces such as handrails, door handles, computer keyboards and mice, telephones, supports on public transport and after sneezing and blowing your nose), or with alcohol solutions by rubbing your hands for 15-30 seconds.
• Enclosed spaces should be kept ventilated.
• Avoid close contact with people who have flu and do not share food or utensils with them (such as cutlery, glasses, serviettes and napkins) or other objects without cleaning them properly.
• If you get symptoms of flu or the doctor has diagnosed you with the illness, you should make sure not to share enclosed spaces with people for the first 3-5 days, especially people who are ill in hospital and community care workers.