1. Presented by Qassim J. Odda Master In Adult Nursing
Diphtheria
Presented by
Qassim J. Odda
Master In Adult Nursing

2. Definition
is acute bacterial disease of tonsils , pharynx, larynx, nose , skin and sometimes the conjunctiva or genitalia. It's caused by a bacterium called Corynebacterium diphtheria. It can be treated by special drugs, or by antibiotics. There is a vaccine which can prevent diphtheria.

3. Diphtheria can cause serious problems, like:
Inflammation of the heart, which can lead to death
Different forms of paralysis, by poisoning of nerve cells
Pneumonia
Encephalitis
Problems with the kidneys

4. Signs and symptoms of diphtheria.
Usually begin two to five days after a person gets infected.
They may include:
A thick, gray membrane covering the throat and tonsils
A sore throat and a hoarse voice
Swollen glands (enlarged lymph nodes) in the neck
Trouble breathing, or fast breathing
Nasal discharge
Fever and chills
Malaise (feeling very tired and not having any energy)

5. Categories of diphtheria
Coetaneous diphtheria:- A second type of diphtheria can affect the skin. This type of diphtheria is called coetaneous diphtheria. It causes pain, redness, and swelling on the skin, like other bacterial skin infections. People with coetaneous diphtheria may get ulcers, covered by a gray membrane, on their skin.
Anterior nasal diphtheria:- The onset of anterior nasal diphtheria is indistinguishable from that of the common cold and is usually character­ized by a mucopurulent nasal discharge (containing both mucus and pus) A white membrane usually forms on the nasal septum.

6. Categories of diphtheria:-
3- Pharyngeal and Tonsillar Diphtheria:- The most common sites of diphtheria infection are the pharynx and the tonsils. Infection at these sites is usually associated with substantial systemic absorption of toxin. The onset of pharyngitis is insidious. Early symptoms include malaise, sore throat, anorexia, and low-grade fever (<101°F). Within 2–3 days, a bluish-white membrane forms and extends, varying in size from covering a small patch on the tonsils to covering most of the soft palate. Often by the time a physician is contacted, the membrane is grayish-green, or black if bleeding has occurred. 4- Laryngeal Diphtheria:- Laryngeal diphtheria can be either an extension of the pharyngeal form or can involve only this site. Symptoms include fever, hoarseness, and a barking cough. The membrane can lead to airway obstruction, coma, and death.

7. Treatment of diphtheria
Antitoxin :- injected into vein or muscle ,neutralizes diphtheria toxin already circulating in the body. Before giving antitoxin should be perform skin allergy test
Antibiotics:- diphtheria is also treated with antibiotics such as penicillin or erythromycin . antibiotics help kill bacteria in the body , clearing up infections. Antibiotics reduce to just few days the length of time that person with diphtheria is contagious

8. Complication of diphtheria
Myocarditis
Heart failure
Neuritis such as Paralysis of the soft ,Paralysis of eye muscles, limbs, and diaphragm
Pneumonia
Respiratory failure
Otitis media and respiratory insufficiency due to airway obstruction, especially in infants
Death.

9. Presented by Qassim j. odda Master in adult nursing
Angina
Presented by Qassim j. odda Master in adult nursing

10. definition
Is chest pain caused by inadequate myocardial oxygen supply.
It is three types which including
1- Classical effort (exertional angina, chronic stable angina) consist symptoms with pain relieved by rest
2- Unstable or acute angina - increase in severity , duration and frequency of pain which is eventually relieved by nitroglycerin
3- Prinzmetal or variant angina- pain that occurs at rest
4- Microvasculare angina- impairment of vasodilator reserve causes angina – like chest pain in patient with normal coronary arteries

11. Causes of angina Atherosclerosis Vasospasm Aortic stenosis
Activity or disease that increase metabolic demand

12. pathophysiology Narrowing of the coronary arteries
Obstruction of blood flow to myocardium muscle
Diminishes myocardial oxygen supply
Ischemic cells of cardiac muscle
Chest pain (angina)

13. Assessment findings Sub sternal, crushing , compressing pain
Usually occurs after exertion, emotional excitement or exposure to cold
May radiated to arm
Usually last 3 to 5 minute
2. Dyspnea
3. Palpitation
4. Epigastria distress
5. Tachycardia
6. Diaphoresis
7. Anxiety

14. Diagnosis test findings
E.C.G. abnormal with chest pain
Stress test: - abnormal E.C.G.
Coronary arteriography, plaque accumulation
Blood chemistry:- increase cholesterol level
Cardiac enzymes within normal limits

15. Medical intervention Monitoring vital signs E.C.G
Laboratory studies:- atria blood gas, sodium and calcium
Diet:- low salt, low fat and increase dietary fiber
Oxygen therapy
Ant arrhythmias such as cordaron

16. Complication
Arrhythmias
Heart failure
Myocardial infarction