What is the flu? How is it different from the common cold?

The flu is an infection caused by the influenza viruses while the common cold is an infection caused by a different group of viruses.

Although they are easily confused with each other, the following symptoms are more commonly for the flu:

•   High fever

•   Chills

•   Body aches

•   Extreme tiredness

•   Headache

The flu, unlike the common cold, may cause infections of the lungs and blood, death in vulnerable people. Getting vaccinated, however, can reduce your chance of falling sick.

How does a flu vaccine work?

In laboratories, the influenza viruses are injected into eggs.

Timing of Circumcision

The procedure is generally performed on healthy, medically stable, term infants between one and eight days after birth. A minimum period of 24 hours of observation after delivery.

Most circumcisions are performed in the hospital before the infant (term or preterm) is discharged as this is convenient for parents, practical, and has a demonstrated record of safety. In some areas, the procedure on term infants is performed after discharge to assure that the infant is medically stable (e g, no longer losing weight, tolerating feeding, free voiding,and jaundice has resolved or is waning).

Benefits

• Reduce urinary infections

• Reduce risk of penile cancer

• Decrease risk of sexually transmitted diseases.

• Decrease the risk of HPV infection.

Contraindication

• Bleeding diathesis

• Infection

• Congenital penile anomalies

• Medical instability: This includes term newborns who are ill, as well as low birth weight/premature infants who are not ready for discharge from the nursery.

Post-Procedure Care

Activity

No need to restrict the activities of newborns

Bathing

It's best to avoid full-body bathing until the second day after surgery,

but sponge bathing is fine. After the second day, newborns can be showered as normal, but wash the penis very quickly not beyond 2 minutes. Penis should be put into warm water for 15 minutes, every day 2 times, from 7 days after surgery until the ring falls off and the wound swelling is gone, the totally days of the ring’s falling off is about 12-14 days after surgery.

Incision Care

1. The circumcision site should be cleaned 2-3 times every day after circumcision day until the ring falling off and the incision swelling is gone. Clean should be performed immediately if the incision is dirty by stool. Use NS（immerse penis with 1 potassium permanganate solution add 500ml water in a cup for 5 minutes instead 3 days after circumcision）and take 2ml iodine by syringe to clean the incision, then smear antibiotic cream on the incision and then wrap the penis with Vaseline gauze.

2. Normally, the infant urinates within 4-6 hours after theprocedure.

3. Do not loosen the sting of the bell and do not pull the bell by yourself.

4. At first, the penis will appear red. In a few days, a soft yellow scab will develop. Gradually, the skin on the plastic-ring will be gangrene and the bell will be fallen off in 12-14 days after procedure. This is part of the normal healing process. During this process, parents should watch for worsening redness, swelling, bleeding (larger than a quarter-size on the diaper) or unceasing drainage or plastic-ring doesn't fall off after 2 weeks. Any of these signs should prompt a call to the surgeon.

Follow-up

Follow up OPD 1 week after operation and the ring falls off as needed. If the ring can’t fall off from the penis 2 weeks after operation, please contact your doctor.

What is chronic pain? 

Chronic pain is pain that does not get better for 3 months or longer. Chronic pain may hurt all the time, or come and go. 

How is chronic pain diagnosed? 

Your doctor will ask where your pain is, what it feels like, and when it started. He will ask how your pain is affecting your daily life, your mood, and your sleep. Tell your doctor if anything helps your pain or makes it worse. You may need any of the following: 

•    Pain scalesuse numbers or faces to help you describe how bad your pain is. Your doctor may ask you to rate your pain on a scale of 0 to 10

Arthralgia is pain in one or more joints, with no inflammation. It may be short-term and get better within 6 to 8 weeks. Arthralgia can be an early sign of arthritis. Arthralgia may be caused by a medical condition, such as a hormone disorder or a tumor. It may also be caused by an infection or injury. 

DISCHARGE INSTRUCTIONS

Medicines:

 The following medicines may be ordered for you

•    Acetaminophen decreases pain. Ask how much to take and how often to take it. Follow directions. Acetaminophen can cause liver damage if not taken correctly

•    NSAIDs decrease pain and prevent swelling. Ask your doctor which medicine is right for you. Ask how much to take and when to take it. Take as directed. NSAIDs can cause stomach bleeding and kidney problems if not taken correctly

•    Pain relief cream decreases pain. Use this cream as directed

•    Take your medicine as directed.Contact your doctor if you think your medicine is not helping or if you have side effects. Tell him of her if you are allergic to any medicine. Keep a list of the medicines, vitamins, and herbs you take. Include the amounts, and when and why you take them. Bring the list or the pill bottles to follow-up visits. Carry your medicine list with you in case of an emergency

•    Follow up with your doctor or specialist as directed: Write down your questions so you remember to ask them during your visits. 

Self-care: 

What are allergies? 

Allergies are an immune system reaction to a substance called an allergen. Your immune system sees the allergen as harmful and attacks it. 

What causes allergies? 

You may have allergies at certain times of the year or all year. The following are common allergies: 

•    Seasonal airborne allergies happen during certain times of the year. This is also called hay fever. Tree, weed, or grass pollen are examples of allergens that you breathe in

•    Environmental airborne allergy triggers you may breathe in year-round include dust, mold, and pet hair

•    Contact allergies include latex, found in items such as condoms and medical gloves. Latex allergies can be very serious

•    Insect sting allergies may be caused by bees, hornets, fire ants, or other insects that sting or bite you. Insect allergies can be very serious

•    Food allergies commonly include shellfish, wheat, and eggs. Some foods must be eaten to produce an allergic reaction. Other foods can trigger a reaction if they touch your skin or are breathed in

What increases my risk for allergies? 

Allergic reactions can happen at any time, even if you have not had allergies before. You may develop an allergy after you have been exposed to an allergen more than once. Allergies are most common in children and elderly people, but anyone can have an allergic reaction. Your risk is also increased if you have a family history of allergies or a medical condition such as asthma.

What are the signs and symptoms of allergies? 

•    Mild symptoms include sneezing and a runny, itchy, or stuffy nose. You may also have swollen, watery, or itchy eyes, or skin itching. You may have swelling or pain where an insect bit or stung you

•    Anaphylaxis symptoms include trouble breathing or swallowing, a rash or hives, or severe swelling. You may also have a cough, wheezing, or feel lightheaded or dizzy. Anaphylaxis is a sudden, life-threatening reaction that needs immediate treatment

How are allergies diagnosed? 

Your doctor will ask about your signs and symptoms. He or she will ask what allergens you have been exposed to and if you have ever had other allergic reactions. He or she may look in your nose, ears, or throat. You may need additional testing if you developed anaphylaxis after you were exposed to a trigger and then exercised. This is called exercise-induced anaphylaxis. You may also need the following tests: 

•    Blood tests are used to check for signs of a reaction to allergens

•    Nasal tests are used to see how your nasal passages react to allergens. A sample of your nasal fluid may also be tested

•    Skin tests can help your doctor find what you are allergic to. He will place a small amount of allergen on your arm or back and then prick your skin with a needle. He will watch how your skin reacts to the allergen

•    Antihistamines help decrease itching, sneezing, and swelling. You may take them as a pill or use drops in your nose or eyes 

•    Decongestants help your nose feel less stuffy

•    Steroids decrease swelling and redness

•    Topical treatments help decrease itching or swelling. You also may be given nasal sprays or eyedrops

•    Epinephrine is medicine used to treat severe allergic reactions such as anaphylaxis

•    Desensitization gets your body used to allergens you cannot avoid. Your doctor will give you a shot that contains a small amount of an allergen. He or she will treat any allergic reaction you have. Your doctor will give you more of the allergen a little at a time until your body gets used to it. Your reaction to the allergen may be less serious after this treatment. Your doctor will tell you how long to get the shots

What steps do I need to take for signs or symptoms of anaphylaxis? 

•    Call 120 and go to the emergency department, do not drive yourself

What safety precautions do I need to take if I am at risk for anaphylaxis?

•    Be careful when you exercise. If you have had exercise-induced anaphylaxis, do not exercise right after you eat. Stop exercising right away if you start to develop any signs or symptoms of anaphylaxis. You may first feel tired, warm, or have itchy skin. Hives, swelling, and severe breathing problems may develop if you continue to exercise

•    Carry medical alert identification. Wear medical alert jewelry or carry a card that explains the allergy. Ask your doctor where to get these items

•    Inform all doctors of the allergy. This includes dentists, nurses, doctors, and surgeons

How can I manage allergies? 

•    Use nasal rinses as directed. Rinse with a saline solution daily. This will help clear allergens out of your nose. Use distilled water if possible. You can also boil tap water and let it cool before you use it. Do not use tap water that has not been boiled

What do I need to know about pain in older adults? 

Pain is not a normal part of aging, and may be a sign that something is wrong. Sometimes there is no clear or exact cause of pain. Pain management is an important part of your care. If pain is not treated, it can decrease your appetite, sleep, and energy. It can also affect your mood and your relationships with others.

What are the types of pain? 

•    Acute pain may be caused by an illness or injury. It comes on suddenly and lasts a short period of time. Acute pain usually goes away as your body heals but may become chronic if left untreated

•    Chronic pain describes pain that continues or gets worse over a long period of time. It may last for months or years. It may be pain that remains after you have recovered from an injury. Diseases such as cancer, arthritis, migraines, and back problems are also common causes of chronic pain

How will healthcare providers know if I am in pain? 

You may have many questions and fears about pain. Do not be ashamed to tell your healthcare providers about what you are feeling. Tell them where you hurt and how bad it is. You may try to deny that you are having pain to show courage or to escape treatment. Conditions such as dementia (memory problem), brain damage, or a stroke may make it hard to express pain. The following are common signs that may tell healthcare providers that you are in pain: 

•    Crying, moaning, frowning, or sighing

•    Frequent feelings of sadness, depression, hopelessness, aggression, or anger

•    Noisy breathing, or calling out

•    Not moving, or staying in one position to decrease pain

•    Poor appetite, or changes to usual sleep patterns

•    Pulling away or getting upset when touched

•    Restlessness or pacing

How is the cause of pain diagnosed? 

•    Physical examination may help your healthcare provider find where your pain is. He or she may touch or press different places on your body

•    Pain scales may help measure how much pain you feel. Pain scales may include numbers or faces. Your healthcare provider may ask you to rate the pain on a scale of 0 to 10. He or she may ask you to describe your pain. Tell your healthcare provider if your pain is sharp, dull, or achy. Tell him or her if you have constant pain or if it comes and goes

What is this test?

This test detects and identifies bacteria from a culture of sputum. This test is used to help diagnose possible bacterial causes of respiratory tract infections such as community acquired pneumonia.

Why do I need this test?

Laboratory tests may be done for many reasons. Tests are performed for routine health screenings or if a disease or toxicity is suspected. Lab tests may be used to determine if a medical condition is improving or worsening. Lab tests may also be used to measure the success or failure of a medication or treatment plan. Lab tests may be ordered for professional or legal reasons. You may need this test if you have: 

•    Acute chest syndrome

•    Acute exacerbation of pulmonary cystic fibrosis

•    Aspiration pneumonitis

•    Community acquired pneumonia

•     Pneumonic plague

How should I get ready for the test?

Before a sputum sample is collected, you may be asked to drink more fluids. Drinking more fluids may help you produce a sputum sample.

For this test, a sputum sample is obtained before taking an antibiotic. Tell your doctor if you are taking any medications at the time of the test.

How is the test done?

Sputum is mucus that is secreted by the airways and lungs. To collect a sample of sputum, you may be asked to cough forcefully, and spit out sputum into a container. If you are unable to produce a sputum sample, you may need to have the sample induced. To induce a sputum sample, a doctor will prepare a solution in a nebulizer for you to inhale. You will be asked to inhale the solution over a period of time, which may last up to 20 minutes. You will then be asked to cough and spit out sputum into a container.

How will the test feel?

The amount of discomfort you feel will depend on many factors, including your sensitivity to pain. Communicate how you are feeling with the person doing the test. Inform the person doing the test if you feel that you cannot continue with the test.

Generally, collection of a sputum sample is not painful. If the sample is induced, the coughing may be uncomfortable.

What should I do after the test?

After a sputum sample is collected, call the doctor if you experience a new onset of pain in your throat, trouble swallowing, or if you are coughing up blood.

CARE AGREEMENT: 

You have the right to help plan your care. To help with this plan, you must learn about your health condition and how it may be treated. You can then discuss treatment options with your caregivers. Work with them to decide what care may be used to treat you. You always have the right to refuse treatment.

© 2017 Truven Health Analytics LLC

What is allergy testing? 

Allergy testing is a way to find out if your child is allergic to something, called an allergen. Common allergens include pet dander, pollen, insect bites or stings, and certain foods, such as peanuts. Your child's doctor will use an allergy test to check your child's body's response to the allergen. During the test, he or she will watch for small skin reactions that show your child is probably allergic. He or she will also watch for a rare but serious reaction that needs immediate treatment.

How do I prepare my child for an allergy test? 

•    Your child may be afraid that the test will hurt. Depending on your child's age, it may be helpful to explain the test before it happens. Tell your child why he or she needs this test and what will happen during the test. Explain that he or she might be uncomfortable or feel itchy during the test, but there will be no blood. Also explain that he or she may get medicine to help with any itchiness when the test is over

•    Talk to your child's doctor about all medicines your child takes. Some medicines may keep the allergy test from working correctly. Your child may need to stop taking certain medicines days, weeks, or months before the test. Examples include antihistamines, topical steroids, and medicines to stop vertigo or relieve insomnia. Your child's doctor will tell you if your child needs to stop any medicine, and when to stop it. He or she will also tell you when your child can start taking the medicine again after the allergy test

What are the different kinds of allergy tests? 

•    A skin prick test is used to check for a reaction to an allergen applied to your child's skin. Your child's doctor will place drops of solution on your child's skin. This is usually applied on the upper back in children. Each drop will contain a small amount of 1 possible allergen. Your child's doctor will then prick or scratch the skin under the drops. This will help the solution get into your child's skin. If the skin becomes raised, red, and itchy within 20 minutes, your child may be allergic to that allergen

•    An intradermal test is used to check for a reaction to an allergen injected under the skin of your child's upper arm. This may be used if your child's skin does not react during a skin prick test but he or she may still be allergic to an allergen. Your child's doctor will inject the allergen under the skin and check for a reaction in about 15 minutes. If your child's skin becomes raised, red, and itchy within 20 minutes, he or she may be allergic to that allergen

•    A patch test is used to check for a reaction to an allergen taped to your child's skin. The allergen is put onto a pad. The pad is taped to the skin. Your child will then come back in 3 days and have the area checked for a reaction. He or she will come back again at day 5 to 7 to have it checked again. Your child's doctor will wait 15 to 60 minutes after removing the pad to check for a reaction. This is because your child may have some skin irritation from where the pad was taped to his or her skin. The irritation can be mistaken for an allergic reaction. Your child cannot get the patch test area wet during this test

•    A blood test may be used in children who have certain rashes or take medicine that make skin testing difficult to do. Blood tests may be used for children who are at risk for anaphylaxisduring other kinds of allergy testing. Anaphylaxisis a life-threatening reaction to an allergen. A sample of your child's blood is tested to see if it contains antibodies to specific allergens

What will happen after my child's allergy test? 

•    You and your child's doctor will talk about the results of the allergy test. If your child had a positive test result, this means he or she showed signs of an allergic reaction to an allergen. You and your child's doctor can talk about any additional tests your child may need. The tests can find how severe the allergy is and if he or she may need medicine to prevent or control a reaction. This is called an action plan

•    Rarely, after a prick or intradermal test, your child may develop signs of an allergic reaction. Depending on the kind of test your child had, you and your child will need to watch for signs of an allergic reaction. This can happen within hours of an allergy test. Your child's doctor will tell you what to do if your child has a reaction. Your child may need to take an antihistamine or other medicine to stop the reaction

Call 120 for any of the following: 

•    Your child has any of the following signs or symptoms of anaphylaxis: 

  o  Itching, a rash, hives that spread over his or her body

  o  Trouble breathing, swelling in his or her mouth or throat, or wheezing

  o  Feeling he or she is going to faint

When should I contact my child's doctor? 

•    Your child has new or worsening rashes, hives, or itching

•    Your child has an upset stomach or is vomiting

•    Your child has stomach cramps or diarrhea

•    You have questions or concerns about your child's condition or care

CARE AGREEMENT:

You have the right to help plan your child's care. Learn about your child's health condition and how it may be treated. Discuss treatment options with your child's caregivers to decide what care you want for your child.

© 2017 Truven Health Analytics LLC All illustrations and images included in CareNotes® are the copyrighted property of A.D.A.M., Inc. or Truven Health Analytics. 

What is dehydration?  

Dehydration is a condition that develops when your body does not have enough fluid. You may become dehydrated if you do not drink enough water or lose too much fluid. Fluid loss may also cause loss of electrolytes (minerals), such as sodium.

•    Vomiting, diarrhea, or fever

•    Being in the sun or heat for too long

•    Sweating while playing sports

•    Diseases, such as stroke, diabetes, or infections

•    Medicines that cause you to lose water and salt, such as diuretics (water pills)

•    Older age with decreased ability to sense thirst or to urinate

What are the signs and symptoms of dehydration? 

•    Dry eyes or mouth

•    Increased thirst

•    Dark yellow urine

•    Urinating little or not at all

•    Tiredness or body weakness

•    Headache, dizziness, or confusion

•    Irregular or fast breathing, fast or pounding heartbeat, and low blood pressure

•    Sudden weight loss

How is dehydration diagnosed?

Your doctor will examine you and check your breathing and heartbeat. He or she will look at your eyes, skin, mouth, and tongue. He or she will ask you how much liquid you have been drinking, and how much you are urinating. Tell him or her if you have been vomiting or have diarrhea. Blood and urine tests are used to check your electrolyte levels. The tests may show the cause of your dehydration, such as infection or diabetes. They may also show if your kidneys are working correctly.

How is dehydration treated? 

•    Oral liquids: 

  o     If you are mildly to moderately dehydrated, you may need an oral rehydration solution (ORS). This drink contains the right amount of salt, sugar, and minerals in water to replace body fluids. Ask your doctor where you can get an ORS

  o     dehydrated and how often you should drink it

  o     A sports drink is not the same as an ORS. Do not drink sports drinks without asking your doctor

  o     Do not drink soft drinks or fruit juices. These can make your condition worse

 •    You may receive fluid through an IV. Electrolytes may also be included in the fluid

What can I do to prevent dehydration? 

•    Drink liquids as directed. Liquids that contain water, sugar, and minerals can help your body hold in fluid and help prevent dehydration. Drink liquids throughout the day, not just when you feel thirsty. Men should drink about 3 liters (13 eight-ounce cups) of liquid each day. Women should drink about 2 liters (9 eight-ounce cups) of liquid each day. Drink even more liquid if you will be outdoors, in the sun for a long time, or exercising

•    Stay cool. Limit the time you spend outdoors during the hottest part of the day. Dress in lightweight clothes

•    Keep track of how often you urinate. If you urinate less than usual or your urine is darker, drink more liquids

When should I seek immediate care? 

•    You have a seizure

•    You are confused or cannot think clearly

•    You are extremely sleepy, or another person cannot wake you

•    You become dizzy or faint when you stand

•    You are not able to urinate

•    You have trouble breathing

•    You have a fast or irregular heartbeat

•    Your hands or feet are cold, or your face is pale 

When should I contact my doctor? 

•    You have trouble drinking liquids because you are vomiting

•    Your symptoms get worse

•    You have a fever

•    You feel very weak or tired

•    You have questions or concerns about your condition or care

CARE AGREEMENT:

You have the right to help plan your care. Learn about your health condition and how it may be treated. Discuss treatment options with your caregivers to decide what care you want to receive. You always have the right to refuse treatment.

© 2017 Truven Health Analytics LLC All illustrations and images included in CareNotes® are the copyrighted property of A.D.A.M., Inc. or Truven Health Analytics.

What are gallstones?

The gallbladder is an internal organ that sits just under your liver. It looks like a small 'bag.' It stores digestive juices that are made by the liver. Sometimes these juices become soild and form stones, called gallstones.

What problems can gallstones cause?

About 60% of people with gallstones never get sick from them. They might never know they have gallstones. However, a gallstone can leave your gallbladder and go into the passageway from your gallbladder to your intestine. It can get stuck in that passageway. If the stone completely blocks the passageway, you will have severe pain in the right upper part of your belly. You may also feel pain in your upper back. The pain usually starts suddenly and lasts for as long as 3 hours. This is known as an 'attack.'

Complete or partial blockage can also cause your gallbladder to get irritated and inflamed. If this happens, you will usually have pain for more than 3 hours. You may also get a fever. Your skin may turn a yellowish color, known as jaundice.

Who gets gallstones?

You're more likely to get gallstones if:

•    You are a woman

•    You have diabetes

•    Your mother had gallstones

•    You are pregnant or taking birth control pills

•    You have a high blood level of triglycerides (a type of fat)

How gallstones are usually treated?

If you have gallstones but no pain, chances are good the stones won't be a problem for you. Your doctor might suggest you leave them alone. 

Once you have one attack of pain, you are likely to have another one. You may want to think about having your gallbladder removed in surgery to prevent a future attack. You and your doctor should talk about your situation and decide what is right for you. If your gallbladder is irritated or inflamed, it is probably a good idea to have it removed. The surgery is safe and effective. Without surgery, an irritated or inflamed gallbladder might get infected. It could even burst open, causing serious problems.

Are there other treatments?

Yes, there are other treatments. Your doctor might be able to use sound wave therapy to break up the stones so they can move into the intestine without problems. However, people who have this treatment sometimes form new gallstones after a few years. There is also a pill called Actigall which dissolves gallstones in some people. The pill is very expensive and it does not work for everyone.

This document is intended to provide health related information so that you may be better informed. It is not a substitute for your care team's medical advice and should not be relied upon for treatment for specific medical conditions.

© 2017 The General HospitalCorporation.

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