Indian Journal of Surgical Nursing

Congestive hepatopathy includes a spectrum of hepatic derangements that occur in the settings of Right heart failure. If there is subsequent hepatic fibrosis the term cardiac cirrhosis may be used. The timely diagnosis of a cardiac etiology of liver dysfunction is important because such dysfunction is potentially reversible if the underlying cardiac disease is treated before the development of frank cirrhosis. Below, we present a case of 18 years old adolescent girl who was incidentally found to have Atrial Septal defect. Abdominal USG revealed Nutmeg Liver. In this case report the literature will be discussed on cardiac events resulting in Nut Meg liver and its management. Introduction: Congestive hepatopathy is also known as Nutmeg liver and chronic passive congestion of the liver, which is an liver dysfunction due to venous congestion, usually caused by congestive heart failure, The gross pathological appearance of a liver with Nutmeg is Speckled like a grated nut meg kernel [6]. Treatment is directed to remove the cause. So, therapy aimed at improving Right heart function. True nutmeg liver is usually second to left sided heart failure causing congestive right heart failure and the treatment options are limited [12]. Case Report: A 18 years old adolescent girl with a known atrial septal defect, cystichygroma in the left neck, presented to the cardiology department complaining of shortness of breath (grade IV), non productive cough, orthopnea, fatigue. On physical examination the findings were Tachypnea, cold extremities and bibasilar crackles on pulmonary auscultation; An abdominal ultra sound was requested and the findings were congestive hepatopathy, splenomegaly minimal left pleural effusion and moderate volume of ascities. X-ray showed cardiomegaly obliterating left CP angle, patchy air space opacities, right mid zone and lower zone pulmonary edema changes. 2D Echo cardiogram showed cyanotic heart disease, Large oss with atrial septal defect with predominantly left to right shunt, dilated right atria, right ventricle& pulmonary artery; severe tricuspid regurgitation with moderate pulmonary artery hypertension, Right ventricular dysfunction with moderate atrial regurgitation; mild pulmonary edema, global hypokinesia of left ventricle, mild left ventricle systolic dysfunction. Conclusion: The study highlight cardiac cause should be thought for differential diagnosis when patient presents with liver cirrhosis; the incidence of patients with Nutmeg liver are presenting in general practice. 

Keywords: Congestive Hepatopathy; Right Heat Failure; Atrial Septal Defect; Nut Meg Liver; Congestive Heart Failure; Liver Dysfunction; Cirrhosis of Liver.
 

  Perineal trauma is the damage that occur to the female genitals during labour, which can occur spontaneously or iatrogenically. Perineal trauma results discomforts and complications to a larger extent after childbirth affecting their daily actitivity. The extent of perineal tear can be reduced with simple assessment of striae gravidarum. Striae, are stretch marks which can be seen during pregnancy. These striae uausally occurs due to poor skin elasticity, therefore calculating striae gravidarum during III trimester can reduce the risk of perineal injury and enhancing the midwifes to go for intervention such as episiotomy, the aim of episiotomy is to increase the diameter of the vaginal outlet to facilitate the passage of the fetal head and, ideally, prevent a vaginal tear. Some studies shows that, through clinical assessment in late pregnancy of striae gravidarum can predict the extent of perineal tear helping to take appropriate measures during labour. Thus, this review aimed to focus on striae gravidarum as an effective tool indicating the breadth of perineal tear. 

Keywords: Perineal Tear; Striae Gravidarum.

  Even as we speak chronic kidney failure is taking a huge toll on lakhs of families in India. This is unfortunate because kidney failure is the easiest of all organ failures to manage. We have dialysis which can replace kidney function to a significant extent and kidney is the easiest solid organ to transplant. This sad situation is because of a number of factors, the most important of which is the lack of awareness at all levels of the society. Compared to similar patients in the developed world or even some other developing countries, kidney failure patients have extremely poor outcomes in India. As things today we are not even addressing the tip of the iceberg. In the past, one of the major problems and causes of failure in Hemodialysis (HD) was represented by the lack of good vascular access (VA). Obtaining vascular access is one of the most difficult problems associated with HD. To carry out HD, a very rapid blood flow is required and access to a large blood vessel is essential. After the introduction of the fistula, in the last few decades, the advent of prosthetic Arteriovenous graft (AVG) and central venous catheters (CVCs) has given physicians the opportunity to choose the most appropriate VA for HD patients. However, the native AVF remains the first choice for VA, especially because of the infectious and thrombotic complications more frequently associated with AVGs and CVCs 

Keywords: Dialysis; Hemodialysis; Vascular Access; Arteriovenous Graft

  An experimental study on effectiveness of modified early ambulation on activities of daily living, functional activity and psychological wellbeing among the patients undergone abdominal surgery in Kempagowda Institute of Medical Sciences, Bangalore. Complications due to lack of early ambulation are the main cause for morbidity and mortality in India and all over the world. Many researchers have been done to prove the early ambulation improves postoperative recovery, reduce incidence of postoperative complications and promote early discharge. The investigator has selected only on three aspects of postoperative recovery such as activities of daily living, functional activity and psychological wellbeing. The main objectives of the study were directed to determine the effectiveness of modified early ambulation on activities of daily living, functional activity and psychological wellbeing among the patients undergone abdominal surgery in the both study and control group. Also the study goal was directed to determine the difference between selected demographic variables and activities of daily living, functional activity and psychological wellbeing in the study group and the control group. The collected data were collected and analyzed by using descriptive and inferential statistics (F-test and t-test) was used to evaluate the effectiveness of modified early ambulation. The finding of the study revealed that there was significant difference in modified early ambulation and postoperative scores in the activities of daily living, functional activity and psychological wellbeing in the study group. There is no significant difference in relation to selected demographic variables and activities of daily living, functional activity and psychological wellbeing scores. The conclusion of the study reveals that there is an effectiveness of modified early ambulation on patient’s undergone abdominal surgeries. 

Keywords: Modified Early Ambulation; Activities of Daily Living; Functional Activity; and Psychological Wellbeing.