Treating Diseases

Disease treatment can aim to:

• Cure the disease permanently - for example, eradicating a bacterial infection with antibiotics
• Delay the progress of a disease that cannot be cured - for example, using drugs to inhibit the growth of an inoperable tumour
• Palliate the effects of the disease, especially to reduce pain and discomfort - for example, using analgestic drugs such as paracetamol to reduce pain
• Reduce or remove the symptoms of a disease - fro example, using insulin to normalise metabolism in diabetes
• Rebuild or repair damage to body tissues and structures - for example, facial reconstruction following an accident
• Replace damaged or diseased body tissues and organs - for example, heart transplants and hip replacements

Humans have evolved a range of physiological mechanisms that act to heal injuries and fight diseases. 

Many relatively minor illnesses are overcome in this way without any medical intervention.

The immune system helps to fight infection by producing a physiological response that raises the body temperature and produces antibodies that kill the infective agent.

With minor illness and injuries, self-treatment is often adepquate.

This could be buying non-prescription medication to reduce the discomfort caused by coughing, headaches, or the inflammation of joints. 

Self-treatment also includes, resting, and drinking plenty of fluids. 

However, it is bad to ignore persisent symptoms or rely too heavily on self-treatment. Persistent illness or conditions that gradually get worse will require professional treatment.

Nursing by informal carers, such as parents of ill children, or adults looking after elderly or disabled relatives, can provide basic nursing care. 

This care includes the following actions and skills:

• Monitoring health - for example, taking the patient's temperature and watching for signs of improvement or deterioration
• Supervising treatment - for example, making sure that medication is taken at the prescribed intervals as some patients, especially the very young or very old, are not able to manage their own medication
• Maintaining hygiene - for example, washing, bathing and toileting the patients
• Maintaining incontinence - for example, by changing nappies or incontinence pads 
• Providing nutrition
• Proving social contact, support and stimulation - for example, for young children who might otherwise become bored or depressed
• Communicating with other support services - for example, getting advice from NHS direct
• Prevent pressure sores which can form is patients sit or lie in the same position for a long time

Hospital nursing involves some of the skills that an informal carer would provide, though usually at a higher level of sophistication:

• A greater range of monitoring equipment will be used
• Accurate record keeping is required
• Expertise is required with a much greater range of treatment procedures
• Maintaining privacy and confidentiality are important

Nurses need additional skills:

• Confidence and sensitivity in carrying out procedures 
• Skill in effective communication
• Ability to empathise with patients
• Ability to empower patients
• Ability to work as a team to provide care

Hospital nursing involves some of the skills that an informal carer would provide, though usually at a higher level of sophistication:

• A greater range of monitoring equipment will be used
• Accurate record keeping is required
• Expertise is required with a much greater range of treatment procedures
• Maintaining privacy and confidentiality are important

Nurses need additional skills:

• Confidence and sensitivity in carrying out procedures 
• Skill in effective communication
• Ability to empathise with patients
• Ability to empower patients
• Ability to work as a team to provide care

• Provided in special units in hospitals called intensive care units (ICUs) or intensive treatment units (ITUs)
• They are used for patients who are critically ill and are at extreme risk of dying
• Each patient's condition is monitored continuously 
• Most patients require artificial feeding via a drip and some might require ventilation
• Levels of staffing are higher than in other wards
• Intensive care nursing demands particularly high levels of vigilance form staff, a clear understanding of a wide range of medical conditions and treatments
• They must have exterise to take rapid corrective action in a medical emergency
• Intensive care requires scrupulous attention to hygiene to reduce the risk of infection

• Some diseases result from malfunctions in the body's chemical processes, for example, type 1 diabetes, in which damage to the pancreas reduces or stop the production of insulin
• Drug treatment can help to adjust chemical processes and imbalances in the body
• A drug used for medical purposes is a substance that is administered to the patient in carefully controlled amounts, usually repeatedly and regularly, in order to achieve one or more of the following:
• To make up for chemical imbalance 
• To help the body fight infectious disease agents
• To relieve or palliate unpleasant symptoms
• To reduce pain

A drug usually has three different names

• Brand name (given by pharmaceutical company marketing the drug)
• Generic name (indicating the type of family of drug)
• Chemical name (gives the chemical composition)

• Drugs are sometimes grouped together because they have a similar chemica composition
• Drugs that belong to the same chemical family have similar effects on the body
• Drugs can also be grouped on the disorder they are designed to treat

• Some drugs are extracted from the tissues in plants and animals and are then purified, such as morphine extracted from poppies and penicillin extracted from fungal mould
• Most drugs are synthesised by routine industrial chemical processes, including drugs originally devised from plants and animals
• Synthetic production of drugs is often cheaper and produces a purer and safer product
• Certain drugs are manufactured biologically, using genetically modified life forms
• Before a new drug can be licensed for use, it must be tested for effectiveness and safety
• Initial tests are carried out on animals, and if sever adverse effects occur at this point, the drug is unlikely to be tested any further
• If animal testing reveals no adverse effects, and achieves the desires outcome, the drug will continue to human testing
• The drug will be assessed by the Committee on Safety of Medicines
• Drugs with sever adverse effects may be approved if the benefits are proportionally great
• Once licensed, the drug can be marketed by a pharmaceutical company, under a brand name

• Most drugs can only be access through a prescription from a GP or medical practitioner
• Some drugs are available without a prescription and can be purchased in pharmacies and supermarkets
• Non-prescription drugs are intended to treat aches and pains, inflammation and allergic reactions, rashes, coughs and congestion caused by the overprodudction of mucus
• These drugs are safe enough not to need medical supervision, provided they are used in accordance with the instructions
• Non-prescription drugs are sold under brand names
• However, these are most expensive and these can be bought cheaper under the generic name 

 By Mouth

• The patient will swallow a tablet, capsule or liquid
• Drug passes into the intestines, where it is absorbed into the bloodstream
• Transported through the blood to all parts of the body
• Released over a period of several hours, providing continuous relief from symptoms
• Does not give immediate relief
• Drugs destroyed in digestive system

Spray or Inhaler

• Drugs are inhaled
• Delivers fine spray of drugs into airways and lungs
• Immediate relief
• Self administered
• Benefits are restricted to respiratory system

Suppository

• Bullet shaped blocks of gel that contain drugs
• Inserted into rectum via the anus
• Gel dissolved and drugs are absorbed via the wall of the rectum
• Can be used to administer drugs that would be destroyed by digestive system
• It may cause embarrassed or be an undignified way of medicating yourself

Injection

• Injected directly into the body via a neddles
• Injected subcutaneously (layer of fat just beneath skin surface)
• Injected intravenously (into a vein)
• Injected intramuscular (into a muscle)
• Provide rapid delivery of drugs to the body, improtant in emergencies
• Slight discomfort caused by the needles
• Has to be administered by practitioner

Creams

• Used to deliver drugs to one particular area
• Called topical creams
• Useful for treating skin conditions 
• Drugs in creams can also be used to penetrate some distance into tissues below the skin
• This provides slow action
• It is limited to tissues at or just below skin surface

• Many drugs produce a range of effects on body tissues
• The intended effect is the reason for using the drugs
• However, there may be adverse effects which are unpleasant and potentially harmful
• Common adverse effects include naesea, comiting, diarrhoea and constipation
• Adverse effects are tolerate in drugs that produce strong positive benefits, such as saving a life or curing a serious disease
• Adverse effects can occur when prescription or non-prescription drugs are misused
• Misuse includes taking high doses than are recommended, failing to take drugs at the intervals recommended, or taking drugs that were prescribed for someone else or for a different condition

• Sometimes the effects of a drug on the body can be significantly altered
• If a person is taking two different drugs, the two drugs can interact to produce adverse effects
• This is why GPs ask patients about any medication they already take, before prescribing drugs
• Interactions can also occur between medically refined drugs and herbal rememdies

Surgery includes a range of techniques in which body tissues are cut in order to:

• Remove unhealthy tissues (lumpectomy, where a lump or tumour is removed)
• Modify or rebuild damamged or diseased body structures (reattaching a finger severed in an accident)
• Bypass malfunctioning organs (coronary bypassm where a section of diseaseed coronary artery is bypassed bt connecting a section of healthy artery or synthetic tube)
• Implant electronic or mechanical devices to improve body function (heart pacemaker)

• Involves procedures that require the opening of the chest, abdomen or cranium
• Procedure itself causes significant injury to the patient, which may take several weeks to heal completely
• Heart and brain procedures are delicate and may take several hours
• Blood loss is a problem in operations and is sometimes necessary for patients to have a blood transfusion during
• Requires a general anaesthetic, which puts patients to sleep, immobilises them, prevents any feeling of pain and relaxes muscles
• Brain surgery is sometimes carried out with local anaesthetic because it is useful for the patient to be alert
• There is always a risk of infection when a part of the body is cut open
• Operating theatres are always kept in aseptic conditions (absence of bacteria and ciruses)
• Wash hands, sterilised gowns, disposable gloves, masks, air entering is filtered, sterilised instruments
• Not appropriate to make all areas of hospitals aseptic because of large number of people
• Resistant strains of bacteria are a problem in hospitals
• The risk of infection cannot be entirely removed from hospitals

• Involves taking organs from a donor and using them to replaced diseased organs in a patient
• Organs and tissues that can successfully transplanted include the heart, lungs, liver, kidneys, bone marrow and cornea
• There are problems with transplant surgery including the immune system of the patient might attack a new organs, this is called rejection
• Rejection is avoided by carefully matching the donor tissues with the patient's own tissues
• Tissues are more likely to match if the donor and recipient are closely related
• The risk of rejection can be reduced by giving the patient corticosteroid and immunosuppressant drugs, however they may make the patient more suseptible to infection

• Emergency surgery has to be performed without delay in order to save someone's life or avoid serious worsening of a patient's condition
• For example, a patient who has life threatening injuries after a car accident will recieve life saving emergency surgery
• When emergencies arise, it is sometimes necessary to cancel previously arranged procedures as emergencies take priority

• Elective surgery is surgery that is recommended to and agreed by a patient, but it is not an emergency
• The patient will be put on a waiting list for elective surgery
• Waiting lists are prioritised according to the severity of the condition

• Minor surgery involves procedures that are less damaging to body tissues
• They are shorter procedures that take less recovery time
• General anaesthetic may not be necessary and a local may be used instead
• Local anaesthetic enables the patient to stay awake and cooperate with the practitioner
• Can sometimes be performed during an outpatient visit and will not require a stay in hospital, this is called day surgery

• Endoscopy is a technique used to obersve relatively inaccessible parts of the body
• Long tube that can be inserted through a body opening
• It is equipped with a light and fibre optic cable which transmits an image to a camera, shown on a television screen
• Can be used to collect tissue samples by using a tiny brush or miniature forceps attachments
• Endoscopy minimises the damage to the surrounding tissues 

• A laser produces a beam of light that is intense enough to cut through body tissues
• The beam can be focused on a very small spot, enabling great precision to be used
• Lasers can be used to remove skin blemishes, or correct visual defecrs by removing tissue from the cornea
• Also used to carry out surgery on the retina of the eye
• Laser treatments can be carried out during outpatient vists
• Only requires local anaesthetic
• CO2 laser, which can be operated in continuous or pulsed mode, is commonly used
• Used in internal surgery, including excision of brain tumours
• Also used for skin treatments, including removal of noncancerous moles and scarring

• Uses a range of miniature, specialised equipment to perform operations on very small structures in the body
• Equipment includes, binocular microscope, through which the surgeon views the operation site, and small surgical instruments such as miniature scalpels and stitching needles
• This is used to operate on the eye and middle ear
• Necessary during replantation operations, in which a severed limb or finger may be rejoined to the body
• In this case, small structures such as blood vessels and nerves, have to be individually reconnected

The purpose of dialysis is to remove toxins and waste products such as urea from the blood in patients whose kidneys have failed. 

It is not a cure - kidney failure is incurable

Although, in some cases patients can have healthy kidneys from donors transplanted into their bodies 

• Haemodialysis is the technique used in emergency cases, such as acute kidney damage, poisoning or drug overdose
• Patients who need repeated treatments over a long period usually have a shunt attached to the forearm
• To do this, an incision is made in the person's forearm and a tube (the shunt) is sewn in, which attaches to both an artery and a vein
• A needle is placed in the shunt, and a tube is attached to needle is connected to a dialysis machine which continuously pumps blood from the patient across an artificial membrane through which waste products diffuse
• To make up for lost minerals and liquid lost through the filtering of the blood, a saline solution is fed into the cleaned blood before being pumped back into the body via another needle inserted in the downstream end of the shunt
• Takes around 4 hours, and repeated every 2 days, or 3 times a week

• Advantages of haemodialysis include the fact that it is quicker than alternative methods such as peritoneal dialysis
• It also results in the more complete removal of waste products
• A disadvantage is that it usually requires hospital treatment                        

Haemodialysis is done as when people have damaged kidneys, the process of maintaining the balance of electrolytes and water, and excreting waste products may fail causing harmful effects

Dialysis can take over the function of the kidneys until they start working normally again, or for the rest of the person's life if a kidney transplant is not performed 

• Used for non emergency cases who have chronic kidney failure
• In need of dialysis at regular intervals for the rest of their lives or until they undergo a transplant
• Incision made in the lower abdomen and a catheter is inserted permanently into the peritoneal cavity (a body structure containing the intestines)
• During dialysis, a suspended bag of liquid containing salts is allowed to empty its contents under gravity through the catheter into the peritoneal cavity
• This takes about an hour
• The dialysate is kept in the cavity for several hours, during which time the waste products will diffuse from the blood into the dialysate
• The mixture of dialysate and waste products are drained into a bag and disposed of
• This method relies on the diffusion of waste products from the blood into the peritoneal cavity
• Four times a day, every day
• Or, when using a continuous cycling peritoneal dialysis, it can be done overnight taking nine hours

• One advantage of peritoneal dialysis is that it is usually carried out in the patient's home which is more convenient than visting a hospital regularly
• One problem is the risk of infection in the peritoneal
• The blood is not cleaned as effectively as in haemodialysis which is why the procedure has to be repeated more often
• The process is more time consuming than haemodialysis

• Used to break gallstones into small pieces which can move them through the bile ducts to the intestines and be excreted
• Used to treat stones in the kidneys and urinary tract, to be passed through the urine
• Technique involves bombarding the stones with high-intensity and high-frequency sound waves
• The energy of waves is absorbed by the stones and shatters them
• A machine called a lithotripter produces the beam of sound waves via a liquid filled cushion places near the organ containing the stones
• A patient is given a general or epidural anaesthetic 
• X ray equipment is used which allows the operator to locate the stones and adjust the lithotripter to ensure that the shock waves target the stones
• One advantage of this procedure is that it avoids the need for surgery
• It is less invasive than the surgical removal of stones
• A disadvantage is that it is not effective in preventing the stones from being formed, with gallstones recurring in many cases within a few years

• Technique used to destroy cancer cells by using ionising radiation (high intensity x-rays)
• Used for cancers that are localised in one part of the body
• Radiotherapy is performed using external radiation 
• A machine produces a beam of radiation, directed to the part of the body to be treated
• The radiation damages healthy tissues in the body when reaching the cancerous cells
• A converging beam is used to minimise this
• Some radiation uses internal radiation
• This is radiation produced inside the body
• This is done by implanting pellets of radioactive material into the diseased tissue using a needle
• The radioactive pellets remain in the body and emit gamma rays with steadily reducing intensity
• Often used in conjuction with other methods such as after a tumour has been removed
• Delay futher development of cancer that is too advanced to be cured
• Used to destroy non=cancerous tissues such as an overactive thyroid gland

Side effects of radiotherapy:

• Tiredness
• Nausea
• Hair loss
• Vomitting
• Body tissues becoming less elastic, such as lungs so harder to breath
• Infertility when performed on pelvic area
• Radiotherapy can cause cancer
• Benefits outweigh the risks 

How it is done: 

• Patient lies on a table under linear accelerator
• A radiographer operates the machine which sends x-rays through diseased areas of the patient's body
• Usually lasts up to 30 minutes (the whole procedure)
• Performed on an outpatient basis