The incidence of breast cancer in men has increased in recent years with larger tumors and more aggressive growth than in women, according to a study released today at the website of the journal “Cancer.”

According to Sharon Giordano, professor of breast oncology at the University of Texas and author of the research, the increase was from 0.86 per 100,000 men in 1973 to 1.08 in 1998.

The oncologist says that the research results also indicate that breast cancer in men is biologically different from women.

“Breast cancer in men is rare (less than one percent of all cancer of this type) or about 1,600 new cases in the U.S. in 2004,” said Sharon.

The researcher said that “even with this small effect men should remain alert to the possibility that the disease affects them.”

With information provided by the National Cancer Institute, Giordano examined 2524 cases of cancer in men and 380,856 women. When compared to women, researchers found that men with breast cancer had higher mean age, 67 years vs. 62 years for women.

In addition, the disease had been discovered at an advanced stage when the cancer was gone to his lymph nodes.

“It’s ironic that tumors in men are easier to detect than in women. However, the disease is discovered them in a more advanced stage than in females,” said the oncologist.

Dr. Giordano said that in many cases, to detect growth, involve men experiencing a benign condition called gynecomastia, is an atypical growth of breast tissue that affects one third of men at some stage in his life, especially in adolescence.

The most common types of breast cancer in men are invasive ductal or unclassified carcinomas (93.4 percent) and papillary carcinoma, the study said.

Nutritional support
Nutrition plays an important role in the holistic approach of healing the wounds. A good fovorece nutritional support not only the healing of pressure ulcers but also can avoid the appearance of them. An important part of the healing of these is local and occurs even with nutritional dysfunction, although the scientific community agrees that a poor nutritional status, a delay or inability to complete healing of injuries and encouraging the emergence of new ones.

Cynically severe malnutrition is diagnosed if serum albumin is less than 3.5 mg / dL, total lymphocyte count is below 1800/mm3, or if body weight decreased more than 15%. The nutritional needs of a person with pressure ulcers are increased.

The diet of patients with pressure ulcers should ensure a minimum contribution of:
* Calories (30-35 Kcal x Kq.peso / day)
* Proteins (1.25 to 1.5 g / Kg.peso / day) (may be necessary to increase up to 2gr./Kg. weight / day).
* Minerals: Zinc, Iron, Copper
* Vitamins: Vit C, Vit A, B Complex
* Contribution water (1 cc. Kcal.día Water x) (30 cc Water / day x Kg.peso)

If the patient’s usual diet does not cover these needs should be used to supplement oral enteral nutrition hyperproteic to avoid situations of deficiency.

Emotional Support
The presence of a skin lesion may cause a significant change in activities of daily living because of physical, emotional or social challenges that can translate into a deficit in self-care demand and the ability to provide these self-care. In the case of pressure ulcers they may have important consequences on the individual and his family, in variables such as autonomy, self-image, self esteem, etc.. therefore be borne in mind this important dimension to the time to plan your care.

Care of the ulcer
A basic plan of local care of ulcer should consider:

• Debridement of necrotic tissue
• Clean the wound
• Prevention and treatment of bacterial infection
• Choosing a product that continually keep the ulcer bed moist and body temperature.

Debridement
The presence in the wound bed necrotic tissue and eschar either black, yellow, .. , Wet or dry in nature, serving as ideal medium for bacterial growth and impedes the healing process. In any case the overall situation of the patient condition debridement (patients with bleeding disorders, patients with terminal illness, etc.). The characteristics of the tissue to debride also guide the type of debridement performed.

From a practical way we can classify the methods of debridement:
“sharp (surgical)”, “chemical (enzymatic)”, “suicidal” and “mechanical”.
These methods are not mutually incompatible, so it would be advisable to combine them for best results.

• Sharp or surgical debridement

Surgical debridement is a bloody procedure that requires knowledge, skill and technique and sterile equipment. Moreover, the policy of each institution to determine level of care performed by whom and where. Sharp debridement should be carried out by planes and in different sessions (except radical surgical debridement), always starting from the central area by seeking early release of devitalized tissue on one side of the lesion.

Faced with the possibility of the occurrence of pain in this technique, we recommend the implementation of an antalgic t6pico (2% lidocaine gel, etc.).. The bleeding can be a common complication that usually we can control by direct pressure, hemostatic dressings, etc.. If the situation did not yield the above measures will be used to suture the bleeding vessel. Once controlled the bleeding would be desirable to use for a period of 8 to 24 hours a dry dressing, changing later by a wet dressing.

• The wet (enzyme)

Chemical or enzymatic debridement is a method to assess when the patient does not tolerate surgical debridement and no signs of infection. There are several products on the market enzymatic (proteolytic, fibrinolytic, …) that can be used as chemical agents detersión necrotic tissue. Collagenase is an example of such substances.

There is scientific evidence indicates that it favors debridement and granulation tissue growth. When intended to be used, you should protect your skin using a paste periulceral zinc siliciona, etc.., Like, that increasing the level of moisture in the wound to enhance their action.

• Autolytic Debridement

Autolytic Debridement be fostered through the use of products introduced in the moist healing principle. It is caused by three factors, hydration of the bed of the ulcer, fibrinolysis and the action of endogenous enzymes on devitalized tissue. This form of debridement is more selective and atraumatic, requiring no specific clinical skills and being generally well accepted by patients.

It has a slower action in time. Any dressing capable of producing wet curing conditions, generally and the hydrogels in a specific amorphous structure are capable of producing products autolytic debridement. For wounds with tissue sloughing, the hydrogels in amorphous structure (gels), for its moisturizing facilitate the elimination of non-viable tissue and should therefore be considered as one option for debridement

• Mechanical debridement.

This technique is not selective and traumatic. Mainly done by mechanical abrasion by friction forces (friction), use of dextranomer, through irrigation pressure wound dressings or wet utilizaci6n that last 4-6 hours drying adhere to necrotic tissue, but also the woven healthy, that starts with his retirement. At present techniques obsolete.

• Cleaning the lesion

Clean the injury initially and every priest.
Use as standard saline.
Use minimal mechanical force to clean the ulcer and for their subsequent drying.
Use effective pressure washing to facilitate hauling of debris, bacteria and remnants of previous treatments, but without ability to produce healthy tissue trauma.

The most effective pressure washing is provided by gravity or by example that we do through a 35 ml syringe with a needle of 0.9 mm catheter that projects the saline over the wound at a pressure of 2 kg ./cm2.

Pressure washing of the ulcer effective and safe ranges between I and 4 kg./cm2.

Can not clean the wound local antiseptic (povidone iodine, chlorhexidine, hydrogen peroxide, acetic acid, hypochlorite solution,) or skin cleansers.

All chemicals are cytotoxic to the new tissue and in some cases their continued use can cause systemic problems in their absorption into the body.

Prevention and treatment of bacterial infection

• Choice of dressing

The available scientific evidence demonstrating the clinical effectiveness and the perspective cost-benefit (spacing of priests, handling minor injuries …) of the technique of wound healing in a moist environment versus traditional or cure.

An ideal dressing should be biocompatible, protect the wound from external aggression physical, chemical and bacterial, to keep the ulcer bed continuously moist and dry the surrounding skin, eliminating and controlling exudate and necrotic tissue by absorption, leaving the minimum amount of waste in the lesion, being adaptable to difficult locations and be easy to apply and remove.

The gauze can not meet most of the above requirements.

“The selection of an oppositional cure in a moist environment must take place by considering the following variables:
Location of injury
Stadium
Severity of ulcer
Amount of exudate
Presence of tunneling
State of surrounding skin
Signs of infection
General condition of the patient
Level of care and availability of resources
Cost-effectiveness

Ease of application in contexts of self-care
To avoid the formation of abscesses or “false closure” of injury, be required to complete part (between half and three quarters) and tunneling cavities with products based on the principle of wet cure.

The frequency of dressing changes each pair is determined the specifics of the chosen product.

Dressing should be selected to enable optimal management of exudates without Allowing it to dry out the bed of the ulcer or periulceral tissue injury.

• Adjunctive Treatment

Currently, the electrical stimulation is the only adjunctive therapy with complementary features enough to justify the recommendation. May arise in those two pressure ulcers Stage III and IV who have not responded to conventional therapy. In any case you should make sure that it has adequate equipment and personnel trained in their use, following the protocols that have Demonstrated safety and efficacy in controlled trials.

• Colonization and bacterial infection in pressure ulcers

All pressure ulcers are contaminated by bacteria, which is not to say that injuries are infected. In most cases, effective cleaning and debridement impossible for bacterial colonization to progress to clinical infection. The diagnosis of infection associated with pressure ulcer, should be primarily clinical.

The classic symptoms of local infection of the skin ulcer are:
Inflammation (erythema, edema, tumor, heat)
Pain
Odor

Purulent discharge
The infection of an ulcer may be influenced by patient-specific factors (nutritional deficiencies, obesity, drugs, immunosuppressants, cytotoxic, concomitant diseases, diabetes, tumors, …, old age, incontinence, etc.). And others related to the injury (stage , presence of necrotic tissue and sloughing, tunneling unstressed injuries, circulatory disturbances in the area, etc. ..) In the presence of local signs of infection should be intensified cleaning and debridement.

If, within two to four weeks, the ulcer is not progressing well or continuing with signs of local infection, having ruled out the presence of osteomyelitis., Cellulitis or sepsis, should be implemented a treatment regimen with a local antibiotic effectiveness against microorganisms most frequently infected pressure ulcers (eg silver sulfadiazine, fusidic acid …) and for a maximum period of two weeks.

If the injury does not respond to local treatment must be carried out then, bacterial cultures, qualitative and quantitative, preferably by percutaneous needle aspiration biopsy tissue, avoiding, if possible, the collection of exudate smear can detect only surface contaminants and not the real organism responsible for infection.

Identified the germ will pose specific antibiotic therapy, reevaluate the patient and the injury.

Infection control.

• Follow precautions for body substance isolation
• Use clean gloves and change them with each patient
• Hand washing between procedures with patients is essential.
• Can multiple ulcers in patients, starting with the least contaminated
• Use sterile instruments surgical debridement of pressure sores
• Do not use local antiseptics.
• Systemic antibiotics should be given a prescription low in patients with bacteremia, sepsis, advanced cellulitis or osteomyelitis.
• Comply with waste disposal regulations of their institution.

Surgical repair of pressure ulcers
It should consider surgical repair in patients with pressure ulcers stages III or IV, unresponsive to conventional therapy. Similarly, elements will be necessary to assess the quality of life, risk of recurrence, patient preferences, and so on. Along with the potential to be a candidate for surgical treatment (postoperative immobility avoiding pressure on the affected region, proper nutrition, medically stable, etc.)..

Educations and improving the quality of life
The education program should be an integral part of quality improvement. Educational programs are an essential component of care for pressure ulcers. They must integrate basic knowledge about these lesions and should cover the full spectrum of care for prevention and treatment. They will be directed towards patients, families, caregivers and health professionals.

Palliative care and pressure ulcers
Whether a patient is in terminal stage of their illness does not justify to be made claudicaren order to avoid the occurrence of pressure ulcers. In the event that a patient have pressure ulcers should act:

• It blames the care environment of the occurrence of injuries.
• It is a common complication in many cases at that stage, probably inevitable.
• Raising realistic therapeutic goals according to the chance of cure, avoiding as possible aggressive techniques.
• Keeping the wound clean and protected, to prevent the development of infection.
• Selecting dressings which allow the frequency distance of the cures to prevent discomfort caused by this procedure.
• Improving patient comfort, avoiding pain and trying to control, if any, the stench of the lesions (using activated charcoal dressings, Metronidazole gel, etc.).
• In dying situation will be necessary to assess the need for repositioning the patient.

Evaluation indicators and benchmarks
The evaluation process is an essential tool for improving the effectiveness of the procedures employed in the care of pressure ulcers. It is necessary to establish a quality program with the aim of improving care provided to patients, facilitate teamwork and make objective clinical practice.

The problems of these injuries must be approached from an interdisciplinary approach. The results of the care can be measured based on the incidence and prevalence of pressure sores. The incidence and prevalence studies should be conducted periodically by the ideal would monitor them and integrate them into a local policy on a pressure ulcer.

As an instrument to assess the evolution of these injuries can use the severity index. Descriptive other variables can be used to evaluate the process time. Concerning the lesion (staging, number of injuries, length, volume, source etc.). Or refer the patient (age, gender, risk assessment scale for pressure ulcers etc.)..

Pressure ulcers can and should be avoided with good nursing care within an overall plan that includes the multidisciplinary work of the physician, nurse, patient and family. We must find the ideal treatment for each type of ulcer and in many cases, using different treatments, as observed evolution.

When blood pressure is consistently high, we can say that a picture is suffering from hypertension. Systolic blood pressure rises due to various reasons such as physical exercises, and the hard work, but also by strong emotions such as anger, fear, and anxiety. Diastolic blood pressure is very significant in relation to the state of the heart, and reflects the level of basal pressure in the arterial network.

In this sense, the emotional roller coaster, and physical and mental activity can alter levels of PS. It happens that as you change the physical and mental activity, also modified the requirements of blood from different parts of the body. To meet these needs extras, the heart has to pump blood with greater pressure.

Thus she can say that blood pressure depends on the activity of each person, which may also vary in the same person during different parts of the day. So much so that the PS changes not only when a person walks or runs, but when you sit, or stand.

But as noted, hypertension also depends on the mental constitution of a particular person, so that two different people might respond differently to similar situations.

There are two types of hypertension. The first is called primary or essential, while the second, secondary.

Primary Hypertension

In this case, patients do not experience any specific symptoms, even if they have high blood pressure. The causes of this specific type of hypertension are still unknown day for medical science. But we do know, however, is that if it is not detected and controlled at an early stage, can cause heart attacks and kidney damage, thereby reducing life expectancy by years and even decades. Usually, the causes that are attributed to primary hypertension, has to do with:

a. The stress and effort

b. Emotional problems

c. Genetic factors

d. The world of work

e. Obesity

f. The geographic location and climatic condition of the place where one stays

g. The type of personality, especially the ambitious, overworked, anxious and hyperactive

h. Bad lifestyles, such as lack of exercise, use or abuse of stimulants, or an inappropriate diet.

Secondary Hypertension

This is a type of hypertension that occurs as a collateral consequence of some physical cause, such as:

a. Infections or kidney damage

b. Malfunction of the endocrine glands

c. Aortas arteries narrow or very broad

d. Hardening of the arteries, or thick compound formation in the inner walls of the same, condition called atherosclerosis.

e. Loss of elasticity in arteries or veins, blood clots, or fat accumulation, which results in the closure of many arteries, causing damage to the organs to which these arteries supply blood.

f. Pregnancy

g. Blockages in blood vessels formed at birth. To get through these vessels, the pressure must increase. These blockages of the vessels can also develop later in life mainly because of the same PS.

h. Malfunction of the pituitary gland

i. Excess or lack of work of the thyroid gland

j. Blockages in the vessels of the kidney

k. Excessive secretion of adrenal hormones

Hypertension is usually asymptomatic, in other words means it is a disease that has no easy to notice symptoms. Indeed, hypertension often goes generally unnoticed, so more than once can only be detected when it is too late, and the same and becomes chronic. For that reason, hypertension is also called the “silent murderer” or “disease in disguise.”

Once the chronic hypertension has been made, most likely emerge stronger symptoms such as headaches, presence of strange sounds in the ears, constant feeling of fatigue, cloudy vision, or failure in kidney function.

The brain is the largest and most voluminous body of the head, consisting of over 15,000 million specific nerve cells, called neurons.

Neuron, morphologically. It consists of 3 parts:
A) SOMA: The starry body of the cell.
B) Axon: It is the main extension and connecting with other neurons.
C) Dendrites: They are responsible for receiving the information from the axons of other neurons.

However, the neuron can be activated by itself?, Well no, as any engine needs its liquid element.      The neuron secretes a chemical mediators known by the name of neurotransmitters. These are what activate the neuron transmitting the messages and information from one neuron to another.

But the brain to function properly, needs not only nerve cells and the smooth functioning of neurotransmitters. Also need to be well supplied by blood, using either oxygen and glucose and has the enzymes (which are proteins) required for the biochemical reactions that will allow interneuronal transmission of information. (See Annexes 1 and 2 outline the normal brain and then the cerebral cortex in Alzheimer’s disease.)

Causes of Alzheimer’s disease, incidence and risk factors.
The cause of Alzheimer’s disease is unknown, but is not part of the normal aging process. Have been ruled out earlier theories regarding the accumulation of aluminum, lead, mercury and other substances in the body.

Biological Factors:
The neurons that control memory and thinking are impaired, interrupting the passage of messages between them. These cells develop distinct changes: senile plaques and neurofibrillary bundles (degeneration of brain tissue).

The cortex of the brain (the main source of intellectual functions) are atrophy, shrink and the spaces in the center of the brain become enlarged, thus reducing its surface.

The second significant finding is a high concentration of sticky protein called beta amyloid, which forms patches called neuritic plaques.

Inflammatory Response
Some researchers believe that beta amyloid fragments may break loose oxygen free radicals (normal chemical in the body that cause various processes are harmful when produced in excess). One of these processes may be the inflammatory response in which the immune system releases antibodies whose mission is to combat harmful agents, but, if produced in excess, can damage body cells themselves.

Genetic Factors
Researchers are closer to identifying defective genes responsible for Alzheimer’s early onset, a rare but extremely aggressive form of the disease

The brain tissue shows “neurofibrillary tangles” (twisted fragments of protein within nerve cells that clog), “neuritic plaques” (abnormal clusters of dead nerve cells and dying, other brain cells and protein) and “senile plaques” ( areas where products have accumulated around protein dead neurons). Although these changes occur to some extent in all brains with age, there are many more in the brains of people with Alzheimer’s disease.

The destruction of nerve cells (neurons) leads to a decrease in neurotransmitters (substances secreted by a neuron to send a message to another neuron), whose right balance is critical to the brain. The three neurotransmitters commonly affected by Alzheimer’s disease are acetylcholine, serotonin and norepinephrine, acetylcholine is the most affected.

By causing both structural and chemical changes in the brain, Alzheimer’s disease appears to disconnect areas of the brain that normally work together.

Approximately 4 million Americans currently suffer from Alzheimer’s disease. The most important risk factors for dementia are older age and family history of dementia. The greater the person, the greater the risk of developing this disease.

About 10% of people over 70 have significant memory problems and about half of these are caused by Alzheimer’s disease. The number of people with the disease doubles every decade after age 70 and having a close blood relative who developed AD increases your risk. Because women live longer than men, are more likely to develop it.

Two types of Alzheimer’s disease, the early onset and late onset. In the first, symptoms appear before 60 years, and in some cases, early onset disease runs in families and involves autosomal dominant, inherited mutations that may be the cause of the disease. So far, three genes have been identified early onset, which is the least common, comprising only 5 and 10% of cases.

Alzheimer’s disease late onset, which is the most common type, develops in people 60 years or more and is believed to be less likely to occur in families. Alzheimer’s disease late onset may occur in some families, but the role of genes is less direct and definitive. It is possible that these genes may not cause the problem itself, but simply increase the probability of formation of plaques and tangles or other diseases related to Alzheimer’s disease in the brain.

Conceptual definition of nursing diagnosis.
A theoretical and conceptual framework is a list of concepts interrrelacionados provides a way of thinking about:
- The concept of customer (individual and environment)
- Goal of nursing.
- Nursing Interventions

Methodological definition of nursing diagnosis
The idea of methodological concept tells us how to get to a diagnosis through the nursing hierarchy of needs “phenomenon” and the actions of the nursing care.
The methodological concept of nursing diagnosis is the conclusion of the assessment that allows the design and construction plan of care through the collection of information, interpretation of data …
Campbell defines the nursing diagnosis from a methodological point of view as the identification of subjective responses, and the establishment of the changes that you must enter the nurse for the changes occurring.

In summary, the diagnosis comes from the Greek word dia-gignoskein, which is known through, analyze the nature of a situation. Thus we can define the diagnosis as the identification of the nature of a situation or health problem and the possible cause of it. Clinical trial on a response from the person to life processes and health problems. A necessity is that the individual must meet in order to remain within a state of health or within normality.

One problem is the result of an unmet need to which the person responds in different ways, is what we call symptoms (emotional, physical, verbal or not).

One hypothesis is an assumption, assumption, conjecture, or starting point of an argument that should be supported by a body of theoretical knowledge or approved by science, must be comparable and possible to prove scientifically.

Structure of nursing diagnosis
The essential components of nursing diagnoses are based on the PES format, the following:
1. Health problem, is the title or label, is the concise description of the problem.
2. Etiology, the factors that contribute to this cause the problem.
3. Signs and symptoms are the manifestations that are often in the diagnosis in particular.

The normal amount of cholesterol in the blood of a healthy individual did not exceed the 200 mg / dl. Cholesterol itself is not bad, makes essential functions (synthesis of hormones, formation of cell membranes). What is harmful is its excess. There are two types of cholesterol, LDL that is bound to lipoproteins, LDL, bad cholesterol, when there is an excess is deposited in the arteries forming atheromas. HDL cholesterol, which is bound to lipoproteins, HDL is called good cholesterol, transported to the liver to make bile salts.

General care for lowering cholesterol :
1 .- Diet appropriate, to minimize the excess cholesterol foods (eggs, butter, sausages, offal, pork, beef, lamb and game, seafood, cheeses and semi-dried, whole milk) and triglycerides of saturated, increasing unsaturated (olive oil, seeds, fish, blue or white).
2 .- If you are overweight, the diet should be low in calories.
3 .- If it is hypertension, diet should be low in salt.
4 .- Reduce your consumption of snuff.
5 .- Reduce alcohol consumption.
6 .- Perform moderate physical exercise on a regular basis
7 .- Take medication:

– Take medications at the same time.
- Put them in the light, lest we forget.
- Remember the Time.

The public health nurse is the nurse of “any court” not only by the type of approach, the first collective to individual for the second but by its representation of men and health. The nature of their activities will be based on different concepts and the place of the individual devices will be changed.  The nurse refers the person (usually a woman), which provides comfort in times of painful illness. The nurse is also the one that makes the link between the doctor and between “what is happening,” what will happen, “what will I do” … It is much less clear for the “public health nurse.

It therefore seems difficult that the nurse specializing in public health as it does for the techniques of surgery or nursery. The formation of the public health nurse should enable it to understand human health and a truly global with tools and methods specific differentiated care. Moreover, such training should enable them to exchange experiences with other types of non-professional caregivers, such as social workers and people (or caregivers) of different cultures … to affect the diversity and complementarity approaches to health.  In other words, training can be specific to the nurse, public health training aimed at other health professionals or social development: the DESS “Health Promotion and Social Development:

The nurse of “public health” with his particular vision of man and his health could then propose an alternative and complementary products under the care, support and prevention.