DEFINITION:-
It is a collection of air in the pleural space normally the pressure in the pleural space is negetive compare to atmospheric presure. This negetive pressure is require to maintain lung inflation.

ETIOLOGY:-
It may be due to internal or external trauma which can be differentiate according to the type of trauma & site of involve it.
TYPES:-
1. Closed pneumothorax:-
There is no association with external injury or wound this is most common form of sponteneous pneumothorax.

Cause:-
A. Injury to the lungs due tio any mechanical ventilation

B. Injury to the lungs due to any broken ribs
C. Rupture of the bells & belbs
D. Perforation
E. Under weight smokers

2. Open pneumothorax:-
In this type of pneumothorax air enter into pleural space due to external injury or trauma. for eg:- stab wound , gun shoot , any surgical procedure of thorax
3. Tension pneumothorax:-
Pneumothorax with rapid accumulation of air into pleural space causinghigh intrapleural pressure with result in tension of heart & blood vessel.
Clinical features :-
1. Lungs may collapse
2. Mediastinal shift

4.Hemothorax-
Accumulation of bloos in intrapleural space . it is mostly associated with open pneumothorax.

Causes:-
1. Cheast trauma
2. Lung malignancy
3. Comlication of anticoagulant therapy
4. Pulmonary embolism
5. Tearing of pleural adhesions
5.Cyclothorax:
If pneumothorax is mild tachycardia &dyspnea will occur . if it is severe in condition respiratory distress, severe dyspnea, rapid breathing &air hunger which isa severe form of respiratory distress , chest pain , cough with or without haemoptysis , anxiety

DIAGNOSTIC EVALUATION:-
1. Physical examination on auscultation no breath sounds over the affected area
2. Cheast x rays shows the pressure & shadow of pneumothorax
3. Examination of purcussion shows hyper ressonance.
Medical management :-
1. It depends on cause or severity of the diseasecondition in mild cases constructive treatment ilke oxygen administration should be provided
2. In severe cases cheast drainage should be done small chest trube is inserted into the second intercostal space , in caes of severe accumulation the tube is inserted into 4th intercostal space to remove the accumulated air .


SURGICAL MANAGEMENT:-
1. In case of repeated pneumothorax pleuroctomy may be done
2. Pleurodysis:-
Artificial production of adhesions between visceral 7 parietal pleura with the help of chemical agent.
3. Needle venting :-
Pricking a large bore needle into the thorax to remove accumulated air
NURSING MANAGEMENT :-
1. PROVIDE SUPPLIMENT OXYGEN PLACE THE PATIENT IN SEMIFOWLERS POSITION.
2. OBTAIN TRAY FOR DRAIN OUT THE ACCUMULATED SUBSTANCES
3. AFTER DRAINAGE ASK THE PATIENT TO REPORT ANY INCREASE DYSPNEA
4. PALOPATED FOR SUBCUTENEOUS EMPHYSEMA IN UPPER CHEAST & NECK REGION.

Defination- Major histocompatibility complex is tightly linked clusterof genes whose product play role in intercellular recognition and to make defference between self and nonself molecule.MHC molecule act as a antigen presenting structure. T cell recognize antigen only when it is combined with an MHC molecule.
Types- MHC molecule have two types
1) Class I MHC molecule 2) Class II MHC molecule
Structure- Type I MHC- It has a 45 KD alpha chain associated noncovalently with a 12 KD beta 2 microglobulin molecule. Alpha chain is a trans membraneglycoprotein encoded by A, B, C region in human HLA complexes and by K, D/L region in mice. Association of alpha chain and beta 2 microglobulin require for expression of class I molecule on cell membrane. Alpha chain bind to plasma membrane by its hydrophobic transmembrane segment and hydrophilic cytoplasmic tail. Alpha chain is made up of three external domain(α1,α2,α3). Each domain have 90 amino acid, a trans membrane domain have 25 hydrophobic amino acid, a short segment of hydrophilic amino acid and a cytoplasmic segment of 30 amino acid. Peptide which bind to class I MHC is made up of 8-9 amino acid.
Type II MHC- Class II MHC bind to peptide and present these peptides to CD4 T celles. These peptides derived from exogenous protein. Peptide degred with in the endocytic processing pathway Class II MHC peptide contain 13-18 amino acid. Peptide binding cleft in class II MHC molecule is open at both ends and allow peptide to extend at both ends like a long hot dog in a buns.Peptide have an internal sequence containing 7-10 amino acid. This sequence has an aromatic or hydrophobic residue at the amino terminus and 3 additional hydrophobic residue in the middle portion and carboxy terminal end of the peptide.

DEFINITION:- It is the collection of fluid in the pleural space. It is a type of primary disorder and due to this secondary sign and symptoms will occur.
TYPES:-
1. Transudate ( Hydrothorax)
2. Exudate

1. Transudate:-
In this type fluid passess through the membranes.
2. Exudate:-
It is a leakage of fluid from the blood vessels into the tissues.

TRANSUDATE occurs in non inflammatory condition. It is a process of accumulation of proteins poor, cell poor fluid which move across intact capilliaries walls. For eg.;- increased hydrostatic pressure in the congestive heart fauilure, decrease onchotic pressure in renal and liver disease.
Accumulation of fluids and cells in an area of inflammation for eg;- Any inflammatory condition , pulmonary malignancies, nephrotic syndrome occurs due to exudate condition.
PATHOPHYSIOLOGY:-
TRANSUDATE:-
Any alteration in the formation and reabsorbation of pleural; fluid due to imbalance in hydrostatic and onchotic pressure . It has low content of protein & the nature of fluid is clear & pale yellow./

EXUDATE:-
It occurs due to any inflammation and bacterial infection, tumors which causes exudation process . It has a high protein content & fluid is dark yellow & amber.

Pleural effusion

CLINICAL FEATURES:-
1. Pleuritic pain
2. Progressive dyspnea
3.Decreased cheast wall movement
4. fever
5. chills
6. Malignant effusion may result in dyspnea and coughing
7. Malaise
DIAGNOSTIC EVALUATIONS:-
1. Physical Examination
2. Pleural biopsy
3. Chest X-ray
4. Pleural fluid analysis
5. C T scan
6. Thoracentesis

MEDICAL MANAGEMENT:-
1. To discusss he underlying cause to prevent reaccumulation of fluid to relief discomfort &dyspnea are the purpose of management including thoracentessis aspiration through syringe.
2. Provide appropriate antibiotics
3. Provide diuretics therapy

NURSING MANAGEMENT:-
1. Take care of patient and prepare him for thoracentesis procedure
2. Reduce the pain by maintain the position &administering analgesics
3. Educate the patient & his family regarding care of drain tube if the client is an out patient.
4. Frequent turning of the patient position will facilitate drainage of the accumulation fluid.

Description:- Basal Cell Carcinoma
Definition:- Basal cell carcinoma is a type of skin Cancer; Basal cell carcinoma often appears as a Waxy bump, though it can take other form. Basal cell carcinoma occurs most often on areas of the skin that are often exposed to the sun, such as own face and neck.
Causes:- (1). Basal cell carcinoma occurs when one of the skin’s basal cell develops a mutation in its DNA, a Mutation in the DNA causes a Basal Cell to multiply rapidly and continue growing when it would normally die. Eventually the accumulating abnormal cell may form a Cancerous tumor
(2). Ultraviolet light & other causes; Much of the damage to DNA in basal cells is thought to result from ultraviolet(UV) radiation found in sunlight and in commercial tanning beds.But sun exposure doesn’t explain skin cancers that develop on skin not ordinarily exposed to sunlight. This indicates that other other factors may contribute to own risk of skin cancer , such as being exposed to toxic substances or having a condition that weakens own immune system
Symptoms:- Although a general warning sign of skin cancer is a sore that won’t heal or that repeatedly bleeds and scabs over, basal cell cancer may also appear as:-
1) A pearly white or waxy bump,
2) Often with visible blood vessels, on face , ears or neck.
3) A flat, scaly, brown or flesh-colored patch on back or chest.
4) More rarely, a white, waxy scar

Remedies:-
1). Eat at least 5 servings of fruits and vegetables each day, especially those food rich in the Antioxidants Beta Carotene, vitamin C , and citrus fruits.
2). Include in Diet plenty of whole grains, sea vegetables, beans and soyabeans, hot peppers, cabbage, tomatoes, onions, rosemary, garlic grapes, licorice root, green tea, white fish, mushrooms.
3). Avoid red Meat, processed foods, red and yellow dyes, monosodium glutamate, nitrites(found in cured meats), saccharin sugar, dairy products, alcohol, caffeine containing drinks.

Definition-:Diabetes melietus is a metabolic disorder which is characterized by hyperglycemic condition due to defective functioning of insulin hormone…
It may be due to abnormal secretion of insulin & altered functioning of insulin hormone which secrets by beta cells of pancreas…
Etiology-: according to etiology it divides in 3 types;
• Insulin dependent diabetes melietus
• Non insulin dependent diabetes melietus
• Gestational induced diabetes melietus….
Absolute or relative lack of insulin produce by beta cells resulting in hyper glycemia….
Impaired secretory respons of insulin to rises in glucose & due to this gluneogenesis may occurs..
IDDM:-it may cause due to following reasons-
• Autoimmunity
• Viral infections
• Environmental theories
• Other disease conditions.
• Old age
NIDDM:-It may cause by following reasons-
• Hereditary
• Genetic
• Obesity
• Beta cells defect
GIDM:-It define as glucose intolerance occurring during pregnancy &disappear after delivery…

Clinical menifestations:-there are many sign & symptoms :
1. Hyperglycemia
2. Weight loss
3. Poly urea
4. Poly depsia
5. Poly phagia
6. Blurred vision
7. Altered tissue perfusion
8. Poor wound healing
9. Recurrent infection
10. Skin infection may be appear
11. Dry skin
12. Kitoacidosis
13. Dehydration
Diagnostic evaluations:-many tests are useful for evaluation
• Glucose tolerance test
• Fasting glucose test
• Blood test
• Urine test
• Physical examinations
• History taking
Management;-management of this divided in 3 types;-
1. Medical management
2. Dietary management
3. Exercise
• Medical management: many hypoglycemic agents are given for reduce level of glucose:-
Eg; tolbutamide; metformine; glycazideetc;
• Dietary management;-dietary control with caloric restriction of carbohydrate maintain ideal body weight .
The goal of meal planning is to control blood glucose level& weight reduction is another goal;;
• Exercise:-regular schedule of exercise also helpful in reduction of blood glucose level
Complications:-
1. Diabetes keto acidosis
2. Cerebral vascular disease
3. Retinopathy
4. Neuropathy
5. Peripheral vascular disease
6. Cardiac disorders