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How to Reduce Pain and Stiffness in Arthritis with Hot and Cold Therapy

You want to reduce pain and stiffness in the joints soon disappear? Now you can try to do hot and cold therapy. This therapy uses heat energy at once cold to relieve symptoms of arthritis. According to health experts, hot and cold works by stimulating the body's ability to heal itself.

According to the doctors, the heat is used, serves to dilate blood vessels, stimulate blood circulation and reduce stiffness. In addition, the heat also serves to eliminate the sensation of pain. You can use a variety of equipment such as heating pad, heat lamp, or using steam heat by warm baths or compresses with a cloth soaked in hot water.

In contrast to heat, cold compresses reduce the inflammation by means of screwed or shrink the blood vessels. Although the sensation of water ice compress or pack a bag of ice will cause discomfort in the beginning, but this way can reduce pain.

When using heat therapy of steam, make sure the temperature is not too hot to avoid the possibility of skin burns. Choose a temperature you can tolerate, either with a bath of warm water, using a bottle filled with hot water, or hot spa.

You can do a heat treatment of at least 15 minutes before physical exercise. Then you should immediately use again after exercise. Additionally, you can also use the steam any time you require additional treatment to relieve the pain.

Effectiveness of heat therapy. Many arthritis sufferers reported having experienced a reduction in pain and stiffness after a hot shower or do the hot spa. The use of hot steam otherwise effectively relax muscles, improve blood supply to the affected area and relieve muscle stiffness. However, avoid heat therapy if you suffer from diabetes, hypertension, cardiovascular disease, or if you are pregnant.

According to the doctor and patient reports, this therapy is also effective in relieving the pain of arthritis. Ice bag used as a compress on the inflamed area will be working to reduce inflammation and swelling. Ice bag is particularly good for relieving pain in joints due to the heat generated by arthritis. In addition to ice, you can also try the local spray as fluoromethane (nonflammable) on the back or the affected area before and after physical activity. This cooler serves to relieve muscle stiffness and improve your ability to withstand pain. Or to make things easier, you can make an ice pack to wrap vegetables that have been refrigerated or frozen.

Which is better, hot or cold? Some patients prefer cold therapy compared to vapor. While some other patients who claimed to get the best results by combining the two. To get the right choice, you could do the experiment.

To get the best results, try using steam heat therapy or a bag of ice at least twice a day. According to the American College of Rheumatology, compresses or massaging the affected area with ice for 5-10 minutes, within 48 hours of first relapse, can help to relieve pain. Medium heat should be used for pain that persists for more than 48 hours.

Lists of Reflexes You Need to Know

Lists of Reflexes

Accommodation Reflex

The accommodation reflex is a reflex action of the eye, in response to focusing on a near object, then looking at distant object (and vice versa), comprising coordinated changes in vergence, lens shape and pupil size (accommodation). It is dependent on cranial nerve II (afferent limb of reflex), superior centers (interneuron) and cranial nerve III (efferent limb of reflex).

Acoustic Reflex

The acoustic reflex is an involuntary muscle contraction that occurs in the middle ear in response to high-intensity sound stimuli or when the person starts to vocalize.

Asymmetrical Tonic Neck Reflex

The asymmetrical tonic neck reflex (ATNR) is a primitive reflex found in newborn humans, but normally vanishes around three months of age.
It is also known as the "fencing reflex" because of the characteristic position of the infant's arms and head, which resembles that of a classically trained fencer. When the face is turned to one side, the arm and leg on the side to which the face is turned extend and the arm and leg on the opposite side flex.

Ankle Jerk Reflex

The ankle jerk reflex occurs when the Achilles tendon is tapped while the foot is dorsi-flexed. A positive result would be the jerking of the foot towards its plantar surface. Being a deep tendon reflex, it is monosynaptic. It is also a stretch reflex. These are monosynaptic spinal segmental reflexes. When they are intact, integrity of the following is confirmed: cutaneous innervation, motor supply, and cortical input to the corresponding spinal segment.

Babinski Reflex

Babinski reflex is one of the normal reflexes in infants. Reflexes are responses that occur when the body receives a certain stimulus. The Babinski reflex occurs after the sole of the foot has been firmly stroked. The big toe then moves upward or toward the top surface of the foot. The other toes fan out. This reflex is normal in children up to 2 years old. It disappears as the child gets older. It may disappear as early as 12 months.

Biceps Reflex

Biceps reflex is a reflex test that examines the function of the C5 reflex arc and the C6 reflex arc. The test is performed by using a tendon hammer to quickly depress the biceps brachii tendon as it passes through the cubital fossa. Specifically, the test activates the stretch receptors inside the biceps brachii muscle which communicates mainly with the C5 spinal nerve and partially with the C6 spinal nerve to induce a reflex contraction of the biceps muscle and jerk of the forearm.

Brachioradialis Reflex

The brachioradialis reflex (also known as supinator reflex)is observed during a neurological exam by striking the brachioradialis tendon (at its insertion at the base of the wrist into the radial styloid process (radial side of wrist around 4 inches proximal to base of thumb)) directly with a reflex hammer when the patient's arm is relaxing. This reflex is carried by the radial nerve (spinal level: C6,C7)

Corneal Reflex

The corneal reflex, also known as the blink reflex, is an involuntary blinking of the eyelids elicited by stimulation of the cornea (such as by touching or by a foreign body), though could result from any peripheral stimulus.

Glabellar Reflex

Glabellar reflex is a primitive reflex. It is elicited by repetitive tapping on the forehead. Subjects blink in response to the first several taps. If the blinking persists, this is known as Myerson's sign and is abnormal and a sign of frontal release; it is often seen in people who have Parkinson's disease.

Golgi Tendon Reflex

The Golgi tendon reflex is a normal component of the reflex arc of the peripheral nervous system. In a Golgi tendon reflex, skeletal muscle contraction causes the agonist muscle to simultaneously lengthen and relax.

Jaw Jerk Reflex

The jaw jerk reflex or the masseter reflex is a stretch reflex used to test the status of a patient's trigeminal nerve (CN V) and to help distinguish an upper cervical cord compression from lesions that are above the foramen magnum.

Moro Reflex

The Moro reflex is an infantile reflex normally present in all infants/newborns up to 3 or 4 months of age as a response to a sudden loss of support, when the infant feels as if it is falling. It involves three distinct components; spreading out the arms (abduction), unspreading the arms (adduction), crying (usually).
The primary significance of the Moro reflex is in evaluating integration of the central nervous system. It is distinct from the startle reflex,[1] and is believed to be the only unlearned fear in human newborns.

Palmar Grasp Reflex

Palmar grasp reflex (sometimes simply called grasp reflex) is a primitive reflex. It appears as early as 16 weeks in utero and persists until five or six months of age. When an object is placed in the infant's hand and strokes their palm, the fingers will close and they will grasp it with a palmar grasp. The grip is strong but unpredictable; though it may be able to support the child's weight, they may also release their grip suddenly and without warning. The reverse motion can be induced by stroking the back or side of the hand.

Patellar Reflex

The patellar reflex or knee-jerk is a stretch reflex which tests the L2, L3, and L4 segments of the spinal cord.

Plantar Reflex

The plantar reflex is a reflex elicited when the sole of the foot is stimulated with a blunt instrument. The reflex can take one of two forms.

Pupillary Light Reflex

The pupillary light reflex (PLR) or photopupillary reflex is a reflex that controls the diameter of the pupil, in response to the intensity (luminance) of light that falls on the retinal ganglion cells of the retina in the back of the eye, thereby assisting in adaptation to various levels of lightness/darkness.

Rooting Reflex

The rooting reflex is present at birth(age of appearance 28weeks) and disappears around four months of age, as it gradually comes under voluntary control. The rooting reflex assists in the act of breastfeeding.

Righting Reflex

The righting reflex is a reflex that corrects the orientation of the body when it is taken out of its normal upright position.

Triceps Reflex

The triceps reflex, a deep tendon reflex, is a reflex as it elicits involuntary contraction of the triceps brachii muscle. It is initiated by the Cervical (of the neck region) spinal nerve 7 nerve root (the small segment of the nerve that emerges from the spinal cord). The reflex is tested as part of the neurological examination to assess the sensory and motor pathways within the C7 and C8 spinal nerves.

Source : wikipedia

Wilms Tumor - Causes, Clinical Manifestations, Diagnostic, Complication and Management

Wilms Tumor - Causes, Clinical Manifestations, Diagnostic, Complication and Management

Wilms tumor or nephroblastoma is a cancer of the kidneys that typically occurs in children, rarely in adults. It is named after Dr. Max Wilms, the German surgeon (1867–1918) who first described it.

Type of renal carcinoma is the most frequently encountered arise from renal epithelium and cause more than 85% of kidney tumors. These tumors metastasize first to the lungs, bones, liver, brain, and the contralateral kidney. A quarter of patients had metastatic disease at time of diagnosis. (Brunner & Suddarth, 2014).


1. Exactly unknown
2. Genetic predisposition
3. Can be associated with congenital anomalies: which often is sporadic aniridia, genitourinary anomalies, hemihypertrophy, microcephaly and cryptorchidism. (Suriadi & Rita Yulianni, 2006).

Clinical Manifestations
1. There is a mass in the abdomen.
2. haematuria.
3. Hypertension.
4. Abdominal pain.
5. Anemia.
6. Fever.
7. Metastatic to the lungs, shortness of breath, dyspnea, cough, chest pain.
8. Pale.
9. Lethargy.
10. Anorexia.

1. Physical examination.
2. Ultrasound.
3. CT scan.
4. X-rays.
5. CBC, electrolytic, BUN, creatinine and urine analysis.
6. Biopsy.

1. Metastasis.
2. Poor Prognosis
3. Complications from surgery.

1. Chemotherapy with or without radiation
2. Surgery

Fluid Volume Deficit related to Dehydration

Dehydration occurs when water or fluids out of the body more than the incoming fluid, so that the body is not able to function as it should. If the fluid needs are not immediately met, then the body will become dehydrated.

The initial signs of dehydration include:
  • Feeling thirsty.
  • Dizziness.
  • Dark yellow urine color.
  • Frequency of urination less than usual.
The most obvious indicator to determine the body dehydration / less fluid is to look at the color of urine: if bright and clear, the body hydrated, and if the yellow - dark red then it is almost certainly a sign of dehydration.

Dehydration mild - moderate effect and can cause the following symptoms:
  • Dry mouth and sticky.
  • Tired and sleepy.
  • Thirst.
  • The quantity of urine is reduced.
  • Dry skin.
  • Constipation.
  • Headache.
In children, they usually become less active than usual when dehydrated.

Severe dehydration

If left unchecked, the body that dehydration can cause dehydration worse. Severe dehydration is an emergency medical condition, and must be given treatment.

Symptoms of severe dehydration can include:
  • Very thirsty.
  • Mouth, skin, and mucous membranes are very dry.
  • Confusion and irritability.
  • Not urinating more than 8 hours.
  • Urine is very dark, and few in number.
  • Eyes look sunken, heavy, dry and sore.
  • Rapid heartbeat.
  • Low blood pressure.
  • Low level of awareness to a fever.

Fluid Volume Deficit related to excessive output, less input. (Doenges, 1999)

Goal: Adequate fluid volume, so the lack of fluid volume can be resolved.

Expected outcomes:
  • Maintaining fluid balance.
  • Vital signs (pulse = 80-100 x / min, temperature = 36-37 ° C)
  • Capillary refill less than 3 seconds.
  • Acral warm.
  • Urine output is 1-2 cc / kg body weight / hour.

Action Plan

1) Monitor vital signs, capillary refill, status mucous membranes, turgor.
Rationale: circulation volume adequacy indicator, the data hypotension occurs with risk of injury after the change of position.

2) Monitor the amount and type of fluid intake, urine output measure accurately.
Rational: Patients should not consume fluids at all lead to dehydration, or changing caloric intake of fluids to affect electrolyte balance.

3) Discuss strategies to stop vomiting and use of laxatives / diuretics.
Rationale: Helping patients received the feeling that as a result of vomiting and / or use of laxatives / diuretics prevent further loss.

4) Identification of a plan to improve / maintain optimal fluid balance. For example: fluid intake schedule.
Rationale: Involving the patient in a plan to correct the imbalance.

5) Assess function test results electrolyte / kidney.
Rationale: The transfer fluids / electrolytes, renal function decline may extend affect healing.

6) Provide / supervise administration of IV fluids.
Rationale: Emergency measures to correct the imbalance of fluid.

7) Additional potassium, oral or N as indicated.
Rationale: It can prevent cardiac dysrhythmias.