Question

below are the five leading causes of female death include patho, risk factors and medical management/nursing actions for each leading cause

Unintentional injuries/accidents: 3.9%

Diabetes: 2.7%

Influenza and pneumonia: 2.2%

Kidney disease: 1.8%

Septicemia: 1.6% (CDC, 2017a)

Answer 1

Unintentional injuries/accidents-The causes of death and disability among girls and women vary throughout the life course. In childhood, most deaths and disabilities result from communicable diseases such as HIV, diarrhoeal and respiratory diseases, malaria, and maternal and perinatal conditions. At older ages, patterns of death and disability change to noncommunicable chronic diseases such as heart disease, stroke and cancers. The single exception is in Africa, where communicable diseases remain the chief causes of female deaths up to the age of 60 years. In low-income countries, including those in Africa, HIV/AIDS, maternal conditions and tuberculosis together account for one in every two deaths among adult women in reproductive years. Road traffic accidents and suicide are among the ten leading causes of death among adult women in middle-income and high-income countries. Among adolescents, road traffic accidents, injuries and suicide are leading causes of death across all income groups. An analysis of the underlying risk factors that contribute to death among women in reproductive age group shows that unsafe sex is a leading risk factor with almost 23% of deaths in women attributable to this risk factor, whereas alcohol use is a leading risk factor among women in high-income countries.

Cardiovascular disease, often thought to be a “male” problem, is the main killer of older people of both sexes almost everywhere in the world. In fact, each year cardiovascular disease causes a larger number of deaths in older women than in older men – 7.4 million women over 60 years of age compared to 6.3 million men in 2004. Although cardiovascular diseases are often thought of as diseases of affluence, cardiovascular mortality rates for women age 60 and over are more than twice as high in low- and middle-income countries as in high-income countries. They are particularly high in middle-income European countries, followed by the WHO Eastern Mediterranean and African regions.

Part of the explanation is that cardiovascular mortality rates among women in high-income countries have significantly declined over the past 50 years. These declines are the result of several factors, namely: reductions in risk behaviours such as use of tobacco and lack of physical activity; better management and medication of metabolic risk factors such as high blood pressure and high cholesterol; and improved treatment of existing cardiovascular conditions. In low- and middle-income countries, cardiovascular disease in women is often unrecognized, undiagnosed, in part because they show different symptoms than men. Women are also less likely to seek medical help and therefore may not get appropriate care until it is too late.

Poly trauma or multiple trauma is a medical term describing the condition of a person who has been subjected to multiple traumatic injuries. Poly trauma is a major cause of morbidity and mortality in both developed and developing countries. Trauma remains the leading cause of death and disability in children and young adults. The incidence and prevalence of poly trauma varies from region to region. The most common causes are road traffic accidents, fall from heights, bullet injuries, etc. In civilian life, poly trauma is often associated with motor vehicle accidents. It may also result from blast injuries sustained by improvised explosive devices. Poly trauma patients represent the ultimate challenge to trauma care and the optimization of their care is a major focus of clinical research. The heaviest toll of traumatic deaths occurs within the first hour following trauma, often defined as “the golden hour of trauma”. Following the principle of “Time is Essence”, management during the first hour of injury is essential. Most of the patients with poly trauma land in the emergency departments of hospitals. The mission of a trauma team is to enlist the problems, establish priorities, stabilize the patient and finally transfer the patient under the specialized care of the team.

Management of patients with poly trauma at the present hospital
The present hospital is an autonomous body which came into existence by an Act of Parliament of India in 1967 and it is an ’institute of national importance’. It provides high quality treatment and tertiary care to the patients from various states of northern India. A comprehensive emergency department (ED) exists in this hospital, which provides life saving medical and surgical services to the patients under one roof. The ED consists of 110 beds. It caters to medical, surgical and traumatic emergencies round the clock. It has an attached laboratory, digital X-ray/ultrasound/ECG and 6 operation theatres functioning round the clock. The patients with poly trauma are treated in the ED by various specialists (general surgeon, anesthetist, orthopaedic surgeon, neurosurgeon, cardiothoracic surgeon, ENT surgeon etc.), nurses and other paramedical personnel.
Women experiencing a miscarriage are a regular daily occurrence in some Accident and Emergency (A & E) departments. Each woman's miscarriage experience is unique and individual and women deserve an individual response to their problems, one that is built on trust and communication. Therefore, emergency nurses must appreciate that each woman is an individual and must explore the history she brings to the current event, the meaning she attributes to the miscarriage, and its impact on her life. These women need to be cared for in an environment that not only allows privacy but also respect and dignity. Nurses need to be able to communicate effectively, to give good physical care and be willing to take on the emotional significance that miscarriage can have. This paper aims to explore the needs of the woman experiencing a miscarriage. It attempts to look at what emergency nurses can do to meet those needs, and what can be done to make this difficult time as tolerable as possible for the woman or couple, when they present to the A & E department.

Diabetes- The death rate was higher among women, but there has been a shift in sex distribution of type 2 diabetes showing higher rates in men.
The findings emphasize how diabetes affects women and men differently. The reasons included the following:

Women often receive less aggressive treatment for cardiovascular risk factors and conditions related to diabetes.
Some of the complications of diabetes in women are more difficult to diagnose.
Women often have different kinds of heart disease than men.
Hormones and inflammation act differently in women.
Diabetes mellitus is a metabolic disorder that occurs when your blood sugar (glucose), is too high (hyperglycemia). Glucose is what the body uses for energy, and the pancreas produces a hormone called insulin that helps convert the glucose from the food you eat into energy.
Risk factors for diabetes in women
are older than 45.
are overweight or obese.
have a family history of diabetes (parent or sibling)
are African-American, Native American, Native Alaskan, Hispanic, Asian-American, or Native Hawaiian.
have had a baby with a birth weight of more than 9 pounds.
have had gestational diabetes.
There are medications you can take to manage the symptoms and complications of diabetes. Many new classes of medications for diabetesare available, but the most common starting medications include: insulintherapy for all people with type 1diabetes. metformin (Glucophage), which reduces blood sugar.
Nursing Interventions:-
Educate about home glucose monitoring.
Review factors in glucose instability.
Encourage client to read labels.
Discuss how client's antidiabetic medications work. ...
Check viability of insulin.
Review type of insulin used.
Check injection sites periodically.

Influenza-
Causes-
Young children under age 5, and especially those under 6 months
Adults older than age 65
Residents of nursing homes and other long-term care facilities
Pregnant women and women up to two weeks after giving birth
People with weakened immune systems
Native Americans
People who have chronic illnesses, such as asthma, heart disease, kidney disease, liver disease and diabetes
People who are very obese, with a body mass index (BMI) of 40 or higher
Though the annual influenza vaccine isn't 100% effective, it's still your best defense against the flu.

Risk factors
Factors that may increase your risk of developing the flu or its complications include:

Age. Seasonal influenza tends to target children 6 months to 5 years old, and adults 65 years old or older.
Living or working conditions.People who live or work in facilities with many other residents, such as nursing homes or military barracks, are more likely to develop the flu. People who are staying in the hospital are also at higher risk.
Weakened immune system.Cancer treatments, anti-rejection drugs, long-term use of steroids, organ transplant, blood cancer or HIV/AIDS can weaken your immune system. This can make it easier for you to catch the flu and may also increase your risk of developing complications.
Chronic illnesses. Chronic conditions, including lung diseases such as asthma, diabetes, heart disease, nervous system diseases, metabolic disorders, an airway abnormality, and kidney, liver or blood disease, may increase your risk of influenza complications.
Race. Native American people may have an increased risk of influenza complications.
Aspirin use under age 19.People who are younger than 19 years of age and receiving long-term aspirin therapy are at risk of developing Reye's syndrome if infected with influenza.
Pregnancy. Pregnant women are more likely to develop influenza complications, particularly in the second and third trimesters. Women are more likely to develop influenza-related complications up to two weeks after delivering their babies.
Obesity. People with a body mass index (BMI) of 40 or more have an increased risk of flu complications.
Medical/Nursing Management-
Controlling the spread of infection
The influenza vaccine isn't 100% effective, so it's also important to take several measures to reduce the spread of infection, including:

Wash your hands. Washing your hands often with soap and water for at least 20 seconds is an effective way to prevent many common infections. Or use alcohol-based hand sanitizers if soap and water aren't available.
Avoid touching your face.Avoid touching your eyes, nose and mouth.
Cover your coughs and sneezes. Cough or sneeze into a tissue or your elbow. Then wash your hands.
Clean surfaces. Regularly clean often-touched surfaces to prevent spread of infection from touching a surface with the virus on it and then your face.
Avoid crowds. The flu spreads easily wherever people gather — in child care centers, schools, office buildings, auditoriums and public transportation. By avoiding crowds during peak flu season, you reduce your chances of infection.

Also avoid anyone who is sick. And if you're sick, stay home for at least 24 hours after your fever is gone so that you lessen your chance of infecting others.

PNEUMONIA-

Pneumonia is an infection of the lungs. Most cases of pneumonia are caused by bacteria (pneumococcal) or viruses (influenza). Rarely, it can be caused by fungi or parasites.Pneumonia-causing germs can be spread the same way colds and the flu are spread: into the air as droplets by sneezing, coughing, talking, or laughing. These droplets can spread to people as they breathe and to surfaces within 6 feet.

The germs can spread to your hands if you touch anything that has the germ on it. If you then touch your eyes, nose, or mouth, you can get infected.

Certain people are at a higher risk for pneumonia, including:

Adults 65 and older
Children less than 5 years old
People who smoke
Alcoholics
People with lung diseases
People with a recent cold or the flu
People who are now or were recently in the hospital
People who have just had surgery
People with chronic diseases such as heart disease, liver damage, or diabetes
People with weak immune systems such as people with HIV/AIDS or certain types of cancer
People taking drugs which weaken the immune system
People with problems swallowing, coughing or taking deep breaths
People with renal failure
People with sickle cell disease
People who have had their spleen removed
People who are living in nursing homes
signs of pneumonia
Cough (sometimes with thick, creamy, or bloody mucus)
Fever
Chills
Tiredness
Rapid breathing or shortness of breath
Chest pain
Loss of appetite
Headache
Nausea and vomiting
A health care provider can examine you for pneumonia by:

Symptoms
Listening to your lungs
Taking a chest X-ray
Taking a blood or mucus sampl
More tests may be done if the pneumonia is severe or if you have other health problems.

Bacterial pneumonia is treated with antibiotics.
Viral pneumonia can be treated with antiviral drugs.
Mild cases of pneumonia can be treated at home with medicine and rest. Most severe cases are treated in a hospital. In addition to medicine, oxygen and other methods are used to support breathing and body functions.

The lungs cannot send enough oxygen to the body.
Pus pockets and fluid can form around the lung.
Infection can spread to other areas of the body.
In severe cases, pneumonia can cause death.
There are at least 4 million cases of pneumonia every year in the U.S. One out of four will be sick enough to be admitted to a hospital. Adults 65 and older are more likely to be sicker and admitted to a hospital. One out of every 20 cases of pneumonia will be fatal.

Pneumonia causes more deaths than HIV/AIDS.

If you have pneumonia:-
Always finish all antibiotic or anti-viral treatment.
Clean your hands often with soap and water or alcohol hand rub.
Cough or sneeze into a tissue or into your sleeve.
Do not share eating or drinking utensils, hand towels, or toothpaste.
Clean surfaces often such as countertops, refrigerator and freezer handles, doorknobs, and light switches.
Do not smoke.
For more on how to clean hands, see Clean Hands.

Get vaccinated – there are several vaccines (like the flu shot) that can help prevent infection that leads to pneumonia. Talk to your health care provider to see if any of these vaccines are right for you.
Keep your hands clean with soap and water or alcohol hand rub.
Limit or avoid contact with people who are sick.
Keep healthy. Eat the right foods and get enough sleep.
In pregnancy
Pneumonia can be more severe if you are pregnant. Tell your health care provider if you have signs of pneumonia during pregnancy. If you are pregnant, check with your health care provider before taking any medicine. Ask your provider which vaccinations you need before you get pregnant, or ones that you need during pregnancy.
NURSING MANAGEMENT :-
Supportive interventions include oxygen therapy, suctioning, coughing, deep breathing, adequate hydration, and mechanical ventilation. Other nursing interventions are detailed on the nursing diagnoses in the subsequent sections.Promoting good fluid intake through the use of intravenous fluids will help promote release of secretions; humidified oxygen therapy could also be helpful. Physiotherapy may also help to achieve sputum samples and promote recovery.

Kidney Disease-Information on common causes of death in people with CKD is limited. We hypothesized that, as eGFR declines, cardiovascular mortality and mortality from infection account for increasing proportions of deaths. We calculated eGFR using the CKD Epidemiology Collaboration equation for residents of Alberta, Canada who died between 2002 and 2009. We used multinomial logistic regression to estimate unadjusted and age- and sex-adjusted differences in the proportions of deaths from each cause according to the severity of CKD. Cause of death was classified as cardiovascular, infection, cancer, other, or not reported using International Classification of Diseases codes. Among 81,064 deaths, the most common cause was cancer (31.9%) followed by cardiovascular disease (30.2%). The most common cause of death for those with eGFR≥60 ml/min per 1.73 m2 and no proteinuria was cancer (38.1%); the most common cause of death for those with eGFR<60 ml/min per 1.73 m2 was cardiovascular disease. The unadjusted proportion of patients who died from cardiovascular disease increased as eGFR decreased (20.7%, 36.8%, 41.2%, and 43.7% of patients with eGFR≥60 [with proteinuria], 45–59.9, 30–44.9, and 15–29.9 ml/min per 1.73 m2, respectively). The proportions of deaths from heart failure and valvular disease specifically increased with declining eGFR along with the proportions of deaths from infectious and other causes, whereas the proportion of deaths from cancer decreased. In conclusion, we found an inverse association between eGFR and specific causes of death, including specific types of cardiovascular disease, infection, and other causes, in this cohort.
ESRD occurs when the kidneys are no longer able to work at a level needed for day-to-day life. The most common causes of ESRD in the United States are diabetes and high blood pressure. These conditions can affect your kidneys. ESRD almost always comes after chronic kidney disease.
RISK FACTORS :-
Risk factors for chronic kidney disease (CKD), such as hypertension, hyperglycemia, albuminuria, renal structure, and sex hormones, have been reported to have different effects on males and females. Thus, CKD progression may differ depending on sex. In addition to CKD management, treatment at earlier stages can reduce complications and prevent disease progression as well as high medical expenses at late stages. We examined the differences in predictive risk factors for renal progression between male and female patients with early CKD.This case cohort study recruited patients aged 18 years or older treated in the outpatient departments of 8 hospitals in Taiwan between August 2008 and September 2014. In total, 1530 patients were included in the analysis. Renal progression was defined as ≥25% decline based on baseline estimated glomerular filtration rate. To examine the predictive risk factors for renal progression, we constructed a subset multivariate logistic model with stepwise variable selection by using P < 0.10 for variable retention. The numbers of male and female patients with CKD exhibiting renal progression were 100 (11.64%) and 84 (12.52%), respectively. After adjusting for all the potential confounders, stepwise logistic regression analysis showed that main independent predictive risk factors for the male patients– (C statistic = 0.72) were proteinuria (odds ratio [OR] 2.20; 95% confidence interval [CI] 1.26–3.84), age (OR 1.04; 95% CI 1.02–1.06), anemia (OR 2.75; 95% CI 1.20–6.30), and poor control of blood pressure (OR 1.84; 95% CI 1.05–3.22). However, the main independent predictive factors for the female patients were (C statistic = 0.75) poor glycemic control (OR 2.28; 95% CI 1.22–4.25), poor blood pressure control (OR 1.93; 95% CI 1.06–3.50), and family income (OR 2.51; 95% CI 1.01–6.20). In conclusion, this study demonstrated that proteinuria was the most crucial risk factor for male patients, whereas poor glycemic control was the main risk factor for female patients. Poor blood pressure control was a shared risk factor for male and female patients.
PATHOPHYSIOLOGY :-
Whatever the underlying etiology, once the loss of nephrons and reduction of functional renal mass reaches a certain point, the remaining nephrons begin a process of irreversible sclerosis that leads to a progressive decline in the GFR. Hyperparathyroidism is one of the pathologic manifestations of CKD.
NURSING MANAGEMENT

Nursing goal of treating patients with acute renal failure is to correct or eliminate any reversible causes of kidney failure. Provide support by taking accurate measurements of intake and output, including all body fluids, monitor vital signs and maintain proper electrolyte balance.
The main treatments are: lifestyle changes to help you stay as healthy as possible. Medicine to control associated problems, such as high blood pressure and high cholesterol. dialysis treatment to replicate some of the kidney's functions, which may be necessary in advanced (stage 5) CKD.
Hemodialysis uses a machine to clean your blood. This type of dialysis can be done at a dialysis center or in a clean room in your home.Hemodialysis that is done in adialysis center is called in-center hemodialysis, and it is the most common treatment for kidney failure.

Septicemia
CAUSES :-
Septicemia occurs when a bacterial infection elsewhere in the body, such as the lungs or skin, enters the bloodstream.The most common infections that lead to septicemia are: urinary tract infections,lung infections, such as pneumonia.kidney infections,infections in the abdominal area.
RISK FACTORS :-
Are very young or very old.
Have a compromised immune system.
Have diabetes or cirrhosis.
Are already very sick, often in a hospital intensive care unit.
Have wounds or injuries, such as burns.
Have invasive devices, such as intravenous catheters or breathing tubes.
PATHOPHYSIOLOGY :-
Sepsis has been shown to develop when the innate immune response becomes amplified and dysfunctional, leading to an imbalance between pro-inflammatory and anti-inflammatory responses. It is the innate immune response that plays a major role in sepsis pathophysiology.
MEDICAL MANAGEMENT :-
People who have sepsis often receive intravenous fluids right away, usually within three hours. Vasopressors. If your blood pressure remains too low even after receiving intravenous fluids, you may be given a vasopressor medication, which constricts blood vessels and helps to increase blood pressure.
NURSING MANAGEMENT :-
1. Risk For Infection :-Compromised immune system.Failure to recognize or treat infection and/or exercise proper preventive measures.Invasive procedures, environmental exposure (nosocomial).Client will achieve timely healing; be free of purulent secretions, drainage, or erythema; and be afebrile.
Nursing Interventions   Rationale
Assess client for a possible source of infection (e.g., burning urination, localized abdominal pain, burns, open wounds or cellulitis, presence of invasive catheters, or lines).   The most common causes of sepsis are respiratory tract and urinary tract infection, followed by abdominal and soft tissue infections. Other causes of hospital-acquired sepsis are the use of intravascular devices.
Teach proper hand washing using antibacterial soap before and after each care activity.   Hand washing and hand hygiene lessen the risk of cross-contamination. Note: Methicillin-resistant Staphylococcus aureus (MRSA) is most commonly transmitted bacteria via direct contact with health care workers who unable to wash hands between client contacts.
Maintain sterile technique when changing dressings, suctioning, and providing site care, such as an invasive line or a urinary catheter.   Medical asepsis inhibits the introduction of bacteria and reduces the risk of nosocomial infection.
Investigate reports of pain out of proportion to visible signs. Pressure-like pain over an area of cellulitis may indicate developing of necrotizing fasciitis due to group A beta-hemolytic streptococci (GABHS), necessitating prompt intervention.
Inspect wounds and sites of invasive devices daily, paying particular attention to parenteral nutrition lines. Document signs of local inflammation and infection and changes in character wound drainage, sputum, or urine.   Catheter-related bloodstream infections (CR-BSIs) are increasing where central venous catheters are used in both acute and chronic care settings. Clinical signs, such as local inflammation or phlebitis, may provide a clue to a portal of entry, type of primary infecting organism (s), as well as early identification of secondary infections.
Inspect oral cavity for white plaques. Investigate reports of vaginal and perineal itching or burning. Depression of immune system and use of antibioticsincrease the risk of secondary infections, particularly yeast-thrush.
Encourage client to cover mouth and nose with a tissue when coughing or sneezing. Place in a private room if indicated. Wear mask when providing direct as appropriate.   Appropriate behaviors, personal protective equipment, and isolation prevent the spread of infection via airborne droplets.
Encourage or provide frequent position changes, deep breathing, and coughing exercises.   Good pulmonary toilet may reduce respiratory compromise.
Limit use of invasive devices and procedures when possible. Remove lines and devices when infection is present and replace if necessary. Reduces the number of possible entry sites for opportunistic organisms.
Dispose of soiled dressings and other materials in a double bag.   Appropriate disposal of contaminated material reduces contamination and spread of organisms.
Wear gloves and gowns when caring for open wounds or anticipating direct contact with secretions or excretions.   Prevents spread of infection and cross contamination.
Provide isolation and monitor visitors, as indicated,   Body substance isolation should be used for all infectious clients. Wound and linen isolation and handwashing may be all that is required for draining wounds. Clients with diseases transmitted through air may also need airborne and droplet precautions.
Note temperature trends and observe for shaking chills and profuse diaphoresis.   Fever [101°F-105°F (38.5°C-40°C)] is the result of endotoxin effect on the hypothalamus and pyrogen-released endorphins. Hypothermialower than 96°F (36°C) is a grave sign reflecting advancing shock state, decreased tissue perfusion, and failure of the body’s ability to mount a febrile response. Chills often precede temperature spikes in the presence of generalized infection.
Monitor for signs of deterioration of condition or failure to improve with therapy.   Deterioration of a clinical condition or failure to improve with therapy may reflect inappropriate or inadequate antibiotic therapy or overgrowth of resistant or opportunistic organisms.
Obtain specimens of urine, blood, sputum, wound, and invasive lines or tubes for culture, and sensitivity, as indicated.   Identification of portal of entry and organism causing the septicemia is crucial to effective treatment based on susceptibility to specific medications.
Monitor laboratory studies, such as WBC count with neutrophils and band counts   The normal ratio of neutrophils to total WBCs is at least 50%; however, when WBC count is markedly decreased, calculating the absolute neutrophil count is more pertinent to evaluating immune status. Likewise, an initial elevation of band cells reflects the body’s attempt to mount a response to the infection, whereas a decline indicates decompensation.