Inflammatory bowel disease.

THE INCIDENCE of inflammatory bowel disease (IBD) is in- creasing worldwide. The underlying causes of IBD, which encom- passes Crohn's disease and ulcerative coLitis, are unknown but are thought to be a com- bination of genetics, environmental factors, abnormal immune re- sponses and disruption to the microbiota in the gut. IBD can be a devas- tating disease, affect- ing quality of Life and increasing risks for bowel cancer. Effec- tive management has been an elusive goal, but with better under- standing of the inflam- matory and immune pathways involved in IBD, more successful therapies are entering clinical practice. To deliver quality care and help people with IBD manage this dis- ease, nurses must be familiar with the cur- rent understanding of its causes.

Sex hormones and health.

THE REPRODUCTIVE hormones - oestrogen, progesterone and testosterone - do more in the body than control reproduction. Sex hormones influence both physical and mental health and well- being, from osteoporosis and cancer to depression and premenstrual dysphoric dis- order. As the mechanisms by which these hormones exert their non-reproductive ef- fects become better known, we are beginning to under- stand how they affect health and well-being. Hormone therapies (con- traception, replacement, management of cancers, etc) are increasingly common, and can have adverse effects for women. ControlLing these requires careful manage- ment, balancing risk and benefit. An understanding of the roles and effects of the reproductive hormones allows nurses to provide best care in relation to these and to new therapies as they enter clinical practice.

COPD: obstructed lungs.

CHRONIC OBSTRUCTIVE pulmonary diseases (COPD) affect 14 per cent of the population over 40 years of age. With an ageing population, the number of those requiring care for COPD is expected to increase, having a significant effect on health-care resources. COPD is projected to become the third leading cause of death globally by 2020. This disease has a major impact on economic and social well-being, and on quality of life. It is regarded as largely preventable but, once developed, is a progressive and complex condition characterised by frequent exacerbations and co-morbidities. Smoking is the primary cause of COPD but up to 30 per cent of those with COPD have never smoked. It is increasingly recognised COPD may have its origins prenatally and in early childhood. Treating exacerbations, improving exercise capacity, and delaying progression of disease are key management strategies. No curative or disease modifying therapies are available. Nurses are essential in providing comprehensive care to patients in both acute care and for long-term management. They also have a vital role to play in preserving healthy lung function in the early years of life to reduce the risk of COPD in older age.

Diseases of the Liver.

IMPAIRED LIVER function affects every aspect of the body's physiology. Diseases of the liver have more widespread and life-threatening impacts than malfunctioning of any of the body's other conditions. accessory organs. Non-alcoholic fatty Liver disease rates are soaring, concurrent with the obesity epidemic and increasing rates of type 2 diabetes. Alcoholic liver disease and viral hepatitis also contribute to high rates of liver damage in the population, making liver disease one of the commonest causes premature death. Liver transplants, hepatocellular carcinomas, and deaths from Liver disease are increasingly due to preventable or treatable liver conditions. Understanding normal liver function allows nurses to predict the impact of Liver disease on their patients' health and well-being. Knowledge of underlying causes of impaired liver function enhances our ability to support and counsel those who are at risk of, or have been diagnosed with liver disease.

Genetics, epigenetics and disease.

THE PROMISE of the Human Genome Project - to identify and treat the genetic causes of disease - has not been achieved. How genes affect cells and cause or prevent disease is not as simple as switching individual genes on or off. In the last decade, our understanding of the complex inter retionships of genes and the impact on them of environmental conditions has grown. We can say with increasing confidence that exposure to stressors (physical, nutritional and emotional), before conception, prenatally and throughout Life, has a measurable effect on genetic expression. Nurses need to be aware of current research and theories in genetics. Counselling women during their reproductive years about how nutrition and lifestyle will affect the health of their unborn children is a useful nursing role. Genotyping of individuals is becoming popular, and genetic engineering techniques more accessible. We need to understand what these can, and cannot, provide in terms of health risks and disease management. Understanding new technologies related to genetics and epigenetics can allow nurses to share fully in the discussions about ethical and safety concerns.

'Could this be sepsis?'.

SEPSIS IS a leading cause of preventable death, the incidence of which has increased markedly over the past 40 years. While mortality rates are improving, one-fifth of patients with severe sepsis die. Early identification and intervention arekey to survival - delayed care for inpatients who develop sepsis is the main reason why this group has a higher mortality rate than people admitted with sepsis. Internationally, the Surviving Sepsis Campaign promotes screening of "every patient, every shift, every day" for sepsis, while new United Kingdom guidelines recommend health practitioners ask, "Could this be sepsis?" for any patient with signs of a possible infection. Nurses are best placed to identify sepsis early and ensure timely treatment. A thorough understanding of the events underlying development of sepsis, and its risks, will help nurses in this life-saving role. The goal is that all nurses, in all settings, consider, as a first priority, the possibility of sepsis in any infant, child or adult presenting with an infection.

Capnography: monitoring CO2.

MONITORING RESPIRATORY and metabolic function by using capnography to measure end tidal carbon dioxide is standard practice in anaesthesia. It is also becoming more common in intensive care units and during procedural sedation. End tidal carbon dioxide (EtCO2) monitoring may also be used to assess effectiveness of cardiopulmonary resuscitation. Capnography is now emerging in general medical and surgical wards to monitor respiratory depression in patients using opioid analgesics. Using EtCO2 to monitor respiratory function offers many benefits over pulse oximetry. It is important to understand the differences between these two monitoring methods, and why capnography is increasingly favoured in many situations. An understanding of the physiological processes involved in CO2 excretion allows nurses to use capnography in a safe and meaningful way, while monitoring at-risk patients in acute care.

Arthritis: joints inflamed.

ARTHRITIS IS a generic term for inflammatory joint disease. There are various forms of arthritis, including osteoarthritis, rheumatoid arthritis and spondyloarthritis. Arthritis can be a chronic debilitating condition or a transient effect of bacterial or viral infections. As a chronic condition, arthritis can cause loss of quality of life, disability and, with rheumatoid disease, early death. The economic burden of arthritis, in terms of management and loss of productivity due to disability, is high and set to increase with the ageing population. Recent advances in our understanding of the causes and progression of a number of forms of arthritis have raised hopes of better management and possible remission. Pharmacotherapy has moved from symptom management to addressing underlying disease processes. However, therapies that prevent or cure arthritis remain elusive. Current care for people with arthritis relies on a multidisciplinary approach and substantial pharmacological intervention. Nurses have a key role to play in guiding patients through treatment, ensuring they receive optimal therapy to reduce the impact of arthritis and its management on their lives.