CHAPTER TWENTY FOUR

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CHAPTER TWENTY FOUR
CARING FOR PERSONS WITH COMMON HEALTH PROBLEMS
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TYPES OF ILLNESSES

• ACUTE ILLNESS BEGINS SUDDENLY AND CONTINUES
  FOR A SHORT PERIOD
• CHRONIC ILLNESS PROGRESSES SLOWLLY, OVER A
  LONG PERIOD OF TIME
• TERMINAL ILLNESS RECOVERY IS NOT EXPECTED AND
  IT ENDS IN DEATH

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CANCER

• TUMOR - RAPID GROWTH OF ABNORMAL CELLS
• MALIGNANT TUMOR GROWS RAPIDLY AND INVADES
  OTHER BODY TISSUES
• BENIGN TUMOR GROWS SLOWLY AND REMAINS IN A
  LOCALIZED AREA
• METASTASIS THE SPREAD OF CANCER TO OTHER AREAS
  OF THE BODY

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• RISK FACTORS FOR CANCER
• TOBACCO SMOKING, CHEWING, AND SECOND-HAND
  SMOKE
• EXPOSURE TO RADIATION SUN, TANNING BOOTHS,
  X-RAY PROCEDURES
• ALCOHOL
• DIET HIGH FAT DIET, OVERWEIGHT
• CHEMICALS AND OTHER SUBSTANCES METALS,
  PESTICIDES, ASBESTOS
• HORMONE REPLACEMENT THERAPY
• DIETHYLSTILBESTROL SYNTHETIC ESTROGEN
• CLOSE RELATIVES WITH CERTAIN TYPES OF CANCER -
  MELANOMA, BREAST, OVARIAN, PROSTATE, COLON CANCER

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CANCER TREATMENTS

• SURGERY TUMORS ARE REMOVED TO CURE OR CONTROL
  THE CANCER.
• RADIATION X-RAY BEAMS ARE DIRECTED TO THE
  CANCEROUS AREAS. DESTROYS BOTH CANCER AND NORMAL
  CELLS.
• CHEMOTHERAPY DRUGS ARE GIVEN THAT DESTROY BOTH
  CANCER AND NORMAL CELLS.
• TREATMENT SIDE EFFECTS INCLUDE
• WEAKNESS, NAUSEA, VOMITING, DIARRHEA, LOSS OF
  APPETITE, HAIR LOSS

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CARE OF PERSONS WITH CANCER

• PAIN RELIEF OR CONTROL
• REST AND EXERCISE
• FLUIDS AND NUTRITION
• PREVENTION OF SKIN BREAKDOWN
• PREVENTION OF CONSTIPATION
• DEALING WITH TREATMENT SIDE EFFECTS
• PSYCHOLOGICAL, SOCIAL, AND SPIRITUAL NEEDS

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MUSCULOSKELETAL SYSTEM
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ARTHRITIS INFLAMMATION OF A JOINT
OSTEOARTHRITIS
THE WEARING AWAY OF THE CARTILAGE THAT COVERS THE
ENDS OF BONES AT THE JOINT.
OCCURS WITH AGING, JOINT INJURY, OBESITY. PAIN
OCCURS WITH WEIGHT-BEARING AND JOINT
MOVEMENT. HIPS, KNEES, SPINE, FINGERS, AND THUMB
OR COMMONLY AFFECTED.
JOINTS BECOME STIFF AND PAINFUL
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RHEUMATOID ARTHRITIS
CHRONIC INFLAMMATION OF THE JOINTS CAUSES
REDNESS, SWELLING,STIFFNESS, AND PAIN CAN OCCUR
AT ANY AGE MORE COMMON IN WOMEN
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TREATMENT OF ARTHRITIS

• MEDICATIONS TO TREAT THE PAIN AND INFLAMATION
• HEAT OR COLD APPLICATIONS
• SURGICAL REPLACEMENT OF AFFECTED JOINTS
• ASSIST WITH ADLS
• ACTIVE AND PASSIVE ROM EXERCISES
• ENCOURAGE ACTIVITY AND INDEPENDENCE
• PROVIDE ADAPTIVE EQUIPMENT CANE,WALKER, PLATE,
  SILVERWARE, RAISED TOLIET SEAT

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OSTEOPOROSIS
MORE COMMON IN WOMEN BECAUSE OF HORMONAL CHANGES
AND LOSS OF CALCIUM AFTER MENOPAUSE
SIGNS AND SYMPTOMS INCLUDE LOW BACK PAIN,
GRADUAL LOSS OF HEIGHT, AND STOOPED
POSTURE FRACTURES CAN EASILY OCCUR.
LOSS OF BONE TISSUE AND LACK OF CALCIUM CAUSES
BONES TO BECOME BRITTLE AND POROUS. TOBACCO USE,
ALCOHOLISM, BEDREST, AND IMMOBILITY ARE OTHER
RISK FACTORS BONES OF THE SPINE, HIPS AND WRISTS
MOST OFTEN AFFECTED
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PREVENTION OF OSTEOPOROSIS

• CALCIUM AND VITAMIN SUPPLEMENTS
• WEIGHT-BEARING EXERCISE WALKING
• STRENGTH TRAINING WEIGHT LIFTING

TREATMENT OF OSTEOPOROSIS

• BACK BRACES
• WALKING AIDS
• PROTECT FROM FALLS AND ACCIDENTS
• BE GENTLE!

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FRACTURES
A BROKEN BONE
IN A CLOSED FRACTURE THE BONE IS BROKEN BUT THE
SKIN IS INTACT
IN AN OPEN FRACTURE THE SKIN IS BROKEN AND THE
BONE PROTRUDES FROM THE SKIN
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RULES FOR CAST CARE

• DO NOT COVER A WET CAST WITH BLANKETS, OR OTHER
  MATERIAL. CASTS GIVE OFF HEAT AS THEY DRY AND
  CAN CAUSE BURNS IF THE HEAT IS NOT ALLOWED TO
  ESCAPE.
• USE PILLOWS TO SUPPORT THE CAST. DO NOT LET THE
  CAST REST ON A HARD SURFACE.
• SUPPORT THE CAST WITH YOUR PALMS, NOT YOUR
  FINGERTIPS.
• CHECK FOR ROUGH EDGES ON THE CAST.
• DO NOT STICK ANYTHING DOWN THE CAST TO SCRATCH.
• ELEVATE THE CASTED EXTREMITY.
• REPORT C/O PAIN, NUMBNESS, ODOR, SWELLING, PALE
  SKIN, CYANOSIS, OR DRAINAGE ON THE CAST.

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TRACTION

• KEEP THE PERSON IN GOOD ALIGNMENT
• DO NOT REMOVE THE TRACTION
• LET THE WEIGHTS HANG FREELY
• DO NOT ADD OR REMOVE WEIGHTS
• PERSON USUALLY MUST REMAIN ON THEIR BACK
• GIVE GOOD SKIN CARE TO PREVENT BREAKDOWN
• CHANGE THE LINEN FROM TOP TO BOTTOM
• PERSON CAN USE A TRAPEZE TO HELP MOVE UPPER BODY
• CHECK PIN SITES FOR SIGNS OF INFECTION

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AMPUTATION
AMPUTATION IS THE REMOVAL OF ALL OR PART OF AN
EXTREMITY.

PROSTHESIS- ARTIFICIAL BODY PART
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HIP FRACTURE

• HIP FRACTURES ARE COMMON IN ELDERLY PERSONS
• HIP FRACTURES ALWAYS REQUIRE SURGERY
• MAY NEED PIN, SCREWS OR JOINT REPLACEMENT

• REHABILITATION WILL BE NEEDED AFTER SURGERY
• PARTIAL WEIGHT BEARING SOME WEIGHT MAY BE PUT
  ON AFFECTED LIMB
• FULL WEIGHT BEARING TOTAL WEIGHT MAY BE PUT ON
  AFFECTED LIMB

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• KEEP HIP ABDUCTED WHEN IN BED
• PUT PILLOW BETWEEN LEGS
• DO NOT ROTATE THE HIP OUTWARD
• DO NOT BEND FROM WAIST (MORE THAN 90)
• DO NOT ALLOW THE PATIENT TO CROSS HIS LEGS

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NERVOUS SYSTEM
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CEREBROVASCULAR ACCIDENT (CVA) (STROKE)
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• A MINOR STROKE MAY CAUSE MINOR DAMAGE
• A MAJOR STROKE MAY CAUSE SEVERE DAMAGE
• SYMPTOMS DEPEND ON THE AREA OF THE BRAIN DAMAGED
• A STROKE ON THE LEFT SIDE OF THE BRAIN CAUSES
  SYMPTOMS ON THE RIGHT SIDE OF THE BODY
• A STROKE ON THE RIGHT SIDE OF THE BRAIN CAUSES
  SYMPTOMS ON THE LEFT SIDE OF THE BODY
• HEMIPLEGIA PARALYSIS ON ONE SIDE OF THE BODY
• EXPRESSIVE APHASIA DIFFICULTY IN SPEAKING OR
  WRITING
• RECEPTIVE APHASIA DIFFICULTY IN UNDERSTANDING
• MAY NEED ASSISTANCE WITH ADLS

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• EMOTIONAL COMPLICATIONS OF A STROKE
• ANGRY OUTBURSTS
• SUDDEN TEARS ( LABILE TEARS )
• INAPPROPRIATE CRYING OR LAUGHING
• INCREASED IRRITABILITY
• MAY HAVE PERSONALITY OR BEHAVIOR CHANGES

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WARNING SIGNS OF A STROKE

• SUDDEN NUMBNESS OR WEAKNESS OF THE FACE, ARM, OR
  LEG, OR ON ONE SIDE OF THE BODY
• SUDDEN CONFUSION, TROUBLE SPEAKING, OR
  UNDERSTANDING
• SUDDEN TROUBLE SEEING IN ONE OR BOTH EYES
• SUDDEN TROUBLE WALKING, DIZZINESS, OR LOSS OF
  BALANCE
• SUDDEN, SEVERE HEADACHES

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PARKINSON'S DISEASE
CAUSED BY LACK OF A CHEMICAL NEUROTRANSMITTER
IN THE BRAIN.
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PARKINSON'S DISEASE

• CHRONIC DISEASE THAT AFFECTS CONTROL OF MOTOR
  FUNCTION
• INTELLIGENCE IS NOT AFFECTED
• MASK-LIKE FACIAL EXPRESSION
• TREMORS
• SWALLOWING PROBLEMS
• MEDICATIONS MAY HELP SYMPTOMS

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MULTIPLE SCLEROSIS ( MS )

• ONSET USUALLY BETWEEN THE AGES OF 20 AND 40
• PROGRESSIVE DISEASE THAT AFFECTS THE BRAIN AND
  SPINAL CORD
• GRADUAL DESTRUCTION OF MYELIN, SUBSTANCE THAT
  COATS AND INSULATES THE NERVE FIBERS
• CAUSES INTERFERENCE WITH THE TRANSMISSION OF
  NERVE IMPULSES
• SYMPTOMS INCLUDE NUMBNESS, WEAKNESS,
  TREMORS, LOSS OF BALANCE, AND PARALYSIS
• THERE IS NO CURE FOR MS

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SPINAL CORD INJURIES
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NERVOUS SYSTEM INJURIES

• INJURY OCCURS TO THE BRAIN OR SPINAL CORD
• PERSON MAY BE COMATOSE

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HEARING LOSS

• SYMPTOMS OF HEARING LOSS
• SPEAKING TOO LOUDLY
• LEANING FORWARD TO HEAR
• TURNING AND CUPPING THE BETTER EAR TOWARD THE
  SPEAKER
• ANSWERING QUESTIONS INAPPROPRIATELY
• ASKING FOR WORDS TO BE REPEATED

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COMMUNICATING WITH THE HEARING IMPAIRED

• ALERT THE PERSON TO YOUR PRESENCE
• DO NOT APPROACH THE PERSON FROM BEHIND
• POSITION YOURSELF AT THE PERSONS LEVEL
• FACE THE PERSON WHEN SPEAKING
• STAND OR SIT IN GOOD LIGHT
• SPEAK CLEARLY AND DISTINCTLY
• DO NOT SHOUT
• DO NOT COVER YOUR MOUTH, SMOKE, EAT, OR CHEW GUM
  WHILE TALKING
• SIT ON THE SIDE OF THE BETTER EAR
• KEEP CONVERSATIONS SHORT

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CARING FOR A HEARING AID

• TURN OFF THE HEARING AID WHEN NOT IN USE.
• CHECK AND REPLACE THE BATTERIES AS NEEDED
• DO NOT GET THE HEARING AID WET!!!
• TAKE THE HEARING AID OFF BEFORE SHOWERING OR
  SHAMPOOING
• CLEAN THE EARMOLD WITH A SLIGHTLY DAMP CLOTH
  WHEN NEEDED

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CATARACT
CLOUDING OF THE LENS PAINLESS PROGRSSIVE RESULTS
IN LOSS OF VISION LENS MUST BE SURGICALLY REMOVED
AND A NEW LENS IMPLANTED
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GLAUCOMA

• PRESSURE WITHIN THE EYE INCREASES
• SYMPTOMS INCLUDE BLURRED VISION,AND THE PERSON
  SEES HALOS OR RINGS OF LIGHTS AROUND OBJECTS
• CAN CAUSE TOTAL BLINDNESS IF NOT TREATED
• TREATED WITH EYE DROPS THAT DECREASE THE
  PRESSURE IN THE EYE

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• CARING FOR THE BLIND PERSON
• IDENTIFY YOURSELF WHEN YOU ENTER A ROOM. GIVE
  YOUR NAME AND TITLE. DO NOT TOUCH THE PERSON
  UNTIL YU HAVE INDICATED YOUR PRESENCE.
• ADDRESS THE PERSON BY NAME WHEN YOU ARE TALKING
  TO THEM. THIS WAY THEY WILL KNOW THE COMMENT OR
  QUESTION IS DIRECTED AT THEM.
• DO NOT REARRANGE THE FURNITURE.
• KEEP DOORS EITHER OPEN OR SHUT NOT PARTLY OPEN.
• KEEP HALLWAYS FREE OF EQUIPMENT.
• WALK SLIGHTLY AHEAD OF THE PERSON.
• TELL THE PERSON WHEN YOU ARE COMING TO A CURB
  OR STEPS.
• EXPLAIN FOOD PLACEMENT BY REFERRING TO THE
  HANDS OF A CLOCK.

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RESPIRATORY SYSTEM
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CHRONIC OBSTRUCTIVE PULMONARY DISEASE COPD

• THREE DISORDERS ARE GROUPED TOGETHER UNDER THE
  NAME COPD
• CHRONIC BRONCHITIS
• EMPHYSEMA
• ASTHMA
• THESE DISORDERS INTERFERE WITH THE NORMAL
  EXCHANGE OF OXYGEN AND CARBON DIOXIDE IN THE
  LUNGS. THEY OBSTRUCT AIR FLOW.

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BRONCHITIS
INFLAMMATION OF THE BRONCHIAL TUBES PART OF AN
UPPER RESPIRATORY INFECTION SYMPTOMS INCLUDE
FEVER, CHILLS, SORE THROAT, AND COUGH.
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EMPHYSEMA
LUNG TISSUE LOSES ITS ELASTICITYAND THE ALVEOLI
REMAIN EXPANDED THE PERSON BREATHES HARDER AND
FASTER IN AN ATTEMPT TO GET MORE AIR
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THE SKIN IS USUALLY CYANOTIC AND THE PERSON
DEVELOPS A BARREL CHEST
THE PERSON LEANS FORWARD IN AN ATTEMPT TO BREATHE
EASIER
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ASTHMA
AIR PASSAGES NARROW WITH ASTHMA RESULTS IN
DIFFICULTY IN BREATHING EPISODES CAN OCCUR
SUDDENLY AND ARE CALLED ASTHMA ATTACKS MEDICATION
IS GIVEN WHICH DILATES THE RESPIRATORY
PASSAGES REPEATED ATTACKS CAN DAMAGE THE
RESPIRATORY SYSTEM
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PNEUMONIA
INFECTION OF THE LUNG TISSUE ASPIRATION PNEUMONIA
CAUSED BY FOOD, FLUID, OR SECRETIONS IN THE
LOWER AIRWAY HYPOSTATIC PNEUMONIA FLUIDS
ACCUMULATE IN THE LUMGS, LEADING TO INFECTION
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TUBERCULOSIS TB

• CAUSED BY A BACTERIAL INFECTION
• STEADY INCREASE IN TB CASES EACH YEAR DUE TO
  INFECTION IN AIDS PATIENTS
• SPREAD BY AIRBORNE DROPLETS
• DISEASE IS FOUND BY SKIN TEST OR CHEST X-RAY
• TREATMENT MAY TAKE FROM 3 TO 7 MONTHS OF DRUG
  THERAPY

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CARE FOR THE PATIENT WITH RESPIRATORY PROBLEMS

• POSITION THE PATIENT FOR EASE IN BREATHING.
• ENCOURAGE FLUIDS.
• ENCOURAGE PROPER NUTRITION.
• PROVIDE FREQUENT REST PERIODS.
• PROVIDE MOUTH CARE EVERY TWO HOURS OR MORE OFTEN
  IF NEEDED.
• ASSIST WITH OXYGEN ADMINISTRATION IF ORDERED.

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CHAPTER 22 ASSISTING WITH OXYGEN NEEDS

• ABNORMAL RESPIRATORY PATTERNS
• TACHYPNEA
• BRADYPNEA
• APNEA
• DYSPNEA
• HYPERVENTILATION
• HYPOVENTILATION

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• PROMOTING OXYGENATION
• POSITIONING
• FOWLERS
• ORTHOPNEIC

• COUGHING AND DEEP BREATHING EXERCISES
• REMOVES MUCUS
• ALLOWS MORE AIR INTO LUNGS

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OXYGEN SOURCES
WALL OUTLET
OXYGEN TANK OXYGEN
CONVERTOR
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COMMON OXYGEN DEVICES
NASAL CANNULA
NON-REBREATHER MASK
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• RULES FOR OXYGEN SAFETY
• FOLLOW NURSES DIRECTIONS AS TO WHEN TO REMOVE
  OXYGEN DELIVERY DEVICE.
• CHECK FOR SIGNS OF IRRITATION FROM THE DEVICE.
• NEVER SHUT OFF OR ADUST THE OXYGEN FLOW RATE.
• TELL THE NURSE IF THE FLOW RATE HAS BEEN
  CHANGED.
• GIVE ORAL HYGIENE AS NEEDED.
• REMIND THE PERSON AND FAMILY NOT TO SMOKE WHEN
  OXYGEN IS BEING USED.

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CIRCULATORY SYSTEM
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HYPERTENSION
MEDICAL TERM FOR HIGH BLOOD PRESSURE HYPERTENSION
IS COMMON IN HEART DISEASE AND DIABETES.
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CORONARY ARTERY DISEASE
CORONARY ARTERIES SUPPLY THE HEART WITH BLOOD.
IF THEY BECOME CLOGGED OR BLOCKED THE BLOOD FLOW
TO THE HEART MUSCLE IS DECREASED.
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RISK FACTORS FOR CORONARY ARTERY DISEASE

• GENDER
• AGE
• FAMILY HISTORY
• SMOKING
• OBESITY
• LACK OF EXERCISE
• HYPERTENSION
• HIGH CHOLESTEROL
• DIABETES
• MAJOR COMPLICATIONS INCLUDE ANGINA PECTORIS AND
  MYOCARDIAL INFARCTION

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ANGINA PECTORIS
ANGINA IS CHEST PAIN THAT OCCURS WHEN NARROWED
BLOOD VESSELS DO NOT ALLOW ENOUGH OXYGENATED
BLOOD TO REACH THE HEART MUSCLE.
ATTACKS MAY BE TRIGGERED BY EXERCISE, EATING, OR
AN EMOTIONAL EXPERIENCE. REST AND NITROGLYCERIN
OFTEN RELIEVE SYMPTOMS.
ANGINA SITES
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MYOCARDIAL INFARCTION
OCCURS FROM AN ABRUPT DECREASE IN CORONARY BLOOD
FLOW MAY BE CAUSED BY A BLOOD CLOT OR OTHER
MATERIAL BLOCKING THE BLOOD VESSEL
RESULTS IN DEATH OF THE CARDIAC TISSUE
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(SKIN OR LIPS)
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CONGESTIVE HEART FAILURE
OCCURS WHEN THE HEART MUSCLE WEAKENS AND FAILS TO
PUMP EFFICIENTLY THE LUNGS FILL WITH FLUID AND
CAUSE SHORTNESS OF BREATH THE BREATHING IS
LABORED AND THE PULSE MAY BE FAST AND
IRREGULAR URINE OUTPUT IS DECREASED BECAUSE THE
BODY IS HOLDING FLUID

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URINARY SYSTEM
KIDNEY STONES
MAY PASS THROUGH THE URINARY SYSTEM UNNOTICED IF
IT IS SMOOTH AND ROUND MAY LODGE IN THE KIDNEY,
URETER, BLADDER, OR URETHRA IF THE STONE IS LARGE
OR IRREGULAR SHAPED PAIN DEVELOPS IN THE BACK
AND RADIATES TO ADJOINING AREA. ALSO HAVE
NAUSEA, VOMITING,CHILLS AND HEAVY PERSPIRATION.
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NEPHRITIS

• INFLAMMATION OF THE KIDNEYS
• RESULTS FROM AN INFECTION OR A CIRCULATORY
  PROBLEM
• KIDNEYS LOSE ABILITY TO FILTER AND RESULTS IN A
  BUILDUP OF TOXINS IN THE BLOOD
• TREATMENT MAY INCLUDE KIDNEY DIALYSIS

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ENDOCRINE SYSTEM
DIABETES

• LACK OF INSULIN AFFECTS THE BODYS ABILITY TO
  USE CARBOHYDRATES
• BODY BURNS FATS FOR ENERGY WHICH CAUSES BY
  PRODUCTS CALLED KETONES
• TYPE I DIABETES INSULIN DEPENDENT
• TYPE II DIABETES CONTROLLED BY DIET

• SIGNS OF HYPOGLYCEMIA
• WEAKNESS
• TREMBLING
• SHAKING
• DIZZINESS
• FAINTNESS
• HEADACHES

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TREATMENT OF DIABETES

• TYPE 1 DIABETES
• TREATED WITH INSULIN INJECTIONS
• TYPE II DIABETES
• TREATED WITH DIET AND EXERCISE
• ORAL MEDICATION

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FOOT CARE OF THE PATIENT WITH DIABETES

• SLOWED CIRCULATION AND NERVE DAMAGE PLACE THE
  PATIENT AT RISK FOR INJURY, INFECTION, AND
  GANGRENE
• EXAMINE THE FEET FOR DISCOLORATION OR INJURY
• PREVENT PRESSURE OF NT FEET OR TOES BY BED
  LINEN, SHOES, OR SOCKS.
• DO NOT CUT THE TOENAILS OF A DIABETIC PATIENT

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CARE OF THE PATIENT WITH DIABETES

• OBSERVE DIETARY INTAKE
• NOTE ANY CHANGES IN THE PATIENTS MOOD, BEHAVIOR,
  OR PERSONALITY
• WATCH FOR SKIN PROBLEMS

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COMMUNICABLE DISEASES

• HEPATITIS
• INFLAMMATION OF THE LIVER
• HEPATITIS A SPREAD BY FECAL-ORAL ROUTE
• HEPATITIS B SPREAD BY SEX WITH INFECTED PERSON
  OR SHARING NEEDLES WITH INFECTED PERSON
• HEPATITIS C CHRONIC HEPATITIS SPREAD BY
  SEXUAL ACTIVITY AND IV DRUG USE
• SIGNS OF HEPATITIS
• JAUNDICE (YELLOW TINGE TO SKIN OR WHITES OF EYE)
• LOSS OF APPETITE, NAUSEA, VOMITING
• DARK URINE, LIGHT-COLORED FECES

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ACQUIRED IMMUNODEFICIENCY SYNDROME

• ATTACKS THE ABILITY TO FIGHT OTHER DISEASES
• MANY DRUGS HELO REDUCE COMPLICATIONS AND PROLONG
  LIFE
• THERE IS NO CURE OR VACCINE
• SPREAD THROUGH BODY FLUIDS BLOOD, SEMEN,
  VAGINAL SECRETIONS, BREAST MILK
• IV DRUG USE
• HIV INFECTED MOTHERS
• ALWAYS FOLLOW STANDARD PRECAUTIONS TO PROTECT
  YOURSELF AGAINST THE AIDS VIRUS

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DEPRESSION

• COMMON IN ELDERLY PERSONS
• THEY HAVE MANY LOSSES DEATH OF FAMILY AND
  FRIENDS, LOSS OF HEALTH, LOSS OF INDEPENDENCE,
• LONELINESS AND DRUG SIDE EFFECTS CAN CAUSE
  DEPRESSION
• SIGNS OF DEPRESSION
• FATIGUE AND LACK OF INTEREST
• FEELINGS OF HOPELESSNESS
• THOUGHTS OF DEATH AND SUICIDE
• POOR GROOMING
• WITHDRAWAL FROM PEOPLE