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The common phenomenon of “radiological lag” (radiological resolu- tion lagging behind clinical improvement) must be recognized buy generic viagra professional canada impotence testicular cancer. As long as the patient remains clinically stable order viagra professional 50mg fast delivery erectile dysfunction treatment medscape, it is likely that an optimal immune balance has been reached generic 100 mg viagra professional mastercard impotence grounds for divorce, and most radiological infiltrates will resolve gradually on a diminishing course of corticosteroids over 2-3 weeks order viagra professional 50 mg on-line erectile dysfunction diabetes cure. No additional corticosteroids are necessary to hasten ra- diological resolution under such circumstances (Lau & So 2003; Yao et al 2003). Successful con- trol of superimposing infections also demands a judicious use of em- pirical and culture-directed antimicrobials. If the oxygen saturation remains low or dyspnea persists, assisted ventilation, either through non-invasive or invasive means, has to be considered. It is a valuable treatment for acute respiratory failure of various causes, and can avoid complications associated with intu- bation and invasive ventilation (Baudouin et al 2002; Peter et al 2002). Its use can improve oxygena- tion and tachypnea within an hour, and this may help to prevent add- ing further corticosteroids for respiratory failure (Liu et al 2003). The actual endotra- cheal intubation procedure bears a high infective risk and healthcare workers must strictly adhere to all infection control measures. To minimize the risk, the procedure is best performed by highly skilled personnel (Lapinsky & Hawryluck 2003) using rapid sequence induc- tion. Other approaches like a “modified awake” intubation technique and elective intubation upon recognizing signs of imminent need for airway management have been recommended (Cooper et al 2003). The tidal volume should be kept low at 5-6 ml per Kg of the predicted body weight, and plateau pressures be kept less than 30 cm H2O. Mechanically ventilated patients should be adequately sedated and a short-term neuromuscular blockade may be required for permissive hypercapnia. China had the great- est number (5327) of cases, but its case-fatality ratio was reported as being only 7%. The estimates in Hong Kong were 13% in patients <60 years old, and 43% in those ≥60 (Donnelly et al 2003). In addition to age, death rates may be affected by other patient factors such as genetic predispositions, the immune status, pre-existing co- morbidities and cardiopulmonary reserve, and by the disease severity which depends theoretically on the viral strain’s virulence, viral load and magnitude of the host’s immune response. The rates may also be related to other factors such as case selection and volume, facilities and manpower, treatment strategies and regimens. Only a small number of deaths were recorded out of a further 160 cases treated with the same regimen (Zhao Z et al 2003). High-resolution com- puted tomography performed 50 days after the commencement of treatment showed that most survivors did not have clinically signifi- cant lung scarring, and none required any form of pulmonary reha- bilitation (Lau & So 2003). Even though a substantial portion may require a period of assisted ventilation, the mortality rate could be kept down to just a few percent by using ap- propriate management and therapeutic strategies. Without being complacent, scientists and clinicians alike are striving for more effective treatment aiming to lower mortality and transmission rates as much as possible. This can only be achieved together with an in- creased understanding of the viral structure and processes (Holmes 2003; Thiel et al 2003) and by defining the potential targets for drug and vaccine development. Three-dimensional computer modeling of key viral proteins may also facilitate the search and design of antivi- rals (Anand et al 2003). On the other hand, massive random screening and targeted searching of potential compounds by various institutions have already tested hundreds of thousands of compounds in vitro, and have had several hits which could be targets for further research (Ab- bott 2003). In the future, they may fa- cilitate the diagnosis, monitoring and tailoring of specific immuno- therapies. While awaiting research breakthroughs, we have to rely on the exist- ing treatment modalities, which have been overviewed in this chapter. It is envisaged that with the early use of efficacious antiviral agents singly or in combination, the necessity for high dose immunomodula Kamps and Hoffmann (eds. Well-conducted randomized con- trolled trials on a sufficient number of cases are necessary to clarify the effectiveness of and controversies surrounding existing treatment regimens; however, these may not be feasible since large-scale out- break will hopefully never be seen again with our heightened prepar- edness. Lancet 2003;361:1615-6 (1) Antibacterial treatment Start levofloxacin 500 mg once daily intravenously or orally Or clarithromycin 500 mg twice daily orally plus amoxicillin and clavulanic acid 375 mg three times daily orally if patient <18 years, pregnant, or suspected to have tuberculosis (2) Ribavirin and methylprednisolone Add combination treatment with ribavirin and methylprednis- olone when: Extensive or bilateral chest radiographic involvement Or persistent chest radiographic involvement and persistent high fever for 2 days Or clinical, chest radiographic, or laboratory findings sug- gestive of worsening Or oxygen saturation <95% in room air www. J Med Microbiol 2003; 52: 715-20 Levofloxacin 200 mg twice daily plus azithromycin 600 mg daily intravenously. Outbreak of severe acute respiratory syndrome in Hong Kong Special Administrative Region: case report. The antiviral compound ribavirin modulates the T helper(Th)1/Th2 subset balance in hepatitis B and C virus-specific immune responses. The relationship between serum interleukins and T- lymphocyte subsets in patients with severe acute respiratory syndrome. Clinical observation on 103 patients with severe acute respiratory syndrome treated by integrative traditional Chinese and western medicine. Preliminary results on the potential therapeutic benefit of interferon alfacon-1 plus steroids rd in severe acute respiratory syndrome [Abstract]. Ventilation with lower tidal volumes as compared with traditional tidal vol- umes for acute lung injury and acute respiratory distress syn- drome. Coronavirus-positive nasopharyngeal aspirate as predictor for severe acute respiratory syndrome mortality. Chest X-ray changes after dis- continuation of glucocorticoids treatment on severe acute respi- ratory syndrome (5 cases report). Clinical manifestation, treat- ment, and outcome of severe acute respiratory syndrome: analy- sis of 108 cases in Beijing. In one study, persistent fever, cough, progressive chest radiograph changes and lymphopenia were noted in all 10 patients (Hon). Teenage pa- tients presented with symptoms of malaise, myalgia, chill, and rigor similar to those seen in adults, whereas the younger children presented mainly with a cough and runny nose, and none had chills, rigor, or myalgia. Other prodromal symptoms reported included malaise, loss of appetite, chills, dizziness, and rhinorrhea. During the lower respiratory phase of the illness, approxi- mately one half of the children had coughing, one third of which was productive. However, these children had higher temperatures, a longer duration of fever, and more constitutional upset in terms of malaise and dizziness. Radiologic Features In the same series (Chiu), pneumonic changes on chest radiographs were present in ten children (47. Both tomographs were abnormal and showed the character- istic ground-glass opacities, as described previously in adults (Chiu). In this series, four teenagers required oxygen therapy and two needed assisted ventilation, whereas none of the younger children required oxygen supplementation (Hon). In addition, the radiologi- cal changes are milder and generally resolve more quickly than in teenagers. Tey are and setting, treatments or other interventions, outcome applicable to various patient-care settings, including family- measures assessed, reported fndings, and weaknesses and biases planning clinics, private physicians’ ofces, managed care orga- in study design and analysis. Telephone: 404-639-1898; therapy for each individual disease: 1) treatment of infection Fax: 404-639-8610; kgw2@cdc. Te consultants then providers have a unique opportunity to provide education and assessed whether the questions identifed were relevant, ranked counseling to their patients (5,6). As part of the clinical inter- them in order of priority, and answered the questions using view, health-care providers should routinely and regularly obtain the available evidence. In addition, the consultants evaluated sexual histories from their patients and address management of the quality of evidence supporting the answers on the basis of risk reduction as indicated in this report. When more history is an example of an efective strategy for eliciting infor- than one therapeutic regimen is recommended, the sequence is mation concerning fve key areas of interest (Box 1). Additional information is available are undergoing treatment), counseling that encourages absti- at www. Gardasil also prevents genital the United States is tested electronically for holes before pack- warts. Rates of condom breakage during sexual intercourse and recommended with either vaccine, as is catch-up vaccination for withdrawal are approximately two broken condoms per 100 females aged 13–26 years. Male condoms made of materials other than latex are avail- In addition, hepatitis A and B vaccines are recommended for able in the United States. In heterosexual serodiscordant relationships called “natural” condoms or, incorrectly, “lambskin” condoms). Communicating the following recommendations reported following the protocol for the use of these products can help ensure that patients use male condoms correctly: suggested that consistent use of the diaphragm plus gel might • Use a new condom with each sex act (i. However, a recent randomized trial of approximately for use in the United States consisted of a lubricated polyure- 9,000 women failed to show any protective efect (46). Sexually active possible after unprotected sex, but have some efcacy as long women who use hormonal contraception (i. Women who take oral contraceptives and method is not advisable for a woman who may have untreated are prescribed certain antibiotics should be counseled about cervical gonorrhea or chlamydia, who is already pregnant, or potential interactions (7). However, across Partner management refers to a continuum of activities trials, reductions in chlamydia prevalence at follow-up were designed to increase the number of infected persons brought approximately 20%; reductions in gonorrhea at follow-up were to treatment and disrupt transmission networks. Clinical-care providers partner management intervention has been shown to be more can obtain this information and help to arrange for evaluation efective than any other in reducing reinfection rates (72,73). Some programs should also receive health counseling and should be referred have considered partner notifcation in a broader context, for other health services as appropriate. Nevertheless, evaluations of partner notification notifcation eforts have improved case-fnding and illustrated interventions have documented the important contribution transmission networks (74,75). While such eforts are beyond this approach can make to case-fnding in clinical and com- the scope of individual clinicians, support of and collaboration munity contexts (65). In most jurisdictions, such reports are protected by statute Women who are at high risk for syphilis, live in areas from subpoena. Infants should not be discharged from the hospital unless the syphilis serologic status of the mother has Special Populations been determined at least one time during pregnancy and preferably again at delivery.

Treatment & disposal Incineration autoclaving / microwaving Colour coding Yellow/Red Container Plastic Bag/ Disinfected container 136 Category No 100mg viagra professional free shipping what food causes erectile dysfunction. Treatment & disposal Disinfection by chemical treatment with 1% hypochlorite solution autoclaving/microwaving and multilation / shredding cheap viagra professional 100 mg erectile dysfunction market. Treatment & disposal Disinfection by chemical treatment with 1% hypochlorite solution and discharge into drains buy 100mg viagra professional otc erectile dysfunction clinic raleigh. X Chemical Waste Waste Chemical used in production in biologicals order 50mg viagra professional otc erectile dysfunction doctors in sri lanka, chemicals used in disinfection, as insecticides, etc. Treatment & disposal Chemical treatment with 1% hypochlorite solution and discharge into drains for liquids and secured landfill for solids. Color Coding Black for solids Container Plastic Bag Summary: Nurses are the persons who have frequent contact with the patients to provide care for 24hours. It is the responsibility of the nurse to be aware of the patients at risk of developing infectious and also a duty to protect them with aseptic techniques. Ignition (an electric spark or naked flame) a source of fuel/petrol, wood or fabric) and oxygen (air) Clothing on Fire: Always follow this procedure: (1) Stop, drop and Roll (2) Stop the casuality panick­ ing, running around or going outside. The outer layer (epidermis) and the inner layer (dermis) and fatty tis­ sue (Subcutaneous fat) the epidermis is protected by an oily substance called sebum secreted from sebaceous glands which keeps the skin supple and water proof. The dermis contains the blood vessels, nerves, muscles sebaceous glands, sweat glands, hair follicles Ends of the sensory nerves (sensations like heat, cold, touch, pain) Blood vessels supply nutri­ ents and regulates the body temperature. Superficial : Only epidermis (eg) Sunburn Partial thickness : Destroys epidermis, Pain, Blister formation Full thickness : No pain sensation, skin scared. Assessing a Burn Types of Burn Causes of the burn Dry burn Flames, contact with hot objects Scald Steam, Hot liquids Electrical Burn High Voltage currents over head cables lighting strikes Frost bite Cold injury Frost bite Chemical burn Industrial chemicals, inhaled fumes and corrosive gases, chemical agents Radiation burns Sun burn, over exposure to ultra – violet rays, Expose to radio active sources. Assess for: Pain, difficulty in breathing, signs of shock Aims: (1) To stop the burning and relieve pain (2) To maintain an open airway(3)To minimize the risk of infection (4) To arrange urgent removal to hospital (5) Principles to be followed stop, drop and roll (6) Help the causality to lie down (7) Continue cooling the affected area (8) Cover the injured area with sterile/clean cloth to protect from infection. If the causalty is unconscious, make sure that the casualty is in safe area, open the causalty’s airway and check for breathing and do C. Do not approach the causalty of high voltage electricity until the current has been switched off and isolated. Chemical burn to the eye, first aider is to wash out the eye so that the chemical is diluted and dispersed. Complaints of headache, dizziness, confusion loss of appetite and nausea, sweating with pale and clammy skin, cramps in the arm, legs and abdomen, Rapid pulse and breathing. Head ache, dizziness, discomfort, restless ness, Hot & 0 0 flushed, dry skin, bounding pulse, high temperature above 104 F (40 C). Causes of Fractures: Direct Force: A bone can be fractured at the point where the force of a blow is applied. In an open fracture, one of the broken bone ends may pierce the skin surface or there may be a wound at the fracture site. Complicated fractures: They occur when the jagged ends of the bone fragments damage blood ves­ sels, nerves or a joint, broken bones in the chest may penetrate the lung, heart or liver. Depressed fractures: These occur in the skull when the broken ends of the bones are pressed in­ wards. Pathological Fractures: These occur when the bone is weakened by loss of calcium, infection or cancer. In old age the bones are more brittle, and may break spontaneously due to calcium loss which is part of the ageing process. People who are drowned may not be able to call for help because they expend all their energy to breathe or to keep the head over water. The drowning sequence: Begins with panic or struggle followed by submersion with breath holding, then water swallowing before passing out, within 3 minutes of being under water, loss of consciousness, within 5 minutes, brain suffers damage, then the heart goes into irregular rhythm before it stops breath­ ing. Additional Care Measures : (1) When you can place him on a firm surface, check breathing and pulse and continue resuscitation if necessary (2) As soon as the casualty begins breathing, place in recovery position. Effects of hemorrhage: The loss of red blood cells causes a lack of oxygen to the tissues of the body. Direct pressure: Place your hand directly over the wound and apply pressure, firm and steady until the bleeding stops. Elevation: Elevate the bleeding part of the body above the level of the heart so that the flow of blood will slow down in that part and blood clothing take place. Pressure Points: Applying pressure over the pressure points pressing over the underlying bone pres­ sure points on the arms (brachial pressure point) on the groin (femoral pressure point). Applying a tourniquet: A standard tourniquet is a piece of web belting about 36" long with a buckle device to hold it tightly in place when applied. Management: Apply direct pressure over the wound with your fingers and palms, with clean pad/cloth you can ask the casuality to apply direct pressure herself. If you suspect the casuality is going into shock, raise and support her legs so that they are above the level of her heart. Dial for an ambulance and transport the casuality to hospital till then the first aider should not leave the casuality until taken over by doctor or nurse. Advise her not to speak, swallow, cough spit because she may disturb the blood clots that have formed in the nose. The nervous system is affected and later if the condition of shock continues, the circulation of blood gradually fails and the patient dies. Prompt first aid treatment is needed to prevent shock increasing, and to help the patient to recover from the primary shock. And look pale, or he may collapse with signs and symptoms as follows: (1) He feels faint, weak and giddy. If shock is severe, raise the lower part of the body unless is injury to the head nor chest 3) Loosens tight clothing, but do not remove clothing 4) If he feels cold, cover him with the blanket, but do not try to warm him by any means 5) Offer him a warm sweat drink, e. Avoid causing pain 7) If there are severe injuries, or shock increases, get the causality to the health center or hospital without delay. Aims of first aid treatment: 1) Have the source of electricity switched off 2) Check breathing, and give artificial respiration immediately if he is not breathing. To bandage a limb, work from below upwards, and from inside towards the outside over the front of the limb. Finish in front, not over the wound, and fix the end with a safety pin, sticking plaster, stitching, or by tearing the end into two tails and tying. The completed bandage should be comfortable, look neat and fulfil its purpose with no restriction of circulation. Choosing the Correct Size :Before applying a roller bandage, check suitable width for the injured area Applying a Roller Bandage: Keep the roller part of the bandage (Head) upper most as your work (the unrolled part) is called the “tail”. Stand in front of the casualty except in cape line (Head bandaging and eye bandage are applied standing behind the client). Splinting:Splints can be made out of wood, card board, iron rods used to support the fractured part and for immoblization. To make two bandages, take a 1 metre square piece of strong cotton cloth, cut in across from corner, and hem the edges. The long side is called the ‘base’, and the corner opposite to it the ‘point’, The bandages may be applied opened out or it can be folded into a ‘broad’ or ‘narrow’ bandages. Three types of slings are used: Large Arm sling: This is used in cases of simple rib fracture and for fracture of the forearm. With the casualty’s forearm flexed and fingers touching the opposite shoulder, a clove hitch, made from a narrow bandage, is placed round his wrist. The ends of the bandages are taken around the neck and tied in the hollow just above the collar bone, on the injured side. First place the open bandage across the chest with the point beyond the elbow and one end over the hand. Take the end behind the elbow across the back and tie to the first end with the knot just in front of the shoulder, on the uninjured side. Improvised Slings : The lower edge of the casualty’s coat or shirt may be turned up and pinned to support the arm, or the hand may be passed inside a buttoned up coat. Fold a narrow hem at the base, place it just above the eyebrows, then take the two ends backwards, cross them below the occiput with the point underneath, then back to the forehead where they are tied. Signs and Symptoms: Headache, dizziness, discomfort, restless ness, Hot & flushed, dry skin, bounding 0 0 pulse, high temperature above 104 F (40 C), rapid unconsciousness First aid: 1) Remove the patient to dry and shady place, loosening his collar, and other tight clothings. First aid: 1) Replace the sodium with salt tablets or an electrolyte solution 2) Adding salt in the diet will prevent heat cramps Points to prevent heat injury: 1) Limiting the strenuous activities in the hot weather 2) Stay indoors and wear a minimum of clothing’s during heat waves. Effects of extreme cold: Effects of extreme cold are common in person who live or work in a climate where temperature falls below 32°F or are in high altitudes. Signs and symptoms: 1) The exposed part becomes cold, painful and ultimately numb 2) Colour first is red, then become white which may later lead to gangrene 3) Injured area is white, waxy and firm to tough. First aid: 1) Remove all wet or tight clothings from the frost bitten area 2) Carry the patient to a closed room with out a fire and undress him carefully. Mittens are generally more effective than gloves 8) Avoid alcohol and cigarettes 149 9) Avoid becoming unduly fatigue 10) Do not use snow, ice cold water 11) If freezing occurs, avoid thawing the part until refreezing is eliminated as a threat. If the snake has been killed it should be taken with the causality to the hospital most of the people die from fear. Though the scorpions are not seriously poisonous but sometimes persons can become unconscious 150 Signs & Symptoms: 1) Severe burning 2) Intolerable increasing pain in the bitten area 3) Giddiness 4) Vomiting 5) Unconsciousness First aid: 1) Patient should make to lie comfortably and soothing cream applied. First aid: 1) Thorough washing of the bitten area and wash the wound with soap and water (Detergent solution) for 5­10 minutes. Apply antibiotic cream 3) Shift the causality immediately to the hospital 4) The dog should be kept under observation for 10 days Cat bite: Cats keep roaming around the houses but if they are disturbed and touched they become violent and can attack. Signs & Symptoms: 1) Local pain, itching and severe swelling 2) Low blood pressure 3) Unconsciousness First aid 1) To relieve the pain try to remove the sting with tweezer. It has a terrible capacity to stick to the body and keep sucking the blood during this period it spreads germs of certain diseases in the body by which tuloramie, rocky mountain spotted fever. Signs & Symptoms: Typhus Fever First aid: 1) The tick or mite has bitten and it is sticked should be immediately removed.

When there is a fever it usually means an infection is present and you must try to locate the site of the infection and decide whether it needs treatment and with what buy generic viagra professional 50mg impotence groups. The pulse:- The pulse can be felt and count in children radically for fifteen seconds multiply by four discount viagra professional 50 mg on line erectile dysfunction pills wiki. In the infant it is sometimes easiest to count the heart rate with the stethoscope apically cheap viagra professional 100mg visa whey protein causes erectile dysfunction. Normal pulse rate: • babies 100-140 beats per minute • children 80-100 beats per minute In fever the pulse rate generally rises discount viagra professional 100 mg with mastercard erectile dysfunction drugs muse. The respiratory rate:- Normal respiratory rate: • < 2 month ,< 60 breath per minute • 2-12 months < 50 breath per minute • 12 month-5years< 40 breath per minute 20 Pediatric Nursing and child health care A rapid respiration of 60 or more in a small, feverish child is a very good indicator of pneumonia c. Anthropometric measurement: • Weight • Height/Length • head circumference • mid-arm circumference • Chest circumstances Weight: The best way to assess nutritional status is to take body weight. The upper line shows the average weight of healthy well nourished children and this is an ideal growth curve. The middle shows the lowest weight that is still considered to be within limits of normal and the weights on this line are 80 % of the weights on the upper line. According to Gomez classification any child whose weight is below this line is marasmic. Height: Height (length) is also used but more difficult to measure than weight especially in infants. It is a less sensitive measure than weight because it does not decrease during malnutrition, it only stops increasing. This means that height is 21 Pediatric Nursing and child health care not affected much for the first six months in malnutrition and is therefore more a measurement of longstanding malnutrition. The need for accuracy in pouring and giving medication is greater than with adult patients. The dose varies with the size, surface area, the age of the child and the nurse has no standard dose as is customary for adult patients. Since the dose is relatively small, a slight mistake in amount of drug given makes a greater proportional error in terms of the amount ordered than with the adult dose. A) Oral administration: Infants will generally accept the medication put into their mouth, provided that it is in a form which they can deadly swallow. The nurse should sit-down and hold infant or if he cannot be removed from his crib, raises him to sitting position or if this is contraindicated elevate his head and shoulders. Medication can be given from medication glass, the tip of teaspoon or rubber-tipped medicine dropper. The child should be told to place the tablet near the back of his tongue and to drink the water, fruit juice, milk offered him in order to wash down the tablet. In younger seriously sick children, tablets crushed and dissolved in water can be given by spoon or through Naso- gastric tube 25 Pediatric Nursing and child health care B) Intramuscular Injections: The procedure of using an intramuscular injection is the same as for the adults. The needle used for intramuscular injection must be long enough so that the medication should be given deeply into the muscle tissue in order to be absorbed properly. C) Intravenous Administration: When a patient’s gastrointestinal tract can not accept food, nutritional requirements are often met intravenously. Parental administration may include high concentrations of glucose, protein or fat to meet nutritional requirements. Many medications are delivered intravenously, either by infusion or directly into the vein. The ability to gain access to the venous system for administering fluid and medications is an expected nursing skill in many settings. They are responsible for selecting the appropriate venipuncture site and being proficient in the technique of vein entry. Ideally, both arms and hands should be carefully inspected before a specific venipuncture site is chosen. To prepare for Gavage feedings, the space from the bridge of the infant’s nose to the earlobe to a point halfway between the xiphoid process and the umbilicus is measured against a No 8 or 10 Gavage tube for children over one year measure from the bridge of the nose to the earlobe to the xiphoid process. The tube is marked at this point by a small Kelly clamp or 27 Pediatric Nursing and child health care piece of tape to ensure that it reaches the stomach after it is passed. Although the tube is passed into the stomach, it is occasionally passed into the trachea accidentally, oil left in the trachea could lead to lipoid pneumonia, a complication that a child already burdened with disease may not be able to tolerate. Once you are assured that the catheter is in the stomach, attach a syringe or special feeding funnel to the tube. Be certain that the child’s head and chest are slightly elevated to encourage fluid to flow downward into the stomach. Then feed with funnel or syringe and allow it to flow by gravity into the child’s stomach. When the total feeding has passed through the tube, the tube is reclamped securely and then gently and rapidly withdrawn to reduce the risk of aspiration. If the tube is to be remain in place, it should be flashed with 1 to 5 ml of sterile water and cupped to seal out air. Cardiac arrest follows quickly after respiratory arrest as soon as the heart muscle is affected by the anoxia, which occurs. The outcome for the child will depend to great extent on the speed with which resuscitation is began. The steps for resuscitation can be remembered as “A, B, C, D” where A is for airway, B for breathing and C is for circulation and D is for drug administration. Oxygen administration: Oxygen administration elevates the arterial saturation level by supplying more available oxygen to the respiratory tract. Nursing care must be planned carefully when children are in tents: • The tent should be open as little as possible so that as high an oxygen concentration as possible can be maintained. Most children do not like nasal catheter because it is irritant; assess the nostrils of the infant carefully when using nasal catheter. The pressure of catheter can cause areas of necrosis, particularly on the nasal septum. Administering Enemas: Enemas are rarely used with children unless a part of preoperative preparation or are required for radiological study. The usual amount of enema solution used are as follows: • Infant: less than 250 ml • Preschooler: 250-350 ml • School age child: 300-500 ml • Adolescent: 500 ml 30 Pediatric Nursing and child health care For an infant: • Use a small soft catheter (no 10 to 12 French) in place of an enema tip. This may be true, but such a diagnosis is difficult to prove and should never be made without taking a careful history and performing a proper examination in any child with fever. Young children appear to tolerate fever better than adults but some develop convulsions. If you still do not have a definite cause for the fever, rule out (Malaria, Early measles, Pneumonia, meningitis) A) Features of Febrile convulsions: • Begin between 6 month and 5 years of age • Incidence is 3 % by 5 years of age • Epilepsy develop in 3 % of cases • % are neurologically abnormal • 30 % of cases develop further seizure with fever • Febrile seizures lasting over 30 minutes are more serious • Repeated convulsions may damage the brain. The best treatment is controlling and preventing high fever rather than giving continuous anticonvulsants. If the fever is high (over 39 degree centigrade) • Tepid sponging with ordinary water will help to reduce but ice cold water is harmful because it causes constriction of blood vessel in the skin and prevents heat loss. Children must be able to get rid of the heat, otherwise febrile convulsions can be precipitated c. Take care the airway does not become blocked by the tongue or secretions by placing the patient in the coma position with the mouth downwards and using suction p. A malaria blood film, a lumbar puncture, dextrostix in blood or clinistix in urine, measuring blood pressure, and a thorough history and examination will usually reveal the cause. In case of a feverish, toxic, comatose child, also start treatment with penicillin and chloramphenicol and refer to hospital. This is not only due to congenital malformation or perinatal injury to the central nervous system but also the frequency of “febrile“ convulsions in response to a rapid rise of temperature at the onset of acute infective illnesses 1. Nursing Management during seizure: • Provide privacy • Protect head injury by placing pillow under head and neck • Loosen constrictive clothing’s • Remove any furniture from patient side • Remove denture if any 35 Pediatric Nursing and child health care • Place padded tongue blade between teethes to prevent tongue bit • Do not attempt to restrain the patient during attack • If possible place patient on side 3. Nursing Management after seizure: • Prevent aspiration by placing on side • On awaking re-orient the patient to the environment • Re-assure and calm the patient 3. When an indwelling tube is inserted into the trachea, the term tracheostomy is used. A trachestomy is performed to by pass an upper airway obstruction, to remove tracheoborncheal secretions, to prevent aspiration of oral or gastric secretions in the unconscious or paralyzed patient and to replace an endotracheal tube. There are many disease processes and emergency conditions that make a tracheostomy necessary. After the trachea is (opened) exposed a tracheostomy tube of appropriate size is inserted. The tracheostomy tube is held in place by tapes fastened around the patients neck usually, a square of sterile gauze is placed between the tube and the skin to absorb drainage and prevent infection. Complications: Early complications immediately after the trachestomy is performed include: • bleeding • pneumothorax • air embolism • aspiration • subcutaneous or mediastinal emphysema • recurrent laryngeal nerve damage or • posterior tracheal wall penetration. Immediate Postoperative Nursing care: • The patient requires continuous monitoring and assessment. Nutrition status of the mother 44 Pediatric Nursing and child health care A) Management of low birth weight: ƒ Clean air way ƒ Initiate breathing ƒ Establish circulation ƒ Keep Warm ƒ Administer Vit. Due to maternal origin • Amniotic fluid infection • Obstructed labor • Congenital syphilis Placenta previa • Causeless • Toxemia of pregnancy • Recurrent and the bleeding is painless Gestational Hepatitis B. Due to fetal and maternal origin ƒ Premature separation of placenta ƒ Trauma Abruption placenta 48 Pediatric Nursing and child health care ƒ Causeless ƒ Accidental ƒ Painful(rigid) C. Congenital pneumonia It is caused by aspiration of amniotic fluid or ascending infection. Route of infection: • Transplacental • Amniotic fluid infection • Environment • Instrument Other Neonatal problems: • Congenital abnormalities • Prematurity and related problems • Jaundice • Birth Trauma 4. Neonatal resuscitation: During the initial resuscitation efforts, a 100 % oxygen concentration is administered to the neonate. This adjustment is essential, since elevated pao2 levels can cause irreparable damage to retinal vessels. Furthermore, high oxygen concentrations can directly injure lung tissue premature infants with immature lungs and eye vessels are at particular risk for two conditions that are a direct result of oxygen toxicity: retrolental fibroplasia and bronchopulmonary dysplasia.

Also buy cheap viagra professional 100mg online impotence caused by medications, many patients may fail to report the pain due to their inability to express themselves or because they have become accustomed to it buy viagra professional 100mg mastercard erectile dysfunction doctor in kuwait. Perceptual issues purchase 100 mg viagra professional otc erectile dysfunction doctors in colorado springs, particularly hearing and vision impairment discount viagra professional 100mg online erectile dysfunction doctors san francisco, can often go overlooked by doctor and client, yet they can result in psychiatric sequelae such as hallucinations, anxiety, depression, and confusion. In addition to treating physical disorders, clinicians can use the body as a channel for therapeutic intervention. Numerous nutrient therapies are efficacious for a panoply of psychiatric disorders. Some treatments, such as omega-3 fatty acids, have become so commonplace that they are now considered best practice in mainstream medicine. Herbal treatments have a role in psychiatric medicine and a number of them have been reported safe and effective in the literature. Exercise has been shown to be very effective as a mood elevator and lack of exercise can impair the quality of life for any psychiatric patient as well as retard recovery. Environmental Influences In the early 1900s, when psychoanalysis was the dominant force in psychiatry, Sigmund Freud wrote, “If a man has been his 18 | Complementary and Alternative Medicine Treatments in Psychiatry mother’s undisputed darling, he retains throughout life the triumphant feeling, the confidence in success, which not seldom brings actual success along with it. Many professions use chemicals that can have toxic effects on the brain, including farming, metal plating, laboratory work, mining, and certain types of manufacturing. Toxic waste, a paucity of certain nutrients in the region’s soil, political upheaval or other environmental threats can and do make a difference to mental well-being. Chronic exposure to power lines, for example, has been shown to increase suicide rates up to threefold in electrical workers (Wijngaarden 2000). Also, high-density negative ions in the air, as are seen near waterfalls, produce a 43% improvement in depression (Terman 2007). Spiritual Matters A survey of 1144 American physicians found that amongst all doctors, psychiatrists are the least likely to be religious. Additionally, nonpsychiatrist physicians who are religious are less willing to refer their clients to a psychiatrist (Curlin 2007). By contrast, only 15% of the American population defines itself as atheist, agnostic, or of no religious affiliation (Kosmin 2008). Individuals can suffer great anxiety and depression over a religious issue, be it guilt from transgressions, abortion, infidelity, pornography addiction, dishonesty, child abuse, divorce or other weighty matters. They may not think to mention such things to a psychiatrist since he is a doctor and not a priest/pastor/rabbi. People of Eastern faiths have additional issues and traditions that could trouble them and that are worth exploring. Such a person could benefit from religious counseling perhaps more so than any other form of treatment. Addressing the Mind Traditional treatment of mental and emotional issues involves psychotherapy, some form of practitioner-patient interchange that allows the client to discuss trauma and life issues with the hope of unburdening the individual to some degree or leading him/her towards solutions for the issues he/she faces. But other approaches have emerged—many from Asia—that provide a different look at the mind and living which offers therapeutic benefits. The concept of mindfulness or being in the present has been imported from India, China, and neighboring regions and encourages quieting the mind rather than engaging it or delving into it continuously for solutions. This practice of quieting thought can have many forms, including physical actions such as breathing exercises or taking walks and has become a popular method for calming anxiety, reducing obsessive thought, and relieving depression. Numerous modalities have arisen that utilize these pathways to manipulate mental processes in often simple but powerful ways Aromatherapy has been used effectively to calm and improve behavior. Lavender oil, for example, reduces agitation in 60% of dementia patients (Holmes 2002). It has been found helpful for many disorders and diminishes symptoms of schizophrenia (Talwar 2006) and depression (Maratos 2008). While numerous forms of the therapy exist, they generally consist of clients looking at lights or video screens programmed to shift brain wave patterns. Light therapy is now an established remedy for Seasonal Affective Disorder and is a simple option to medication for some. Massage therapy is a combination of touch and muscle manipulation that can have a relaxing effect. It has been found to significantly reduce symptoms of depression (Hou 2010) and anxiety disorder (Sherman 2010). Patients and caregivers who have hope have less depression and more reason to believe they will succeed (Cheavens 2006). A patient who is given one therapy as his only option can lose all hope if it fails. Many psychiatric patients live lives of quiet desperation, suffering side effects from meds they dislike but feeling they have no other choice. Even if a treatment fails, if other options are on the horizon, this expectation can keep a patient working toward wellness and putting one foot in front of the other on the road that may lead to partial or full recovery. It can even cause the patient to make improvements in his lifestyle as he strives to do his part in the recovery effort. Summary Of all the fields of medicine, few require as holistic a view as psychiatry. So many variables can impact mental and emotional function—and so many approaches can improve it—that the psychiatrist of today is hard-pressed to keep abreast of the investigational and therapeutic tools at his disposal. This means that pharmaceutical treatments in psychiatry, which can bring with them dramatic side effects such as metabolic syndrome, renal failure, anorgasmia, and obesity, are being reevaluated by some as to whether they should always be a first and only form of treatment. With an understanding of the therapeutic tools at his disposal, the clinician’s—and the client’s—chances of success are markedly improved. The Comprehensive Medical Exam in Psychiatry Dan Stradford Virtually every medical student has been taught, “When you hear hoofbeats, don’t expect to see a zebra,” a phrase coined by Dr. The gist is that when a physician sees symptoms, he should consider routine diagnoses, not exotic ones. Psychiatrists are often taught the same phrase regarding psychiatric symptoms that are created by non-psychiatric medical disorders—that although they exist, these conditions are, in fact, rare and unlikely. Unfortunately, this line of thinking has caused many serious medical conditions to go undiagnosed. Factually, physically-created mental and behavioral symptoms are not uncommon and certainly not as rare as a zebra running wild in the Western Hemisphere. From 5–40% of psychiatric patients are found to have medical ailments that would adequately explain their symptoms (Allen 1995). Additionally, up to 25% of mental health patients are found to have medical conditions that exacerbate psychiatric symptoms (Christensen 2009). In older patients with first-time psychiatric symptoms, the likelihood of underlying physical contributors is even greater. In The Comprehensive Medical Exam in Psychiatry | 23 a Danish study of cancer rates in first-time psychiatric patients, lead author Michael E. Benros remarked, “The overall cancer incidence was highest in persons older than 50 years of age admitted with a first-time mood disorder, where 1 out of 54 patients would have a malignant cancer diagnosed within the first year. He concluded: “Our study illustrates the importance of making a thorough physical examination of patients with first-time psychiatric symptoms. Sydney Walker wrote Psychiatric Signs and Symptoms Due to Medical Problems (Walker 1967). A survey carried out in 2001 by the nonprofit Safe Harbor (of which the author is president) found that the 100,000 outpatients seen annually by the Los Angeles County Department of Mental Health were routinely not given medical exams. One reason for this oversight is because diagnoses such as schizophrenia, bipolar disorder, and even major depression are often thought of as discrete disease entities, when in fact, they are not. Because the causes of these syndromes have evaded investigators for centuries, there is a tendency to consider the etiology as unknowable, when, through a thorough medical exam and differential diagnosis, the possibility exists that the causes of even the worst psychiatric manifestations may be determined and may even be completely treatable. Further, it has become customary to treat psychiatric symptoms pharmaceutically, without considering the cause. Additionally, once a patient has been labeled with a psychiatric disorder, there is a tendency on the part of doctors and hospital staff to not look further. Lastly, a psychiatric patient may be unable or unmotivated to voice physical complaints. Failure to identify one or more medical conditions that are causing or exacerbating mental symptoms may result in: − A continuation or worsening of psychiatric symptoms. Signs That Mental Symptoms Have a Medical Cause Numerous signals exist that indicate medically-caused psychiatric symptoms (Koran 1991): 1. Experiencing neurological symptoms such as unilateral weakness, numbness, paresthesias, clumsiness, gait problems, headaches of increasing severity, vertigo, visual symptoms, speech or memory difficulties, loss of consciousness, or emotional lability. A physical illness that can impair organ function (neurologic, endocrine, renal, hepatic, cardiac, or pulmonary). Episodic, recurrent, or cyclical symptoms interspersed with periods of being well. The following symptoms indicate that medical illness is more likely (Diamond 2007): − A change in headache pattern. Conditions That Cause Psychiatric Symptoms Medical conditions can cause symptoms that mimic any psychiatric diagnosis. The most common psychiatric complaints—psychosis, anxiety, and depression—are known to The Comprehensive Medical Exam in Psychiatry | 27 be created by a host of physical ailments. Brain injuries or growths, neurological infections, drug reactions, and severe endocrine disorders are just some of the medical issues that may be indicated. These disturbances can be brought on by conditions such as cardiopulmonary problems, toxic conditions, hypoglycemia, and a broad range of legal and illegal drugs. Depression can include an array of symptoms such as sadness, low self-esteem, lethargy, and apathy.