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By O. Ugolf. Bethany College, Lindsborg, KS.

The best treatment is controlling and preventing high fever rather than giving continuous anticonvulsants buy hoodia 400 mg amex. 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 buy generic hoodia 400mg online. Children must be able to get rid of the heat discount hoodia 400 mg with mastercard, otherwise febrile convulsions can be precipitated c generic 400mg hoodia with visa. 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. 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. Malaria: one negative blood film report does not exclude malaria B Early measles: look for koplik’s spots C Pneumonia: look at the child for flaring of nostrils, rate of breathing, Lower chest in drawing D Otitis media: check eardrums E Meningitis: neck stiffness, irritability F Urinary tract infection: check urine G Tonsillitis: look at the throat H Relapsing fever: take blood film for haemo parasite 4. 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 55 Pediatric Nursing and child health care Causes: 1. In the neonatal period the major causes of convulsions are • Congenital defect of the brain • Cerebral damage occurring during the process of birth from hypoxia or trauma both account for 90 % of the cases. The remaining 10 % includes: • infection of the brain ( meningitis ) • hypoglycaemia • hyperbillirubinaemia with kernicterus etc 2. Feeding Recommendations during sickness and health: Up to 4 months of age • Breast feed as often as the child wants, day and night, at least 8 times in 24 hours. Shiro, kik, merek fitfit, mashed potatoes and carot, gommen,undiluted milk and egg and fruits 57 Pediatric Nursing and child health care • Add some extra butter or oil to child’s food • Give these foods:-3 times per day if breastfed 5 times per day if not breastfed • Expose child to sunshine 12 months up to 2 years: • Breast feed as often as the child wants, Give these foods 5 times per day • Give adequate serving of: porridge made of cereal and legume mixes.

The hydrophobic region interacts with the large lipid molecules discount hoodia 400mg fast delivery, whereas the hydrophilic region interacts with the watery chyme in the intestine discount 400mg hoodia visa. This results in the large lipid globules being pulled apart into many tiny lipid fragments of about 1 µm in diameter hoodia 400mg overnight delivery. Bile salts act as emulsifying agents buy hoodia 400mg overnight delivery, so they are also important for the absorption of digested lipids. While most constituents of bile are eliminated in feces, bile salts are reclaimed by the enterohepatic circulation. Once bile salts reach the ileum, they are absorbed and returned to the liver in the hepatic portal blood. Bilirubin, the main bile pigment, is a waste product produced when the spleen removes old or damaged red blood cells from the circulation. These breakdown products, including proteins, iron, and toxic bilirubin, are transported to the liver via the splenic vein of the hepatic portal system. Bilirubin is eventually transformed by intestinal bacteria into stercobilin, a brown pigment that gives your stool its characteristic color! In some disease states, bile does not enter the intestine, resulting in white (‘acholic’) stool with a high fat content, since virtually no fats are broken down or absorbed. Hepatocytes work non-stop, but bile production increases when fatty chyme enters the duodenum and stimulates the secretion of the gut hormone secretin. The valve-like hepatopancreatic ampulla closes, allowing bile to divert to the gallbladder, where it is concentrated and stored until the next meal. The Pancreas The soft, oblong, glandular pancreas lies transversely in the retroperitoneum behind the stomach. Its head is nestled into the “c-shaped” curvature of the duodenum with the body extending to the left about 15. It is a curious mix of exocrine (secreting digestive enzymes) and endocrine (releasing hormones into the blood) functions (Figure 23. The exocrine part of the pancreas arises as little grape-like cell clusters, each called an acinus (plural = acini), located at the terminal ends of pancreatic ducts. These acinar cells secrete enzyme-rich pancreatic juice into tiny merging ducts that form two dominant ducts. The larger duct fuses with the common bile duct (carrying bile from the liver and gallbladder) just before entering the duodenum via a common opening (the hepatopancreatic ampulla). The smooth muscle sphincter of the hepatopancreatic ampulla controls the release of pancreatic juice and bile into the small intestine. The second and smaller pancreatic duct, the accessory duct (duct of Santorini), runs from the pancreas directly into the duodenum, approximately 1 inch above the hepatopancreatic ampulla. Scattered through the sea of exocrine acini are small islands of endocrine cells, the islets of Langerhans. Unlike bile, it is clear and composed mostly of water along with some salts, sodium bicarbonate, and several digestive enzymes. If produced in an active form, they would digest the pancreas (which is exactly what occurs in the disease, pancreatitis). The intestinal brush border enzyme enteropeptidase stimulates the activation of trypsin from trypsinogen of the pancreas, which in turn changes the pancreatic enzymes procarboxypeptidase and chymotrypsinogen into their active forms, carboxypeptidase and chymotrypsin. The enzymes that digest starch (amylase), fat (lipase), and nucleic acids (nuclease) are secreted in their active forms, since they do not attack the pancreas as do the protein-digesting enzymes. The entry of acidic chyme into the duodenum stimulates the release of secretin, which in turn causes the duct cells to release bicarbonate- rich pancreatic juice. Parasympathetic regulation occurs mainly during the cephalic and gastric phases of gastric secretion, when vagal stimulation prompts the secretion of pancreatic juice. Thus, the acidic blood draining from the pancreas neutralizes the alkaline blood draining from the stomach, maintaining the pH of the venous blood that flows to the liver. The Gallbladder The gallbladder is 8–10 cm (~3–4 in) long and is nested in a shallow area on the posterior aspect of the right lobe of the liver. This muscular sac stores, concentrates, and, when stimulated, propels the bile into the duodenum via the common bile duct.

Given that transobturator with a small incision using various approaches are probably safer and trochar devices order hoodia 400 mg amex. Initially fatalities have occurred due to a welded semi – rigid tape of bowel damage and uncontrolled non – woven monoflament retropubic haemorrhage 400 mg hoodia with amex. Women are placed transobturator procedures show in the Lithotomy position order 400mg hoodia with visa, and the similar cure rates hoodia 400mg without a prescription, but these 10mm tape passes sub – urethrally studies are too underpowered through the obturator fossa to exit to show meaningful differences the skin through a small incision in complications rates. The introducer passes from obturator approaches are safer the obturator fossa medially because of avoidance of pelvic inwards towards the vagina, hence cavity viscera – but no hard 50 the “outside – in” appellation. Another popular “outside – in” device is the MonarcR tape, and The manufacturers (Mentor – one – year data shows similar Porges) have since introduced the results. The objective cure rate is ArisR type 1 light weight superior 82%, with adverse events including mesh, being woven in such a mesh erosions, urinary retention manner as to have low elasticity. Since no “head in continence of 7% – 9%, to head” prospective randomized and a failure rate of up to 7%. This novel approach was developed after extensive In a recent study of 117 women, cadaveric dissection and one the ObtapeR afforded a 92% year data suggest a 91% cure cure (defned as complete or rate, with 5% of cases showing partial satisfaction), with a 5% improvement. Tape erosions complications include voiding over the 22 month follow – up dysfunction in 5% of women, period, occurred in 3 cases. Procedures vaginal fnger may cause some typically take around 20 minutes tissue destruction because of to perform, and may be done as the more extensive dissection, day case procedures if the patient particularly in the atrophic prefers. Although general or vagina with thinner vaginal skin, regional anaesthesia is the norm, leading to infection, erosion they may be done under local or tape displacement. Complications involving the It is diffcult to draw conclusions urethra, bladder and vagina have from these data, and clinical trials been described. It has become Leval common to measure the “passing This dissection is less extensive distance” of the different devices without the need for digital to vital anatomical structures control, and the mesh used is in preserved or fresh cadaver extra - ordinarily well tolerated specimens, but once again this with long – term clinical data does not necessarily translate to available. The mini – sling type be combined with a prophylactic operations work on a different continence procedure? Is the principle to the conventional effcacy of either procedure obturator approach, and are affected by concomitant surgery? At this stage no long and demonstrable problem, term comparative data regarding evidence suggests that abdominal effcacy are available. Stem cells hysterectomy performed at the injected para – urethrally remain time of a Burch colposuspension an interesting possibility, but are has no adverse effect on the still, at this stage, experimental. While The Future the retropubic approach is still popular, the obturator approach Recently the “mini – sling” has many probable advantages to products have become available, recommend this technique, and consisting of shorter lengths of make it the treatment of choice. While the ersatz knock – offs may be slightly cheaper (since no development costs were involved), the originators have the advantage of published clinical trials proving good outcomes. The problem however is that neurological pathology can often be a cause 55 of these dysfunctions and various Most conditions of the central neurological conditions can cause nervous system can produce the overactive bladder symptoms, full range of bladder symptoms, impaired detrusor contractility varying sometimes from one stage and incontinence. Brain tumours These conditions can cause high • Cerebral Palsy pressures within the bladder • Parkinsons disease of above 40cmH20 without the • Shy-Drager Syndrome urethral sphincter opening. This • Multiple sclerosis causes severe back pressure and • Spinal cord injuries – suprasacral upper urinary tract damage. It is however important • Skeletal abnormalities of the in the patient with atypical or spine (disc problems, ankylosing mixed urinary symptoms to be spondylitis) on the lookout for more subtle • Peripheral nerve damage neurological changes before (radical surgery, diabetes instituting treatment, especially mellitus) surgical treatment. Neurological disorders often Table 11: Other Causes Of overwhelm the average clinician, Voiding Dysfunction who probably slept through neurology lectures at university. Until Infammatory recently, however, the correlation • Severe vulvo vaginitis (genital between history, clinical fndings herpes, severe vulvo-vaginal and special investigations has candidiasis) shown poor correlation in women • Urethritis and cystitis and been more extensively and better defned in men. Pharmacological • General anaesthesia The following urinary symptoms • Regional anaesthesia are however important in making • Analgesics (Morphine) the diagnosis of suspected voiding • Anti depressants abnormalities. Be aware however • Anti cholinergics that different studies have linked these symptoms differently to Detrusor Muscle Abnormalities confrmed voiding disorders • Detrusor myopathy • Over distention • Hesitancy • Straining to void Psychogenic • Feeling of incomplete emptying • Terminal dribble Post Partum Voiding Diffculty • Post micturition dribble • Splitting and spraying of urine Idiopathic • Changing position to void Surgical The above urinary symptoms • Will be discussed later in this may also be associated with chapter overactive bladder symptoms and incontinence. Further important questions in the history would be careful questioning about the usage 57 of medications, recent pelvic or for infection and haematuria abdominal surgery, neurological • Post micturition residual symptoms and symptoms of utero- volume. Ultrasound scanning Abdominal and pelvic examinations should concentrate is less invasive and causes less discomfort than urinary on detecting local lesions and anomalies, which might cause catheterisation. It is important to remember however that the urinary obstruction, such as pelvi- accuracy of this measurement abdominal tumours, utero-vaginal depends on the time since the prolapse, vulvo-vaginitis, urethritis last passage of urine until the and evidence of pelvic foor spasm or relaxation. In diffcult cases, with mixed • Urofowmetry is an excellent non invasive screening test urinary symptoms, or where for voiding dysfunction.

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