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Breast Surgery • Encourage deep breathing often order fildena 50 mg with amex, because of danger of pneumonia • Special arm exercises should be given Abdominal Surgery • Encourage deep breathing • Turn from side to side often st • Sit patient on edge of bed 1 day postoperatively and • Start walking second day post operatively (unless contra-indicated) • Intake and output should be recorded • If gastric suction is present make sure it is working properly • Frequent mouth care for patients who are not allowed to drink purchase 50 mg fildena with mastercard. Eye Surgery • Must lie very still because the incision and sutures can be damaged by pulling on the eye muscles effective fildena 100mg. Spinal Surgery • Must lie on abdomen of back with bed flat buy fildena 50mg lowest price, and supported by fracture board mattress. This will make it easier to breathe since the pressure of dressing and swelling may give choking feeling. Tonsillectomy Child • Lie on abdomen or side to prevent blood drainage into throat, lunge or stomach. Adult • If conscious, he may sit in semi- fowler’s positron in order to spit the blood more easily. List some important equipment to provide care for immediate postoperative patients. Legal death is the total absence of brain activities as assessed and pronounced by the physician. If the dying patient is in a ward, move him to a room where there are no other patients, if possible, if this is impossible, put screen around his bed. To show kindness to the family Equipment • Basin for water, wash cloth and towel • Cotton • Gauze • Dressings and tape if necessary • Clean sheet • Stretcher • Forceps • Name tag • Gloves, if necessary Procedure • Note the exact time of death and chart it • If the doctor is present call him to pronounce death • If the family members are not present, send for them • Wash hands and wear clean gloves according to agency policy • Close doors to room or pull curtain • Raise bed to comfortable working level (when necessary) • Arrange for privacy and prevent other patients from seeing in to room. Autoclave Equipment that decontaminates materials by exposing them to steam under pressure. Asphyxia A condition produced by prolonged lack of oxygen Asepsis Absolute freedom from all microorganisms Antiseptic Harmless chemicals that can kill microorganisms or prevent them from multiplying. Aseptic technique Procedure used to prevent microorganisms from reaching the operation site. Blood pressure The force exerted by the heart to pump the blood around the body Bradycardia Abnormally slow heartbeat. Cyanosis Bluish color of lips, tip of the nose, and ear lobes due to lack of or shortage of oxygen in the blood. Congestion Hyperemia, accumulation of blood in a part of blood or fluid in a part of the body e. Detergent A substance usually dissolved in water used as an aid for cleaning purposes. Diagnosis The decision regarding the nature of an illness, arrived at by clinical assessment of the patient and result of investigation. Dry heat Air heated to high temperature by electricity and used for sterilizing purposes. Edema Swelling due to water accumulation in body cells Enema An injection of fluid into the colon or rectum. Fahrenheit System of measuring heat 0 Fever Body temperature elevation above 37 C Flatus Gas in the intestines. Foot board A board placed at the foot of the bed to support the feet Gastrostomy Making an artificial opening into the stomach through which the patient is fed by pouring 166 nourishment through a tube directly into the stomach. Inflammation Reaction of the body to infection or injury, characterized by redness, heat, pain, and swelling at the site. Mitered corner A triangular fold made in bedclothes to hold them in place at the corners. Orthopnea A condition in which one breathes easier in a sitting position Pediculosis Human louse infestation Postural drainage Position adapted to facilitate expectoration of material in patients with lung disease. Preoperative Before an operation Pulse The beat of the heart felt in the arteries. Retention enema An injection of fluid that is retained in the rectum for absorption into the blood stream.

Usually a dose of 400-mgmlcg-body weight is given per day for 3-5 days The approximate expenditure of this treatment is about 1 generic 100 mg fildena amex. If diagnosis is done in the early stages and treatment taken from a specialist most of the patients get relief and lives can be saved buy 100mg fildena otc. This system consists of the large brain order fildena 50mg overnight delivery, small brain buy fildena 25mg without prescription, spinal cord, the nerves emanating from them, the neuromuscular junction and muscles. In the previous chapter we have discussed in detail about the disease of the neuromuscular junction namely, Myasthenia Grams. Duchenne Muscular Dystrophy : This hereditary disease is a sex-linked recessive disorder of muscles related to X- chromosome which is found in about 30 per one-Iakh boys. The child falls while walking, has difficulty in getting up and climbing stairs with a gradual increase in weakness. Symptoms of this disease may be seen in other male offsprings in the family, or in mother’s brothers and their sons. Treatment : No permanent cure has yet been discovered for this disease though steroids can control the disease to some extent. Becker Muscular Dystrophy : This disease is a sex linked recessive disease linked to X- chromosome, in which the muscular weakness is similar to that of Duchenne Muscular Dystrophy, but the amount of the weakness is less and the speed of spreading of the disease is slow. The primary symptoms of the disease are seen in 5 to 15 years of age and the patient usually lives up to 4 to 5 decades. Limb Girdle Dystrophy : This muscular disorder is found in both males and females between the first and fourth decade of life. Apart from this, in facio-scapulo-humeral muscular dystrophy there is weakness of the muscles of the mouth, shoulders and hands. Congenital myopathy : The muscular disorders seen in infants include the central core, nimeline and centro nuclear myopathy. Besides this, any disorder of the main part of the cells namely mitochondria causes a congenital disease called mitochondrial myopathy. Metabolic Myopathy : Congenital metabolic disorders like glycogen storage, myophosphorylase, lipid storage, and some other mitochondrial myopathies are included in this. Periodic Paralysis : A deficiency of potassium in the blood can cause hypokalemic periodic paralysis in which the shoulder muscles and the thigh muscles weaken. Sometimes, it can also affect the muscles of the eyes as well as the respiratory muscles, which can prove fatal if not treated properly. A doctor’s supervision is very essential in this matter, because overdose or low dose of potassium can cause serious side effects. Hyperkalemic periodic paralysis : An excessive amount of potassium in the blood also causes similar type of weakness in the muscles. Paramyotonia congenita : In this disorder the muscular weakness can occur due to cold climate or without any apparent reason. We will now study in detail about the difficult diseases occurring due to the inflammation of the muscles. Polymyositis and Dermatomyositis : In these diseases, initially the process of inflammation occurs in the muscles and the muscles start becoming emaciated-wasted. The main symptom of this disease is the weakness of the muscles that gradually increases and makes the patient handicapped. Changes in the protective immune system of the body, produce cells, which destroy the cells of the muscles and hence this disease occurs. Some times it may hold back, but in most of the cases ifthe right treatment is not taken, the weakness keeps on increasing gradually. Patients suffer from pain in the muscles specially while climbing steps, getting up from the chair, raising the hand up etc. Cyclosporin: This drug helps in controlling the disease well, but in the long run the side effects of the medicine are seen. If physiotherapy is done regularly everyday, it can prevent the muscles from deteriorating to a certain extent. It is important to get immediate advice from the doctor instead of considering the problem as an ordinary pain and letting it deteriorate further.

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The value for the South-East Asia Region is heavily infuenced by 70 Western Pacific 60 India generic 50mg fildena amex; if countries other than India are considered then the percent- South-East Asia age of cases tested is lower but does show an increasing trend over 50 40 Europe the past decade buy cheap fildena 50mg online, as is also the case for the Eastern Mediterranean and 30 Eastern African Regions order 150mg fildena amex. Mediterranean 20 Americas Outside Africa discount 100 mg fildena overnight delivery, most countries within each Region are able to 10 provide a diagnostic test for more than 80% of suspected cases (Fig. Of 42 countries in the African Region that reported on testing, the percentage of cases tested was less than 20% in 21 countries. Most countries with 80 South-East Asia high rates of testing have had a policy of confrming every malaria Western Pacific case for several years; some countries have recently expanded the 60 South-East Asia availability of diagnostic testing with some success (Boxes 5. The number of confirmed malaria cases rose from 53 000 in 2007 to 175 000 in 2009 because of the Figure Box 5. The number of recorded deaths from malaria has fallen ranging from very low in the plains along the Mekong River and in from 350 in 2000 to 5 in 2009. Whereas the vast majority used to be diagnosed 100 000 6000 only on a clinical basis (“probable cases”) almost all cases of P. The frst-line treatment represented less 8 African countries delivered sufcient courses to treat 50%–100% than 10% of the drugs dispensed through the private sector (except of cases. Treatment outlets comprise any place where patients seek treatment for malaria such as hospitals, health centres, health posts, pharmacies, shops or kiosks. However, there is a wide use of less effective treatments to which malaria parasites are scatter of points, with most lying below the line that defnes where becoming increasingly resistant. Thus it appears that for many of oral artemisinin monotherapies, thereby delaying the onset of countries the number of children receiving antimalarial medicines is resistance to that drug and preserving its effectiveness. However, whereas almost all cases received the initiative to other malaria-endemic countries is envisaged. The a diagnostic test in Liberia and Rwanda, only 45% did so in United countries participating are Cambodia, Ghana, Kenya, Madagascar, Republic of Tanzania and less than 1% in Chad. It is Uganda (2002), the percentage of children that received an antima- expected that the Board will make this decision in 2012. A central question regarding the utilization of antimalarial those who do not seek treatment in any health facility. It is never- medicines is whether people in need of these medicines actually theless instructive to compare the percentage of febrile children receive them. The need for antimalarial medicines will depend on receiving an antimalarial in the private sector with that observed for diagnostic practices and the treatment policies existing within a the public sector. In high burden African countries tion of those not treated in a health facility have access to antima- most treatment policies allow for antimalarial medicines to be given larial medicines at home. The use of antimalarial medicines is recorded children attending private sector facilities also appear less likely to in household surveys but information on diagnostic testing, and 7. A high correlation is observed whether or not an adjustment is made for therefore treatment needs, is not available in most of these surveys. Hence, the lower rate of treatment utilization among those who are not treated in a health The lower proportion of children who received an antimalarial when facility may be appropriate. However, from the information available treated at home may be appropriate if fevers are transient, or consid- there is no assurance that children who receive antimalarial medicines ered by caregivers to be less serious and not requiring medication, but are those who are parasite-positive and in need of treatment. In addition household survey data are restricted that 87% of suspected malaria cases attending public health to children under 5, whereas data on the percentage of suspected facilities received a parasitological test, of which 48% tested malaria cases that are test positive are usually only available for all positive. Moreover the analysis does not consider public health facilities in Rwanda required an antimalarial (13% whether health workers withheld a test because other symptoms who were not tested plus 87% x 48% who tested positive). It children receiving an antimalarial is appropriate for those treated in therefore appears that the percentage of children receiving an private sector facilities or those who are not treated in any health antimalarial medicine compared to those needing one was 57% facility. The percentage of malaria among those who do not seek treatment is also required; patients with suspected malaria who received a parasitological test some insight could be derived from malaria indicator surveys that increased to 100% while only 22% were test positive. Unfortunately datasets from many percentage of patients attending public sector facilities that needed of such surveys are not readily available for analysis. The percentage of children attending public facilities who received an Rwanda 2005 % of cases in public sector antimalarial was recorded as 16%. The percentage of need that 20 6 0 had been fulfilled had therefore increased to 75% (16%/22%) Received parasitological test despite the overall percentage of children receiving an antimalarial having decreased. This is largely because the percentage of Need antimalarial (positive test suspected malaria cases testing positive for malaria had dropped or untested) from 48% to 22% owing to decreasing incidence of malaria as a Received result of control activities.

Mix well with a clean spoon until the powder is dissolved - Taste the solution so that you would know its taste like salt - Then give the child frequent small sips out of a cup or spoon discount 100 mg fildena otc. If the answer to either question is ‘yes’ order fildena 50mg on line, use the following management chart to assess purchase fildena 150mg free shipping, classify and treat the child Calcifying Dehydration: - There are three possible calcifications of dehydrations for a child with diarrhea best 100 mg fildena. If there is Falciparum malaria in the area and the child has any fever (38 or above) or history of fever in the past 5 days give anti-malarial treatment according to malaria program recommendation in your area 128 Pediatric Nursing and child health care 9. Treatment of Diarrhea Decide on appropriate treatment: After the examination, decide how to treat the child - if the child has any of the signs in the column labeled “for other problems” specific treatment is needed in addition to treatment given for dehydration - if there is blood in the stool and diarrhea for less than 14 days, the child has dysentry and appropriate antibiotics should be given - if there is diarrhea for longer than 14 days with or without blood in the stool and/or if there is severe under nutrition, continue feeding the child and refer for treatment. Determine the degree of dehydration Look at the upper row, the assessing and classifying chart. What important measures should be taken to prevent dehydration in children with diarrhea? What important pieces of advice would you give to the mother for home treatment of diarrhea? Older children are more likely to have acquired heart diseases such as rheumatic fever, endomyocardial fibrosis. Cyanosis can best be detected under the fingernails or on the mucus membranes of the mouth (lips, under side of the tongue). One of the main causes of this is chronic under saturation of the blood with oxygen. Signs of Cardiac Failure: ƒ Tachycardia-rapid pulse ƒ Tachyponea-rapid respiration ƒ Dyspnea-shortness of breath ƒ Edema and other signs of raised venous pressure ƒ Fatigue and failure to thrive ƒ Arrhythmia-irregular heart beat ƒ Systolic and more frequently diastolic murmurs ƒ Cough ƒ Orthophea Management: Any child with congestive heart failure should be referred to hospital whenever possible. In all cases where you have to start treatment: - check weight of the child ,record the pulse and respiration carefully at 2 hours intervals and indicate the exact time of any drugs given. Digitalization is most important In order to achieve effective blood levels quickly a digitizing dose is calculated and given over 24 hours. The only known cause is damage to the fetus by rubella Virus, when the mother is one to three months pregnant, or by chromosomal abnormality in children with Down’s syndrome. Abnormal communication in the heart or between big vessels ƒ Atrial septal defect ƒ Ventricular septal defect ƒ Patent ductus arteriosus In these due to the highest pressure in the left heart, there is a shunt from left to right heart with an increased blood load in lesser circulation. Congenital obstruction of the blood flow ƒ pulmonary stenosis ƒ aortic stenosis coarctation of the aorta) c. Combination of abnormal communication and stenosis (pallot’s disease is one example) Clinical Features: Besides the above-mentioned symptoms, failure of normal growth and development, repeated attacks of respiratory tract infections, and a loud murmur is usually present. Any child with congestive heart failure should be referred to hospital whenever possible. In all cases where you have to start treatment: ƒ check weight of the child ,record the pulse and respiration carefully at 2 hours intervals and indicate the exact time of any drugs given. Give prophylaxis against subacute bacterial endocarditis Prognosis: Many children with congenital heart disease die in early childhood. Rheumatic Heart Disease: Rheumatic fever is an inflammatory disease related to streptococcal infection affecting mostly the heart and joints, but also other tissues including the brain and skin. This is due to a specific reaction of tissues, mainly the heart and the joints, to the streptococcal toxins. Clinical Features: Painful swelling of one or more big joints ( knee, ankle, elbow, shoulder) may last for one day or longer, subside and another joint may then be affected ( rheumatic polyarthritis) ƒ Fever ƒ malaise ƒ rheumatic carditis (heart become enlarged murmur develops and sign ƒ Of congestive heart failure may occur. Etiology: a) Congenital heart disease ( in the first 3 years of life) b) Acquired heart disease (rheumatic heart disease) c) Non cardiovascular causes (anemia, pulmonary disease. Palpation (may have weak peripheral pulse) Auscultation (gallop rhythm, cardiac murmur may or may not be present) Chest x-ray (cardiomegally may be present) Nursing Care: 1. Administer diuretics as prescribed to remove accumulated sodium and fluid and restrict sodium intake. Practice careful hand washing technique to decrease the dangers of infection 143 Pediatric Nursing and child health care 7. Monitor vital signs frequently and report any significant changes to observe signs off disease progress or response to treatment 10.

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