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Recommendations for managing diabetes related complications Short-term complications: mild to moderate hypoglycaemia • 15–20g glucose should be used to treat hypoglycaemia generic 5 mg enalapril fast delivery. Special considerations Nutrition support consensus guidelines • Standard protocols for nutritional support should be followed and adjustment of medication should be prioritised over dietary restriction purchase 10 mg enalapril amex. End-of-Life Care consensus guidelines • Where palliative care is likely to be prolonged buy discount enalapril 5 mg, meeting fuid and nutritional requirements should utilise non-intrusive dietary and management regimens cheap 10mg enalapril with mastercard. Cystic fibrosis • Standard nutrition management for cystic fbrosis should be applied to individuals with diabetes. Sustained reduction in the incidence of Type 2 diabetes by lifestyle intervention: follow-up of the Finnish Diabetes Prevention Study. Nutrition practice guidelines for Type 1 diabetes mellitus positively affect dietitian practices and patient outcomes. Supporting diabetes self-management in primary care: pilot-study of a group-based programme focusing on diet and exercise. Three-year follow-up of clinical and behavioural improvements following a multifaceted diabetes care intervention: results of a randomized controlled trial. Culturally appropriate health education for Type 2 diabetes in ethnic minority groups: a systematic and narrative review of randomized controlled trials. Telemedicine versus face to face patient care: effects on professional practice and health care outcomes (Review). Cost-effectiveness of medical nutrition therapy provided by dietitians for persons with non-insulin dependent diabetes mellitus. The cost-effectiveness of lifestyle modifcation or metformin in preventing Type 2 diabetes in adults with impaired glucose tolerance. Prevention of Type 2 diabetes mellitus by changes in lifestyle among subjects with impaired glucose tolerance. The long-term effect of lifestyle interventions to prevent diabetes in the China Da Qing Diabetes Prevention Study: a 20-year follow-up study. Sustained reduction in the incidence of Type 2 diabetes by lifestyle intervention: follow-up of the Finnish Diabetes Prevention Study. Nutrition recommendations and interventions for diabetes: a position statement of the American Diabetes Association. Meal replacements are as effective as structured weight-loss diets for treating obesity in adults with features of metabolic syndrome. Pharmacological and lifestyle interventions to prevent or delay Type 2 diabetes in people with impaired glucose tolerance: systematic review and meta-analysis. Glycemic index, glycemic load, and dietary fber intake and incidence of Type 2 diabetes in younger and middle-aged women. Coffee, caffeine, and risk of Type 2 diabetes: a prospective cohort study in younger and middle-aged U. Red and processed meat consumption and risk of incident coronary heart disease, stroke and diabetes mellitus: a systematic review and meta-analysis. Fruit and vegetable intake and incidence of Type 2 diabetes mellitus: systematic c review and meta-analysis. Evidence-based nutrition guidelines for the prevention and management of diabetes 43 Chapter X:References Chapter title head here 58. Chromium picolinate intake and risk of Type 2 diabetes: an evidence-based review by the United States Food and Drug Administration. Primary prevention of diabetes mellitus Type 2 and cardiovascular diseases using a cognitive behavior program aimed at lifestyle changes in people at risk: Design of a randomised controlled trial. Effects of a diet higher in carbohydrate/ lower in fat versus lower in carbohydrate/higher in monounsaturated fat on post-meal triglyceride concentrations and other cardiovascular risk factors in Type 1 diabetes. The effects of a high-carbohydrate low-fat cholesterol-restricted diet on plasma lipid, lipoprotein, and apoprotein concentrations in insulin-dependent (Type 1) diabetes mellitus. Bicentric evaluation of a teaching and treatment programme for Type 1 (insulin-dependent) diabetic patients: improvement of metabolic control and other measures of diabetes care for up to 22 months. Evaluation of an intensifed insulin treatment and teaching programme as routine management of Type 1 (insulin- dependent) diabetes. Day-to-day consistency in amount and source of carbohydrate intake associated with improved blood glucose control in Type 1 diabetes. Glycemic index in the diet of Eurpoean outpatients with Type 1 diabetes: relations to glycated haemoglobin and serum lipids. Long-term dietary treatment with increased amounts of fber-rich low–glycemic index natural foods improves blood glucose control and reduces the number of hypoglycaemic events in Type 1 diabetic patients. Evidence-based nutrition principles and recommendations for the treatment and prevention of diabetes and related complications. Exercise training and glycemic control in adolescents with poorly controlled Type 1 diabetes mellitus. Aerobic ftness and hand grip strength in Type 1 diabetes: relationship to glycaemic control and body composition. The relationship between alcohol consumption and glycemic control among patients with diabetes: the Kaiser Permanente Northern California Diabetes Registry. Day after the night before: infuence of evening alcohol on risk of hypoglycemia in patients with Type 1 diabetes. Comparison of abdominal adiposity and overall obesity in predicting risk of Type 2 diabetes among men (1–3). Comparison of Body Mass Index, waist circumference, and waist/hip ration in predicting incident Diabetes: A Meta-Analysis. Systematic review: comparative effectiveness and safety of oral medications for Type 2 diabetes mellitus. Effects of aerobic exercise on lipids and lipoproteins in adults with Type 2 diabetes; a meta-analysis of randomized-controlled trials. Safety and magnitude of changes in blood glucose levels following exercise performed in the fasted and the postprandial state in men with Type 2 diabetes. Impact of high-fat/low-carbohydrate, high/low-glycaemic index or low-caloric meals on glucose regulation during aerobic exercise in Type 2 diabetes. Effects of a protein preload on gastric emptying, glycemia, and gut hormones after a carbohydrate meal in diet-controlled Type 2 diabetes. Effect of a high-protein, low-carbohydrate diet on blood glucose control in people with Type 2 diabetes. Infuence of fat and carbohydrate proportions on the metabolic profle in patients with Type 2 diabetes: a meta- analysis. One-year comparison of a high-monounsaturated fat diet with a high-carbohydrate diet in Type 2 diabetes. Comparative study of the effects of a one-year dietary intervention of a low-carbohydrate diet versus a low-fat diet on weight and glycemic control in Type 2 diabetes. Comparison of a simple algorithm with carbohydrate counting for adjustment of mealtime insulin glulisine. Effect of wheat bran on glycemic control and risk factors for cardiovascular disease in Type 2 diabetes. Carbohydrate and fbre recommendations for individuals with diabetes: a quantitative assessment and meta- analysis of the evidence. Weight loss in obese diabetic and non-diabetic individuals and long-term diabetes outcomes – a systematic review. Effects of low-carbohydrate vs low-fat diets on weight loss and cardiovascular risk factors: a meta-analysis of randomized controlled trials. Effects of exercise on glycemic control and body mass in Type 2 diabetes mellitus: a meta-analysis of controlled clinical trials. Effect of omega-3 fatty acids on cardiovascular risk factors in patients with Type 2 diabetes and hypertriglyceridemia: an open study. A comprehensive review on salt and health and current experience of worldwide salt reduction programmes. Effects of lifestyle modifcation on central artery stiffness in metabolic syndrome subjects with pre-hypertension and/ or pre-diabetes. Effects of a Mediterranean-style Diet on the Need for Antihyperglycaemic Drug Therapy in Patients with Newly Diagnosed Type 2 Diabetes.

If purchase 5 mg enalapril visa, as usually happens buy generic enalapril, blood flow is also compromised discount enalapril 10 mg online, then one may find evidence of both cytotoxic and even vasogenic edema discount 10mg enalapril amex. Specific neurons and regions of the central nervous system are more vulnerable to oxygen or glucose deprivation than others. Watershed zones are those areas between the terminations of the major cerebral arteries, and are typically parasagittal or lateral parieto-temporo-occipital in location. Permanent or residual clinical manifestations depend upon the extent and localization of the lesions. For the sake of this course, we will restrict ourselves to deficiencies of thiamine (vitamin B1) and cobalamin (vitamin B12). In the acute stage (Wernike’s disease), symptoms are characterized by confusion, ocular disturbances and ataxia. Its clinical recognition is important, since the prompt administration of thiamine will result in a dramatic reversal of the symptomatology. If thiamine deficiency persists, or if the patient has repeated bouts of thiamine deficiency, then neuronal loss may occur and the deficit will become irreversible. In this situation one usually finds 80 that patients also have defects in memory (amnestic syndrome), particularly in the retention of short-term memory, referred to as Wernicke-Korsakoff psychosis. Although Wernicke-Korsakoff disease is the most frequent form of the Korsakoff syndrome, any destructive lesion that bilaterally interrupts the limbic circuit may produce the same amnestic syndrome. Deficiency of vitamin B12 is most commonly seen as a result of the malabsorption syndrome in pernicious anemia. Pathologic changes in the spinal cord, brain, optic nerves and peripheral nerves may occur. Myelin sheaths of spinal cord white matter, particularly at the upper thoracic levels, are most vulnerable. These lesions are asymmetrical and involve the posterior columns and the postero- lateral aspects of the lateral funiculi. They are not restricted to specific tracts and are characterized histologically by a dramatic spongy change. At the ultrastructural level, this spongy change represents intramyelinic edema; that is, excessive fluid between myelin lamellae. With time, axons degenerate, oligodendrocytes are lost, astrocytes proliferate and macrophages appear. Some of the mitochondrial diseases, the "ragged-red fiber" disorders, are caused by mitochondrial genomic mutations, and show a maternal inheritance pattern. Those diseases related to deficiency of lysosomal enzymes often display conspicuous morphologic and biochemical manifestations of "storage" of specific chemical substances. Before discussing these, we will mention those that involve two other organelles: mitochondria and peroxisomes; with the exception of adreno-leukodystrophy, these do not qualify as "storage" diseases. Family history is often positive, and juvenile and adult onsets have been well documented. Neuropathologic lesions in this disease are distinctive and involve all levels of the nervous system. Involvement of the optic system, cerebral and cerebellar white matter, dentate nucleus, and spinal gray is frequently noted. Lesions, primarily of demyelinative type, in spinal roots, dorsal root ganglia, and peripheral nerve also have been reported. Hyperoxaluria I 82 Many of the above disorders have been known clinically and pathologically for years, but only recently have their etiologies been traced to peroxisomal abnormalities. Some (Zellweger) patients display an absence of peroxisomes, due to defects in peroxisome assembly; others (adreno-leukodystrophy) have normal appearing peroxisomes, but are deficient in certain specific peroxisomal functions. In adreno-leukodystrophy very long chain fatty acids are not admitted to the beta-oxidation system of the peroxisome, and demyelination occurs progressively as these fatty acids accumulate (see discussion above under Myelin Disorders). Cerebro-Hepato-Renal (Zellweger) Syndrome is characterized by dysmorphic features and the neonatal onset of profound hypotonia and seizures. This disease is the prototype of a new class of inherited metabolic diseases in which there is an absence of, or severe reduction in, peroxisomes. This results in the dysfunction of multiple enzyme systems, particularly those that catabolize very long chain fatty acids and synthesize ether lipids (plasmalogens). They are called "storage" diseases because catabolic enzyme mutations result in the build-up, or storage, of substrates proximal to the affected catabolic step. Many of these disorders are rare (although within some populations the carrier, or heterozygote, frequency, is high - e. There are 4 major classes of lysosomal storage diseases: gangliosidoses, mucopolysaccharidoses, ceroid storage disorders and leukodystrophies. Gangliosidoses: Gangliosides are acidic glycolipids that form prominent components of neuronal membranes. There are a large number of lysosomal enzymes, each specific for a catabolic step. There are known mutations in many of them, each leading to the accumulation of substrate. This means that one can diagnose a specific disorder by assaying the appropriate enzyme in many tissues, including blood cells and fibroblasts. Enzymatic activity in heterozygous carriers of recessive traits is intermediate between that of normal and homozyotes, enabling the detection of carriers. This is the basis for screening populations at high risk because of an elevated gene frequency and for genetic counseling of the relatives of affected probands. There has been some success in experimental models by bone marrow transplantation with normal cells or with bone marrow stem cells genetically engineered to produce the normal enzyme. The removal of the terminal N-acetyl-galactosamine is catalyzed by the enzyme hexosaminidase A. The enzyme is composed of two different subunits, alpha and beta, each the product of a different gene on different chromosomes. Thus, mutations in either the alpha or the beta subunit can affect hexosaminidase A activity. These abnormally placed post-synaptic elements are innervated by axons, thus creating entirely new synaptic zones, which may bypass the normal dendritic tree and cell body. Tay- Sachs disease is an alpha subunit mutation, the gene for which is encoded on chromosome 15. A mutation in the beta subunit, encoded on chromosome 5 creates a disorder that looks the same as Tay-Sachs disease. The issue is complicated further because different allelic mutations in the same gene can produce different phenotypes. For example, different mutations in the alpha subunit can produce Tay-Sachs disease, a late infantile variant, a juvenile variant that clinically mimics spino-cerebellar degeneration, and an adult variant that looks like a motor neuron disease. Mucopolysaccharidoses: These are caused by mutations in enzymes that catabolize mucopolysaccharides, large molecules that are components of many organs. Thus, the clinical and pathological manifestations of these diseases are far more widespread than those of the gangliosidoses. Typical manifestations include hepato- and splenomegaly, joint and bone deformities, opacities of the lens and cornea, connective tissue abnormalities, and storage of mucopolysaccharides in neurons. Hydrocephalus is also common, due to mucopolysaccharide deposition in the meninges with resultant deficits in the circulation and resorption of cerebrospinal fluid. Three typical variants: infantile (chromosome 1) late infantile, and juvenile (chromosome 16) and an adult form are known. As in many of the storage diseases, the infantile form is the most severe and rapidly progressive. The diagnosis rests on clinical patterns and genetic testing, although the demonstration of typical intracellular inclusions by fluorescence and electron microscopy in neurons, skin, muscle, or white cells can be helpful in narrowing down the diagnosis. Leukodystrophies: As the name indicates, these are disorders that preferentially affect white matter and may be included under Diseases of Myelin. Since oligodendrocytes or myelin sheaths are affected, patients display a loss of myelin or abnormal myelination. Typically, they show neurological signs referable to white matter destruction, such as spasticity. Very long chain fatty acids, normally degraded in peroxisomes, are elevated or "stored" in brain and other organs, particularly the adrenal cortex.

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All the open sections of these cartilages are at the back so that the esophagus can bulge into this section during swallowing discount enalapril online visa. The right bronchus is considerably larger in diameter than the left and extends downward in a more vertical direction order enalapril american express. Each bronchus enters the lung at a notch or 298 Human Anatomy and Physiology depression called the hilus or hilum order 10mg enalapril with amex. The Lungs The lungs are the organs in which external respiration takes place through the extremely thin and delicate lung tissues buy enalapril 5mg. The two lungs, set side by side in the thoracic cavity, are constructed in the following manner: Each bronchus enters the lung at the hilus and immediately subdivides. Because the subdivision of the bronchi resembles the branches of a tree, they have been given the common name bronchial tree. The bronchi subdivide again and again, forming progressively smaller divisions, the smallest of which are called bronchioles. The bronchi contain small bits of cartilage, which give firmness to the walls and serve to hold 299 Human Anatomy and Physiology Figure 10-2. In the bronchioles there is no cartilage at all; what remains is mostly smoothly muscle, which is under the control of the autonomic nervous system. At the end of each of the smallest subdivisions of the bronchial tree, called terminal bronchioles, is a cluster of air sacs, resembling a bunch of grapes. This very thin wall provides easy passage for the gases entering and leaving the blood as it circulates through millions of tiny capillaries of the alveoli. Certain cells in the alveolar wall produce surfactant, a substance that prevents the alveoli from collapsing by reducing the surface tension (“pull”) of the fluids that line them. Because of the many air spaces, the lung is light in weight; normally a piece of lung tissue dropped into a glass of water will float. In the lungs bl9od passes through the capillaries around the alveoli, where the gas exchange takes place. The portion of the pleura that is attached to the chest wall is called parietal pleura, while the portion that is reflected onto the surface of the lung is called visceral pleura. The pleural cavity around the lungs is an air-tight space with a partial vacuum, which causes the pressure in this space to be less than atmospheric pressure. Because the pressure inside the lungs is higher than that in the surrounding pleural cavity, the lungs tend to remain inflated. The region between the lungs, the mediastinum, contains the heart, great blood vessels, esophagus, trachea, and lymph nodes. Physiology of Respiration Pulmonary Ventilation Ventilation is the movement of air into and out of the lungs, as in breathing. The contraction and relaxation of the diaphragm cause a piston-like downward motion that result in an increase in the vertical dimension of the chest. The rib cage is also moved upward and outward by contraction of the external intercostals muscles and, during exertion, by contraction of other muscles of the neck and chest. During quiet breathing, the movement of the diaphragm accounts for most of the increase in thoracic volume. In exhalation, the passive phase of breathing, the muscles of respiration relax, allowing the ribs and diaphragm to return to their original positions. During forced exhalation, the internal intercostals muscles and the muscles of the abdominal wall contracts, pulling the bottom of the rib cage in and down. Air Movement Air enters the respiratory passages and flows through the ever-dividing tubes of the bronchial tree. As the air traverses this passage, it moves more and more slowly through the great number of bronchial tubes until there is virtually no forward flow as it reaches the alveoli. Here the air moves by diffusion, which soon equalizes any differences in the amounts of gases present. Each breath causes relatively little change in the gas composition of the alveoli, but normal continuous breathing ensures the presence of adequate oxygen and the removal of carbon dioxide. Table 17-1 Breathing Volumes Volume Definition Average value Tidal volume The amount of air moved into or out 500 cc of the lungs in quiet, relaxed breathing Vital capacity The volume of air that can be 4800 cc expelled from the lungs by maximum exhalation following maximum inhalation Residual volume The volume of air that remains in the 1200 cc lungs after maximum exhalation Total lung The total volume of air that can be 6000 cc capacity contained in the lungs after maximum inhalation Functional The amount of air remaining in the 2400 cc residual capacity lungs after normal exhalation Regulation of respiration Regulation of respiration is a complex process that must keep pace with moment-to-moment changes in cellular oxygen requirements and carbon dioxide production. Regulation 305 Human Anatomy and Physiology depends primarily on the respiratory control centers located in the medulla and pons of the brain stem. Respiration is regulated so that the levels of oxygen, corbon dioxide, and acid are kept within certain limits. From the cervical (neck) part of the cord, these nerve fibers continue through the phrenic nerve to the diaphragm. The diaphragm and the other muscles of respiration are voluntary in the sense that they can be regulated by messages from the higher brain centers, notably the cortex. It is possible for a person to deliberately breath more rapidly or more slowly or to hold his breath and not breath at all for a time. Usually we breath without thinking about it, while the respiratory centers in the medulla and pons do the controlling. These receptors are found in structures called the carotid and aortic bodies, as well as out side the medulla of the brain stem. The carotid bodies are located near the bifurcation of the common carotid arteries, while the aortic bodies are located in the aortic arch. These bodies contain many small blood vessels and sensory neurons, which are 306 Human Anatomy and Physiology sensitive to decreases in oxygen supply as well as to + increases in carbon dioxide and acidity (H ). The digestive tract, a continuous passageway beginning at the mouth, where food is taken in, and terminating at the anus, where the solid waste products of digestion are expelled from the body 2. The accessory organ, which are necessary for the digestive process but are not a direct part of the digestive tract. The Walls of the Digestive Tract Although specified for specific tasks in different organs, the wall of the digestive tract, from the esophagus to the anus, is similar in structure throughout. Follow the diagram of the small intestine in Figure 11-1 as we describe the layers of this wall from the innermost to the outermost surface. First is the mucous membrane, so called because its epithelial layer contains many mucus-secreting cells. The layer of connective tissue beneath this, the submucosa, contains blood vessels and some of the nerves that help regulate digestive activity. The inner layer has circular fibers, 311 Human Anatomy and Physiology and the outer layer has longitudinal fibers. The alternate contractions of these muscles create the wavelike movement that propels food through the digestive tract and mixes it with digestive juices. Most of the abdominal organs have an additional layer of serous membrane that is part of the peritoneum. The Peritoneum The abdominal cavity is lined with a thin, shiny serous membrane that also covers most of the abdominal organs (Figure 11-2). The portion of this membrane that lines the abdomen is called the parietal peritoneum; that covering the organ is called the visceral peritoneum. In addition to these single layered portions of the peritoneum there are a number of double-layered structures that carry blood vessels, lymph vessels, and nerves, and sometimes act as ligaments supporting the organs. The handle portion is attached to the back wan, and the expanded long edge is attached to the small intestine. Between the two layers of membrane that fOl1ll the mesentery are the blood vessels, lymphatic vessels, and nerves that supply the intestine. This greater omentum extends from the lower border of the stomach into the pelvic part of the abdomen and then loops back up to the transverse colon. There is also a smaller membrane, called the lesser omentum that extends between the stomach and the liver. It is composed of several parts: the mouth, pharynx, esophagus, stomach, small intestine, and large intestine. The digestive tract is sometimes called the alimentary tract, derived from a Latin word that means "food". It is more commonly referred to as the gastrointestinal (Gl) tract because of the major importance of the stomach and intestine in the process of digestion. In to this space projects a muscular organ, the tongue, which is used for chewing and swallowing, and is one of the principal organs of speech. The tongue has on its surface a number of special organs, called taste buds, by means of which taste sensations (bitter, sweet, sour, or salty) can be differentiated. Among these, the cutting teeth, or incisors, occupy the front part of the oral cavity, whereas the lager grinding teeth, the molars, are in the back. Usually, the 20 baby teeth have all appeared by the time a child has reached the age of 2 or 21/2 years. During the first 2 years the permanent teeth develop within the jawbones 317 Human Anatomy and Physiology from buds that are present at birth.

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Over production of aldestrone causes retention of sodium and results in accumulation of fluid in the inertial spaces 4 buy enalapril american express. Nephrotic crisis (albuminuria discount enalapril generic, fever 5mg enalapril overnight delivery, Erysipeloid skin eruption may be possible) Nursing Care: 1 order 5mg enalapril with mastercard. Provide a high protein, high calorie diet and offer in small amounts in frequent interval. The lower urinary tract (urtetha,bladder,or the lower portion of the ureters0 or the upper urinary tract ( upper portion of the ureters, or kidney) or both may be involved. Coli ( most common causative agent) ƒ Proteus ƒ Aerobacter ƒ Entrobacter ƒ kelbsella ƒ Psudomonus 2. Contributing causes ƒ obstruction ƒ infection elsewhere in the body ƒ poor perineal hygiene ƒ Short female urethra ƒ Catheteriztion 155 Pediatric Nursing and child health care Path physiology: Inflammatory changes occur in the affected portion of the urinary tract Inflammation results in urine retention and stats is of urine in the bladder There are inflammatory changes in the renal pelvis and throughout the kidney when this organ is involved: The kidney may become large and swollen Eventually, the kidney become small, tissue is destroyed, and renal function fails. More common in females than in males, ratio 6:1 except in the neonatal period, when both sexes are equally affected. Failure to thrive in infancy 156 Pediatric Nursing and child health care Diagnostic Evaluation: 1. Maintain bed rest, administer analgesics and antipyretic drugs as prescribed, encourage fluid to reduce fever and dilute the concentration of urine during the febrile period 4. Tuberculosis in a child indicates exposure to an adult with contagious disease and should prompt identification and treatment of the source case. The presence of clinical manifestations distinguishes tuberculosis disease from tubercle infection. A chest radiography usually service to distinguish children with the disease from those with the infection. Because the sputum of children with pulmonary tuberculosis is usually negative for mycobacterium, either by acid-fast stain or culture, these children are non infectious. Extrapulmonary tuberculosis: including cervical amenities, tuberculosis meningitis, and milary tuberculosis occurs in app. Infants and young children who immunocompromised or malnourished are at risk of the serious and often fatal form of miliary or tuberculosis meningitis. Children with tuberculosis infection (without evidence of disease) should receive isoniazid prophylaxis for 9 months. Children with pulmonary tuberculosis are usually treated with a 6-month regimen consisting of isoniazid, rifampin, and pyrazinamide for the first 2 months and isoniazid and rifampin the remaining 4 months. In areas where isoniazid and refampin resistance is prevalent, a fourth drug should be added to the regimen (usually ethambutol, or streptomycin). A second degree burn of 10 % or more of the body surface in a child younger than 5 year or a second degree burn of 15 % or more of the body surface in a child over 1 year is considered a very serious injury. Burns inflicted upon the child as a result of child abuse Clinical Manifestations: The characteristics of burn wounds are classified as follows A. First degree burns involves superficial epidermis; the skin is red or pink in appearance,and is painful to touch. Second degree burn involve the entire epidermis; the skin is red, blistered, moist with exudate, and painful to touch. Third degree burn involve the dermis or underlying fat, muscle or bone, the skin appears white,dry and is 160 Pediatric Nursing and child health care painless to touch1. Symptoms of toxemia (Prostration, fever, rapid pulse, cyanosis, vomiting, edema) may develop within 1-2 days after initial burn. Burns of the upper respiratory tract result in symptoms of upper respiratory tract obstruction resulting from edema and inflammation of the glottis, vocal cords, and upper trachea. Treatment: The objective of treatment are to: • replace fluid loss from burn surface • maintain circulation • prevent renal failure • prevent or treat infection • aim toward early repair of the burn wound • restore the child to the best possible state of physical and psychological functioning Complications: Acute: • Infection • wound sepsis • pneumonia 161 Pediatric Nursing and child health care • urinary tract infection • Renal failure • Respirator failure • Post-burn seizure • Anemia and malnutrition etc Long-term: • Malnutrition • Scaring • Contracture • Psychological trauma Nursing Care: 1. Observe for symptoms of respiratory distress and take measures to alleviate if any. Provide high protein, calorie diet in order to provide nutrition necessary for healing and for the growth and development need of the child. Major Signs: • Weight loss or abnormally slow growth • Chronic diarrhea (> 1 month) • Prolonged fever (> 1 month) Minor Signs: • Generalized lymph node enlargement • Oropharyngeal candidiasis • Recurrent common infections, e. The newborn acquires the infection during birth process by direct contact with infected material from vagina of the mother. Clinical Manifestations: The onset is usually within two or three days after birth, but symptoms may appear earlier. The extent of the handicap depends on the duration and severity of untreated condition. Treatment: The treatments of Opthalmia neonatorum include: prompt antibiotic injections and antibiotic eye ointments or drops to prevent eye damage and isolation of the infant. The purulent discharge must irrigate and removed frequently by directing the flow of fluid from the inner cantus outward. Extreme care must be taken that no drops of the return flow splash into the nurse’s eyes. Antibiotic eye ointments are administered to all newborns immediately after birth as prophylaxis. Clinical features: • Rhinitis with purulent or even bloody discharge • Lesions on the (large blisters on palms and soles) and mucocutaneous junctions (mouth, nostrils anogenital) • Signs of systemic involvement: hepatosplenomegaly, prolonged jaundice, and anemia. Check the whole family for syphilis Prevention: All measures which decrease the incidence of acquired syphilis in adults serological tests for syphilis in all pregnant women is desirable. The purpose of immunization is to protect against infectious diseases before they attack any individual. Once an immunization program has been established, it must continue or the disease will return to affect large numbers of unprotected individuals. The aims is to immunize in the first year of life against those infections that cause severe disease in infants and children; and to follow up it up with reinforcing (booster) inoculations and additional vaccines according to age. The most serious diseases of infants are whooping cough, (Pertusis), diphtheria, tetanus, tuberculosis, measles, poliomyelitis. Complications of immunization: • Normal toxicity or reactivity- fever, malaise, local swelling • Bacterial contamination-septicemia, abscess, tuberculosis • Allergic reaction-anaphylaxis b. Provides greater herd immunity-spreads to immunize contact of the vaccine Is easier to administer and less expensive At least three doses are required in primary immunization to establish protection against the 3 poliomyelitis serotypes 1,2,3. Measles Vaccines: Natural measles infection is a serious disease with greater risk of morbidity and mortality than the vaccine. Measles vaccine: Early vaccination produces a poor response in some children because of maternal antibody still in the child’s circulation. Measles is given at 6-9 months in measles endemic areas; and after 12 months elsewhere. Children immunized before 12 months need a second dose after 14 months of age to ensure individual protection 172 Pediatric Nursing and child health care Indication for measles vaccination: • All children in measles endemic area • To interrupt a measles outbreak • the incubation period for the vaccine is shorter than that of the natural disease • measles vaccine given within days of contact stops the spread of the disease Contraindication to measles vaccine: • Sensitivity to vaccine content (e. The six vaccine preventable diseases are estimated to account for at least one-third of infant and child disability and mortality. Often mothers bring their children at less frequent intervals than those suggested here. If the child is first seen at a later stage than indicated in the immunization scheme, the immunization is started with vaccines 1,2,3 and 4, given with four weeks interval. Reusable needles and syringes should be sterilized correctly (steam sterilization or boiling for 20 minutes) 2. What are the dangers of using contaminated syringes and needles during vaccination and what are the steps to be used to prevent it? The vaccine preventable diseases estimated to account for one third of infant and child disability and mortality in Ethiopia. Mental Retardation: If a child is significantly retarded in his psychomotor development (milestones) we suspect subnormal intelligence and speak of mental retardation. In very mild case there may be only minimal brain damage giving rise to slight delay only and less than optimal intelligence may only become obvious in school. He can not sit without support at age 9 months, can not stand at at age 15 months, can not walk at age 18 months b. He can not lough loudly at age 6 months, speak three words at age 2 years, and follow a few simple directions at age 3 years c. He can not grasp actively at age 6 months, and take small objects with thumb and finger at age 1 year.

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