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Outcome measures were defined as the regional incidence rate of shaken baby syndrome diovan 160 mg overnight delivery, the number of parents reached by the program cheap diovan 160mg amex, and parental pre and post-program knowledge about shaken baby syndrome. This format was intended to improve upon the multitude of fragmented, unevaluated programs previously in operation. It was also unique in being the first to determine whether improved public knowledge could translate into a reduction in the incidence rate of shaken baby syndrome. Dias’ original study revealed that a total of 33 infants were diagnosed with shaken baby syndrome at the Children’s Hospital of Buffalo between 1992 and 1998, with an average incidence rate of 7. This data, along with Dias’ experience in treating infants with shaken baby syndrome, shaped the following hypotheses that guided the ultimate program design: 16 17 1. Shaken baby syndrome differs from other forms of child abuse in that it seems to result from impulsive acts of adult rage due to infant crying that may be modifiable with timely parental education. Education efforts must be targeted at parents, and particularly, at males, since 71% of perpetrators are parents and paramours, and males comprise the majority. Due to increased public awareness about shaken baby syndrome from public education campaigns and highly publicized infant fatalities, many parents are already aware that violently shaking an infant is dangerous. Therefore, the aim of the education campaign should be to remind parents about shaken baby syndrome at the appropriate time – during a mother’s post-natal stay in the hospital – after which both parents will soon be immersed in the challenges of infant care. Parents are optimal advocates for infant safety and care and may be most effective at disseminating information about shaken baby syndrome to caregivers that will be in contact with their child. Dias conceived that a shaken baby syndrome education campaign could act as a “vaccine” to “inoculate” parents with information and protect infants from acquiring shaking injuries during the first years of life, when they are most susceptible. Given that the average age at which infants incur inflicted head injuries ranges from five to nine months, the goal that parents retain the program information for at least the first year of each child’s life seemed both effective and attainable (Dias & Barthauer, 2001). In addition, a regional Perinatal Outreach Program providing tertiary infant care in conjunction with Western New York hospitals was already in full operation. The Perinatal Outreach Program consisted of a network of nurse managers from the maternity wards of all hospitals in Western New York. Nurse managers were assigned to receive and distribute the program materials within their respective hospitals. They were to be educated about inflicted infant head injuries and how to implement Dias’ Shaken Baby Syndrome Parent Education Program. In turn, the nurse managers at each hospital would convey the program information to the obstetrical ward nurses. All mothers and as many fathers as possible would be presented with an information pamphlet published by the American Academy of Pediatrics (“Prevent Shaken Baby Syndrome”, 1995). It provides suggestions for coping with infant crying, describes the dangers of shaking an infant, and urges parents to seek immediate medical attention if they suspect that their child has been shaken. The video discusses the dangers of violent infant shaking, describes the mechanism of shearing brain injury, and portrays the stories of three infant victims of shaken baby syndrome. Lastly, parents would be asked to voluntarily sign a commitment statement to verify that they received the program information. Parents would also be asked to answer the following three questions: 1) Was this information useful to you? The posters were intended for display along the hallways of obstetrical wards, in full view of parents and outside visitors. Nurses would be encouraged to provide the information about shaken baby syndrome separately from other standard hospital discharge information (Dias & Barthauer, 2001). The inclusion of the commitment statement in the program design was a key improvement over virtually all other existing shaken baby syndrome prevention programs. The commitment statement was designed to accomplish two main objectives: 1) to actively engage parents in their own education about shaken baby syndrome, and 2) to facilitate program data collection and tracking. By signing a commitment statement, parents would feel that they were entering a “social contract” with the hospital, their infant, and their community in protecting their child against shaken baby syndrome.

Basic Nursing Art 35 • Complete the back rub using long diovan 40 mg on line, firm strokes up and sown the back discount diovan 160mg fast delivery. Petrissape: kneading and making large quick pinches of the skin, tissue, and muscle • Clean the back first • Warm the massage lotion or oil before use by pouring over your hands: cold lotion may startle the client and increase discomfort 1. Effleurage the entire back: has a relaxing sedative effect if slow movement and light pressure are used 2. Petrissape first up the vertebral column and them over the entire back: is stimulating if done quickly with firm p Basic Nursing Art 36 • Assess: signs of relaxation and /or decreased pain (relaxed breathing, decreased muscles tension, drowsiness, and peaceful affect) ⇒ Verbalizations of freedom from pain and tension ⇒ Areas or redness, broken skin, bruises, or other sings of skin breakdown Note • The duration of a massage ranges from 5-20 minutes • Remember the location of bony prominence to avoid direct pressure over this areas • Frequent positioning is preferable to back massage as massaging the back could possibly lead to subcutaneous tissue degeneration. Mouth Care Purpose • To remove food particles from around and between the teeth • To remove dental plaque to prevent dental caries • To increase appetite • To enhance the client’s feelings of well-being • To prevent sores and infections of the oral tissue • To prevent bad odor or halitosis • Should be done in the morning, at night and after each meal • Wait at least for 10 minutes after patient has eaten Equipments • Toothbrush (use the person’s private item. If patient has none use of cotton tipped applicator and plain water) • Tooth paste (use the person’s private item. If patient has none of use cotton tipped applicator and plain water) • Cup of water Basic Nursing Art 37 • Emesis basin • Towel • Denture bowel (if required) Procedure 1. Prepare the pt: • Explain the procedure • Assist the patient to a sitting position in bed (if the health condition permits). Brush the teeth • Moisten the tooth with water and spread small amount of tooth paste on it • Brush the teeth following the appropriate technique. Brushing technique • Hold the brush against the teeth with the bristles at up degree angle. Give pt water to rinse the mouth and let him/her to spit the water into the basin. Recomfort the pt Basic Nursing Art 38 • Remove the basin • Remove the towel • Assist the patient in wiping the mouth • Reposition the patient and adjust the bed to leave patient comfortably 5. Normal solution: a solution of common salt with water in proportion of 4 gm/500 cc of water 2. Move the floss up and down between the teeth from the tops of the crowns to the gum 3. A fracture, the slipper or low back pan Advantage ⇒ Has a thinner rim than as standard bed pan ⇒ Is designed to be easily placed under a person’s buttocks Disadvantage ⇒ Easier to spill the contents of the fracture pan Basic Nursing Art 40 ⇒ Are useful for people who are a. The pediatric bedpan • Are small sized • Usually made of a plastic Offering and Removing Bed Pan • If the individual is weak or helpless, two peoples are needed to place and remove bed pans • If a person needs the bed pan for a longer time periodically remove and replace the pan to ease pressure and prevent tissue damage • Metal bed pans should be warmed before use by: o Running warm water inside the rim of the pan or over the pan o Covering with cloth • Semi-Fowler’s position relieves strain on the client’s back and permits a more normal position for elimination Improper placement of the bedpan can cause skin abrasion to the sacral area and spillage o Place a regular bed pan under the buttocks with the narrow end towards the foot of the bed and the buttocks resting on the smooth, rounded rim o Place a slipper (fracture) pan with the flat, low end under the client’s buttocks o Covering the bed pan after use reduces offensive odors and the clients embarrassment Basic Nursing Art 41 If the client is unable to achieve regular defecation help by attending to: 1. Timing – do not ignore the urge to defecate • A patient should be encouraged to defecate when the urge to defecate is recognized • The patient and the nurse can discuss when mass peristalsis normally occurs and provide time for defecation (the same time each day) 3. Nutrition and fluids For a constipated client: increase daily fluid intake, drink hot liquids and fruit juices etc For the client with diarrhea – encourage oral intake of foods and fluids For the client who has flatulence: limit carbonated beverages; avoid gas- forming foods 4. Exercise • Regular exercise helps clients develop a regular defecation pattern and normal feces 5. Positioning • Sitting position is preferred 3 Measures to assist the person to void include: • Running water in the sink so that the client can hear it • Warming the bed pan before use • Pouring water over the perineum slowly • Having the person assume a comfortable position by raising the head of the bed (men often prefer to stand) • Providing sufficient analgesia for pain Basic Nursing Art 42 • Having the person blow through a straw into a glass of water – relaxes the urinary sphincter Perineal Care (Perineal – Genital Care) Perineal Area: • Is located between the thighs and extends from the top of the pelvic bone (anterior) to the anus (posterior) • Contains sensitive anatomic structures related to sexuality, elimination and reproduction Perineal Care (Hygiene) • Is cleaning of the external genitalia and surrounding area • Always done in conjunction with general bathing Patients in special needs of perineal care • Post partum and surgical patients (surgery of the perineal area) • Non surgical patients who unable to care for themselves • Patients with catheter (particularly indwelling catheter) Other indications for perineal care are: 1. Excessive secretions or concentrated urine, causing skin irritation or excoriation 4. Care before and after some types of perineal surgery Purpose • To remove normal perineal secretions and odors • To prevent infection (e. Patient preparation • Give adequate explanation • Provide privacy • Fold the top bedding and pajamas (given to expose perineal area and drape using the top linen.

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P was established 1963 Notification all cases (rate) 10 /100 diovan 160 mg overnight delivery,000 Year of Rifampicin introduction 1982 Estimated incidence (all cases) 10 generic diovan 40mg on-line. P was established 1973 Notification all cases (rate) 47 /100,000 Year of Rifampicin introduction 1983 Estimated incidence (all cases) /100,000 Year of Isoniazid introduction 1973 Notification new sputum smear + 4439 Use of Standardized Regimens Yes Notification new sputum smear + (rate) 34. P was established 1989 Notification all cases (rate) 16 /100,000 Year of Rifampicin introduction 1980 Estimated incidence (all cases) 29 /100,000 Year of Isoniazid introduction 1970s Notification new sputum smear + 4889 Use of Standardized Regimens Yes Notification new sputum smear + (rate) 7. P was established 1950 Notification all cases (rate) 72 /100,000 Year of Rifampicin introduction 1985 Estimated incidence (all cases) >80 /100,000 Year of Isoniazid introduction 1970 Notification new sputum smear + 2802 Use of Standardized Regimens Yes Notification new sputum smear + (rate) 45. P was established 1962 Notification all cases (rate) 120 /100,000 Year of Rifampicin introduction 1969 Estimated incidence (all cases) 190. P was established 1998 Notification all cases (rate) /100,000 Year of Rifampicin introduction 1972 Estimated incidence (all cases) 74. P was established 1989 Notification all cases (rate) 125 /100,000 Year of Rifampicin introduction 1990 Estimated incidence (all cases) 201 /100,000 Year of Isoniazid introduction 1965 Notification new sputum smear + 13683 Use of Standardized Regimens Yes Notification new sputum smear + (rate) 58 /100,000 % Use of Short Course Chemotherapy Yes % Treatment Success 86 % Use of Directly Observed Therapy Yes 70. P was established 1963 Notification all cases (rate) 28 /100,000 Year of Rifampicin introduction 1970 Estimated incidence (all cases) 28. P was established 1931 Notification all cases (rate) 3 /100,000 Year of Rifampicin introduction 1971 Estimated incidence (all cases) 3. P was established 1920 Notification all cases (rate) 93 /100,000 Year of Rifampicin introduction 1972 Estimated incidence (all cases) /100,000 Year of Isoniazid introduction 1950s Notification new sputum smear + 380 Use of Standardized Regimens Yes Notification new sputum smear + (rate) 40. P was established 1957 Notification all cases (rate) /100,000 Year of Rifampicin introduction 1970s Estimated incidence (all cases) 44. P was established (revised programme) Notification all cases (rate) 251 /100,000 Year of Rifampicin introduction 1979 Estimated incidence (all cases) 827 /100,000 Year of Isoniazid introduction 1968 Notification new sputum smear + 12393 Use of Standardized Regimens Yes Notification new sputum smear + (rate) 135 /100,000 % Use of Short Course Chemotherapy Yes 100 % Treatment Success 58. P was established (revised programme) Notification all cases (rate) 400 /100,000 Year of Rifampicin introduction 1979 Estimated incidence (all cases) 875 /100,000 Year of Isoniazid introduction 1968 Notification new sputum smear + 15346 Use of Standardized Regimens Yes Notification new sputum smear + (rate) 219 /100,000 % Use of Short Course Chemotherapy Yes 100 % Treatment Success 60. P was established (revised programme) Notification all cases (rate) 188 /100,000 Year of Rifampicin introduction 1979 Estimated incidence (all cases) 578 /100,000 Year of Isoniazid introduction 1968 Notification new sputum smear + 4296 Use of Standardized Regimens Yes Notification new sputum smear + (rate) 138 /100,000 % Use of Short Course Chemotherapy Yes 100 % Treatment Success 67. P was established (revised programme) Notification all cases (rate) 423 /100,000 Year of Rifampicin introduction 1979 Estimated incidence (all cases) 530 /100,000 Year of Isoniazid introduction 1968 Notification new sputum smear + 6455 Use of Standardized Regimens Yes Notification new sputum smear + (rate) 228 /100,000 % Use of Short Course Chemotherapy Yes 100 % Treatment Success 69. P was established (revised programme) Notification all cases (rate) 632 /100,000 Year of Rifampicin introduction 1979 Estimated incidence (all cases) 932 /100,000 Year of Isoniazid introduction 1968 Notification new sputum smear + 15264 Use of Standardized Regimens Yes Notification new sputum smear + (rate) 359 /100,000 % Use of Short Course Chemotherapy Yes 100 % Treatment Success 70. P was established 1953 Notification all cases (rate) 6 /100,000 Year of Rifampicin introduction 1971 Estimated incidence (all cases) 5. Surveillance of resistance to anti-tuberculosis drugs is an essential component of a monitoring system. The benefits of surveillance are multiple: strengthening of laboratory networks, evaluation of programme performance, and the collection of data that inform appropriate therapeutic strategies. Most importantly, global surveillance identifies areas of high resistance and draws the attention of national health authorities to the need to reduce the individual or collective shortcomings that have created them. Prevalence of resistance among previously untreated patients reflects programme performance over a long period of time (the previous 10 years), and indicates the level of transmission within the community. The prevalence of bacterial resistance among patients with a history of previous treatment has received less attention because surveillance of this population is a more complex process. Re-treatment patients are a heterogeneous group composed of chronic patients, those who have failed a course of treatment, those who have relapsed, and those who have returned after defaulting.

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Menke’s disease or Kinky hair syndrome: It is fatal sex linked recessive disorder in which there is cerebral and cerebellar degeneration cheap 80 mg diovan with amex, connective tissue abnormalities and kinky hair purchase diovan 160 mg free shipping. Patient has normal absorption of iron but transport across the serosal aspect of mucosal membrane is defective. Sources: Widely distributed in vegetables, chlorophyll, cereals, beans, potatoes, cheese and animal tissues. Small quantities of it promotes bone development, increases retention of calcium and phosphate, prevent osteoporosis • High level of fluoride in bone causes abnormal rise in calcium deposition, increases bone density Flurosis is due to toxicity of fluoride. Zinc Sources are liver, milk, fish, dairy products, cereals, legumes, pulses, oil seeds, yeast and spinach etc. It is transported bound to a protein (α2-macroglobulin and transferrin) It is excreted in urine and feces. The body does not store Zinc to any appreciable extent in any organ, urinary excretion is fairly constant at 10 μmol/day. Deficiency of Zinc: Patients requiring total parentral nutration, pregnancy, lactation, old age and alcoholics have been reported as being associated with increased incidence of Zinc deficiency. Deficiency of selenium: • Liver cirrhosis • Pancreatic degeneration • Myopathy, infertility • Failure of growth Toxicity: - Selenium toxicity is called Selenosis - Toxic dose is 900micro gram/day - It is present in metal polishes and anti-rust compounds 191 - The Toxicity symptoms are Hair loss,failing of nails, diarrhea,weight loss and gaslicky odour in breath(due to the presence of dimethyl selenide in expired air). Introduction Hormones are responsible for monitoring changes in the internal and external environment. Tissue production (paracrine) of hormones is also possible Hormones and Central nervous system interact to shape up development, physiology, behaviour and cognition. The actions and interactions of the endocrine and nervous system control the neurological activities as well as endocrine functions. A messenger secreted by neurons is neurotransmitter while the secretion of endocrine is called hormone. Cellular functions are regulated by hormones, neurotransmitters and growth factors through their interaction with the receptors, located at the cell surface. The basic information provides a solid foundation from which to view the existing and future developments in the rapidly moving discipline. Hormones can be classified based on their structure, mechanism of action, based on their site of production etc. Sometimes the concentration of the hormone is less, which stimulates the production of hormone by a process of feedback stimulation. Some protein hormones are synthesized as precursors, which are converted to active form by removal of certain peptide sequences. Other hormones like glucocorticoids/ minerolacorticoids from Adrenal gland are synthesized and secreted in their final active form. Pro-hormones: Some hormones are synthesized as biologically inactive or less active molecules called pro-hormones. Free Hormone concentration correlates best with the clinical status of either excess or deficit hormone. Hormone action and Signal Transduction Based on their mechanism of action, hormones are divided into two groups, steroid and peptide/protein hormones. Mechanism of action of steroid hormones • The group consists of sterol derived hormones which diffuse through cell membrane of target cells.

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