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Temporal: is superior (above) and lateral to (away from the midline of) the eye 2 buy 200 mg extra super viagra visa keppra impotence. Carotid: at the side of the neck below tube of the ear (where the carotid artery runs between the trachea and the sternoclidiomastoid muscle) 3 cheap extra super viagra 200 mg with mastercard erectile dysfunction doctors fort lauderdale. Apical: at the apex of the heart: routinely used for infant and children < 3 yrs th th th 4. In adults – Left midclavicular line under the 4 , 5 , 6 intercostals space Basic Nursing Art 64 5. Brachial: at the inner aspect of the biceps muscle of the arm or medially in the antecubital space (elbow crease) 7. Radial: on the thumb side of the inner aspect of the wrist – readily available and routinely used 8. Pedal (Dorslais Pedis): palpated by feeling the dorsum (upper surface) of the foot on an imaginary line drawn from the middle of nd the ankle to the surface between the big and 2 toes Method Pulse: is commonly assessed by palpation (feeling) or auscultation (hearing) The middle 3 fingertips are used with moderate pressure for palpation of all pulses except apical; the most distal parts are more sensitive, Assess the Pulse for • Rate • Rhythm • Volume • Elasticity of the arterial wall Pulse Rate • Normal 60-100 b/min (80/min) • Tachycardia – excessively fast heart rate (>100/min) • Bradycardia < 60/min Pulse Rhythm • The pattern and interval between the beats, random, irregular beats – dysrythymia Basic Nursing Art 65 Pulse Volume: the force of blood with each beat • A normal pulse can be felt with moderate pressure of the fingers and can be obliterated with greater pressure. Hyperventilation: very deep, rapid respiration Hypoventilation: very shallow respiration Two Types of Breathing 1. Costal (thoracic) • Involves the external muscles and other accessory muscles (sternoclodio mastoid) • Observed by the movement of the chest up ward and down ward 2. Diaphragmatic (abdominal) • Involves the contraction and relaxation of the diaphragm, observed by the movement of abdomen. Basic Nursing Art 66 Assessment • The client should be at rest • Assessed by watching the movement of the chest or abdomen. Rhythm: is the regularity of expiration and inspiration Normal breathing is automatic & effortless. Systolic pressure: is the pressure of the blood as a result of contraction of the ventricle (is the pressure of the blood at the height of the blood wave); 2. Pulse pressure: is the difference between the systolic and diastolic pressure Blood pressure is measured in mm Hg and recorded as fraction. Conditions Affecting Blood Pressure Fever Increase Stress " Arteriosclerosis " Obesity " Hemorrhage Decrease Low hematocrit " External heat " Exposure to cold Increase Sites for Measuring Blood Pressure 1. Leg using posterior tibial or dorsal pedis Methods of Measuring Blood Pressure Blood pressure can be assessed directly or indirectly 1. Direct (invasive monitoring) measurement involves the insertion of catheter in to the brachial, radial, or femoral artery. The flush methods Basic Nursing Art 68 The auscultatory method is the commonest method used in health activities. Phase 1: The pressure level at which the 1st joint clear tapping sound is heard, these sounds gradually become more intense. Prepare and position the patient appropriately • Make sure that the client has not smoked or ingested caffeine, with in 30 minutes prior to measurement. The arm should be slightly flexed with the palm of the hand facing up and the fore arm supported at heart level • Expose the upper arm 2. The bladder inside the cuff must be directly over the artery to be compressed if the reading to be accurate. For initial examination, perform preliminary palipatory determination of systolic pressure • Palpate the brachial artery with the finger tips • Close the valve on the pump by turning the knob clockwise. Position the stethoscope appropriately • Insert the ear attachments of the stethoscope in your ears so that they tilt slightly fore ward. Basic Nursing Art 70 • Place the diaphragm of the stethoscope over the brachial pulse; hold the diaphragm with the thumb and index finger. The arm found to have the higher pressure, should be used for subsequent examinations 8. Specimen Collection Specimen collection refers to collecting various specimens (samples), such as, stool, urine, blood and other body fluids or tissues, from the patient for diagnostic or therapeutic purposes. General Considerations for Specimen Collection When collecting specimen, near gloves to protect self from contact with body fluids. Get request for specimen collection and identify the types of specimen being collected and the patient from which the specimen collected.

You have now studied the causes of undernutrition and thought about how these might be found in your own community order 200 mg extra super viagra male erectile dysfunction pills review. The next section will give you the opportunity to look at some of the common consequences of malnutrition on a community generic 200mg extra super viagra mastercard fda approved erectile dysfunction drugs. Often there are no obvious signs, and the victims themselves are silent and not aware of the problem. By 24 months, considerable damage to the developing child has been done and satisfactory recovery becomes less likely. Well-nourished women are likely to be fit and healthy and able to look after their family well. The outcomes of pregnancy and lactation are improved when the woman is healthy herself. As you read in an earlier study session in this Module, the nutritional needs of a pregnant and a lactating woman are greater than at other times in her life. During pregnancy, the food the mother eats also helps to meet the nutritional needs of the unborn baby. Malnutrition reduces children’s learning ability, school performance and attendance. Iodine deficiency lowers the ability of children to think and become creative and productive adults. Iodine is necessary for the normal development of the brain of the fetus during pregnancy. As we have discussed earlier, a malnourished child will grow to a malnourished adult. A malnourished mother will give birth to a low birth weight baby; the low birth weight baby will grow as a malnourished child, then to a malnourished teenager, then to a malnourished pregnant woman, and so the cycle continues. As a Health Extension Practitioner you may be able to decrease the rate of malnutrition and minimise the effects of malnutrition on your own community. There are six strategies that have been found to promote proper nutrition in a community. As a Health Extension Practitioner you have a role to play in all of these strategies. Therefore advocacy should be done to promote equal chances of education for both boys and girls since this is important to enable them to become better parents themselves. Healthy environment: Availability and easy access to safe and adequate water for drinking, cooking and cleaning are important aspects of each person’s development and the maintenance of their health. Maternal and childcare: Prevention of prematurity, proper antenatal care and promotion of good feeding practices are important interventions that may help to decrease malnutrition within your community. Healthy social and family life: Strong family planning services may help families to limit the number of children they have; social integration and communal care may support orphans and children with special needs. Proper agriculture:Diversification through planting the right number of different kinds of seeds should be promoted, and food distribution at household level should be equitable, giving children and pregnant mothers priority. Public health measures: These include prevention and treatment of maternal infections during pregnancy and delivery. Immunizations against preventable diseases as well as an emphasis on growth promotion and monitoring activities are also important public health strategies to prevent malnutrition in the community. Part of your role includes working with other professionals and community leaders to help promote these strategies and help improve the nutritional status of people living in your community. Malnutrition is one of the main health problems facing women and children in Ethiopia. Other consequences are poverty perpetuation (a vicious circle) and an intergenerational cycle of malnutrition. The provision of proper antenatal care, safe delivery and postnatal care services are also important. Encouraging the use of family planning methods, prevention and treatment of infections of pregnant mothers, and babies and immunization of children and pregnant women are among other useful strategies for addressing malnutrition.

It is recommended that a multidisciplinary approach purchase extra super viagra 200mg with mastercard erectile dysfunction boyfriend, with agreed protocols for patient assessment including inclusion and exclusion criteria for day surgery purchase extra super viagra 200mg on-line impotence natural home remedies, should be agreed locally with the anaesthetic department. Patient assessment for day surgery falls into three main categories: Social factors (a) The patient must understand the planned procedure and postoperative care and consent to day surgery. However, these problems would still occur with inpatient care and have usually resolved or been successfully treated by the time a day case patient would be discharged. In addition, obese patients benefit from the short-duration anaesthetic techniques and early mobilisation associated with day surgery. Surgical factors (a) The procedure should not carry a significant risk of serious compli- cations requiring immediate medical attention (haemorrhage, cardio- vascular instability). Pre-operative preparation Pre-operative preparation (formerly known as pre-operative assessment) has three essential components: 1 To educate patients and carers about day surgery pathways. All patients must be assessed by a member of the multidisciplinary team trained in pre-operative assessment for day surgery. Pre-operative preparation is best performed within a self-contained day surgery facility, where available. This allows patients and their relatives the opportunity to familiarise themselves with the environment and to meet staff who will provide their peri-operative care. One-stop clinics, where pre-operative preparation is performed on the same day as decision for surgery, offer significant advantages. Screening questionnaires (Appendix 1), in conjunction with pre-set protocols, can offer guidance on appropriate investigations, as routine pre-operative investigations have no relevance in modern anaesthesia. Pre-operative preparation clinics can improve efficiency by enabling early review of the notes of complex cases, ensuring appropriate investigations are carried out and that patients are referred for specialist opinion if deemed necessary. Day surgery for urgent procedures Patients presenting with acute conditions requiring urgent surgery can be efficiently and effectively treated as day cases via a semi-elective pathway. After initial assessment many patients can be discharged home and return for surgery at an appropriate time, either on a day case list or as a scheduled patient on an emergency list, whereas others can be immediately transferred to the day surgery service. This reduces the likelihood of repeated postponement of surgery due to prioritisation of other cases. Some of the procedures successfully managed in this manner are shown in Table 1 [21–25]. Essential components of an emergency day surgery pathway are: 1 Identification of appropriate procedures. Documentation Detailed documentation is important within the day surgery environment as the patient’s experience is often condensed into a few hours. General surgery Gynaecology Trauma Maxillofacial Incision and drainage Evacuation of retained Tendon repair Manipulation of of abscess products of conception fractured nose Laparoscopic Laparoscopic ectopic Manipulation Repair of fractured cholecystectomy pregnancy of fractures mandible ⁄ zygoma Laparoscopic Plating of appendicectomy fractured clavicle Temporal artery biopsy Ó 2011 The Authors 6 Anaesthesia Ó 2011 The Association of Anaesthetists of Great Britain and Ireland Guidelines: Day case and short stay surgery. Documentation should be a continuum from pre-operative preparation to discharge and subsequent follow-up. Single care plans reflecting a multidisciplinary approach are favoured in many units. Variations for specific groups including children and patients undergoing procedures under local anaesthesia should be available. Procedure-specific care plans reflecting integrated care pathways may be used for more complex and challenging cases. Patients should be provided with general as well as procedure-specific information. This should be given in advance of admission to allow time for questioning and preparation for same day surgery. General information should include practical details about attending the day surgery unit whereas procedure- specific information should include clinical information about the patient’s condition and surgical procedure (Appendix 2). Management and staffing Every day surgery unit must have a Clinical Lead with specific interest in day surgery and whose remit includes the development of local policies, guidelines and clinical governance. A consultant anaesthetist with management experience is ideally suited to such a role and job plans must reflect this responsibility. The Clinical Lead should be supported by a day surgery manager who has responsibility for the day-to-day running of the unit. The manager will often have a nursing background and should have the knowledge and skills to make informed decisions and lead on all aspects of day surgery development. Staff working in these Ó 2011 The Authors Anaesthesia Ó 2011 The Association of Anaesthetists of Great Britain and Ireland 7 Guidelines: Day case and short stay surgery. Many units favour multiskilled staff who have the knowledge and skills to work within several different areas of the day surgery unit.

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