By M. Gancka. William Jessup University.

Treatment of fetal compromise: O2 to mother aurogra 100 mg visa; left uterine displacement proven 100mg aurogra; maternal volume expansion/without dextrose/ buy 100mg aurogra with mastercard; discontinuation of oxytocin aurogra 100mg line. Goals of newborn resuscitation: assuring airway patency cheap 100mg aurogra amex; maintaining ventilation/oxygenation; maintaining cardiac output; reducing metabolic requirements. Basic resuscitation in the delivery room: Apgar scores are useful; documentation of the 1-, 5-, and 10- min Apgar scores is important; drugs used in neonatal resuscitation: epinephrine 0. Endotracheal intubation remains the ‘gold standard’ approach to secure the airway of a pediatric victim of cardiopulmonary arrest. Bag-mask ventilation has been shown to be very effective means of ventilating and oxygenating children when properly trained personal is not available. Detection of exhaled carbon dioxide using either a capnograph or colorimetric device is strongly recommended. Cricothyroidotomy is an effective way to provide secure airway in a child when airway cannot be obtained by endotracheal intubation. The recommended cannulation sites include the anterior tibia, distal femur, medial malleolus and anterior superior iliac spine. The recommended dose for epinephrine for the unconscious, asystolic, pulseless cardiopulmonary arrest patient: initial dose 0. Amiodorone/5mg/kg/ may be considered in the treatment algorithms for supraventricular and ventricular arrhythmias. Vagal maneuvers have been added to the treatment protocol for supraventricular tachycardia for children who are hemodynamically stable and/or being prepared for cardioversion. Utilization of vagal maneuvers must not delay cardioversion or administration of adenosine for children with poor perfusion state. The most effective vagal stimulant in infants and children is the application of a bag with ice/ice water to the face. Ambulatory anesthesia for the pediatric patient About 70% of all pediatric surgical cases are done on ambulatory basis. Children are very good candidates for ambulatory surgery because majority of them are healthy, surgical procedures are simple and recovery period is short. Avoiding hospitalization for children is very beneficial – minimal separation from parents, less risk of exposure to hospital infections. Patient selection criteria: the most important for selecting a child for ambulatory surgery are the physical status of the patient, and the type of surgical procedure. These factors should be also combined with how well facility is equipped and the ability to deal with complications. The child preferred to be in good health or any systemic disease must be optimized or under good control. For example, the premature infant is not a good candidate for ambulatory surgery because of immaturity of respiratory center, temperature control, and gag reflex. The age at which a former premature infant (ex-preemie) is no longer at increased risk for postoperative apnea is controversial and should be considered individually. The preanesthetic exam should include history and physical exam, including auscultation of child’s chest to rule out lower respiratory infection and possible pneumonia. When the pediatric patient looks toxic, has fever and you can not rule out lower respiratory infection and possible pneumonia elective cases should be postponed, surgeon informed; chest x-ray may be advisable and ambulatory treatment by primary pediatrician should be instituted. Asthma is common chronic disease of childhood, and many pediatric patients with asthma being scheduled for ambulatory surgery. The decision to proceed with each case depends on severity of asthma and patient’s condition (control of disease). Children with moderate asthma who do require daily medications to control their symptoms should be instructed to continue their medications until the morning of surgery. Sometimes glycopyrrolate (robinul) or small dose of steroids (for patients who are on steroid containing inhaler) may be beneficial in these patients, specifically when they have some respiratory infection symptoms. Information is sought concerning past or present risk factors like prematurity, chronic cardiac or pulmonary conditions and so forth. Many ambulatory centers have presurgical orientation programs when pediatric patients coming few days before surgery to facility and getting a tour with explanations. Inhalation induction is a popular choice for ambulatory surgery in children and sevoflurane is induction agent of choice. Sometimes after induction with sevoflurane anesthesia provider may switch to isoflurane for maintenance. Maintenance of anesthesia with sevoflurane too possible but risk of emergence delirium should be entertained.

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Digitalization is most important In order to achieve effective blood levels quickly a digitizing dose is calculated and given over 24 hours order aurogra 100mg on line. The only known cause is damage to the fetus by rubella Virus 100mg aurogra for sale, when the mother is one to three months pregnant purchase 100 mg aurogra with visa, or by chromosomal abnormality in children with Down’s syndrome cheap 100mg aurogra otc. 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 aurogra 100mg with mastercard, 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. Central nervous system Diseases Meningitis: Meningitis is an inflammation of the meninges (membranes surrounding the brain and spinal cord) and is caused by a viral, bacterial or fungal organisms. Aseptic meningitis refers either viral or other causes of meningeal irritation such as brain abscess or blood in the subarachnoid spaces. Septic meningitis refers to meningitis caused by bacterial organisms such as meningococcus, Staphylococcus, or influenza bacillus. Meningeal infections generally originate in one of two ways either through the blood stream as a consequence of other infections such as cellulites or by direct extension after traumatic injury to the facial bones. In a small number of cases the cause is iatrogenic or secondary to invasive procedures (e. Headache and fever: 144 Pediatric Nursing and child health care Are frequently the initial symptoms. Positive kerning sign: When the patient is lying with the thigh flexed on the abdomen, the leg cannot be completely extended. Positive Brudzink’s sign: When the patient’s neck is flexed, flexion of the knees and hips is produced. Assure the patient that inserting the needle into the spine will not cause paralysis 145 Pediatric Nursing and child health care 2. The thighs and legs are flexed as much as possible to increase the space between the spines of the vertebrae for easier entry into the subarachnoid space 5. Small pillow is placed under the patient’s head to maintain the spine in horizontal position 6. Assist the patient to maintain the position to avoid sudden movement, which can produce trauma 7. Instruct the patient to breathe normally, because hyperventilation may lower an elevated pressure Post procedure Care: 1. The specimen should be sent to the laboratory immediately because changes will take place and alter the result if the specimens are allowed to stand. These jerky movements are called Convulsions and are diagnostic of major or Grand mal epilepsy.

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It mainly affects joints in the spine and the sacroiliac joint in the pelvis generic aurogra 100 mg free shipping, and can cause eventual fusion of the spine cheap aurogra 100 mg on line. Case Definition: The typical patient is a young male generic aurogra 100 mg overnight delivery, aged 20–40 generic aurogra 100mg mastercard, however the condition also presents in females cheap aurogra 100mg mastercard. These first symptoms are typically chronic pain and stiffness in the middle part of the spine or sometimes the entire spine, often with pain referred to one or other buttock or the back of thigh from the sacroiliac joint. Patient needs to be counselled regarding the chronic nature of the disease and need for regular treatment, possible complications and possible treatment options and chances of improvement. Clinical diagnosis: 111 chronic pain and stiffness in the middle part of the spine or sometimes the entire spine, often with pain referred to one or other buttock or the back of thigh from the sacroiliac joint. In 40% of cases, ankylosing spondylitis is associated with an inflammation of the eye (iritis and uveitis), causing redness, eye pain, vision loss, floaters and photophobia. Any 2 out of first four criteria strongly indicate presence of Ankylosing Spondylitis even in the absence of xray and lab investigations. Physical Therapy – Patients to be encouraged to undertake active and passive range of motion exercises for all joints to maintain and prevent the progression of loss of mobility. Deep breathing exercises (Pranayaam) should be promoted to improve chest function. Referral criteria: For further evaluation and management of cases not responding to conventional therapy. Introduction: Benign bone tumour, vascular and very painful, about 1 cm in size; elicits sclerotic reaction by the parent bone when the lesion is in the cortical bone; In cancellous bone the lesion is limited by a thin rim of sclerotic bone; in the spine it can cause scoliosis; if the lesion is in the metaphysis which is intraarticular can produce symptoms of arthritis; If the lesion is in the evolving stage it may not be seen routine plain radiography. Situation 1: Non metro hospital: 116 a) clinical diagnosis may be difficult b) Investigation X-ray c) Treatment may be difficult d) referral criteria – suspicion, inability to diagnose Situation 2. Histopathologist, Facilities for surgery 3) Name of the condition: Benign Bone tumeour – Osteoblastoma I. Non metro Hospital a) clinical diagnosis – nothing specific b)Investigation –X-ray c)Referral criteria: If facilities and know-how are not available for curettage and bone grafting Situation 2: a)clinical Diagnisis is difficult. Introduction: Benign bone tumour arising from chondroblasts; usually present in the small bones of hands and feet and asymptomatic for long time; patient presents usually with a pathological fracture or sometimes pain. Differential Diagnosis: Aneurysmal bone cyst, Tubercular dactylitis, Giant cell tumour, clear cell chondrosarcoma & acrometastases. Introduction: Benign cartilaginous tumours; the former is also called “Codman’s Tumour”. Usually seen in the metaphyseal region of immature skeleton and most of the times it is asymptomatic. It may be an incidental finding in a x-ray taken for some other purpose or bigger lesions may present as pathological fractures. They have a characteristic radiological appearance of serpigenous margins which have pencil lined sclerotic borders. Big lesions are curetted prophylactically to prevent pathological fractures and bone grafted. Once they present with a pathological fracture – either they are immobilized in plaster cast till the fracture unites and then curetted and bone grafted or the fracture is openly reduced and internally fixed and at the same time the lesion is curetted and bone grafted. Introduction: A benign very slow growth of in the subcutaneous tissue or intermuscular connective tissue – does not metastasise but recurrence rate after excision is very high. Differential Diagnosis: Other malignant soft tissue tumours like synovial sarcoma or fibrosarcoma. Introduction: Freak outgrowths from the growth plates – multiple osteochondromatosis- which is familial and producing remodeling and growth abnormalities and ten times more potent for malignancy than its solitary counterpart. Freak inclusions of cartilaginous masses from growth plates into the metaphysic producing streaks of lucency is Ollier’s disease – usually present in one side of the body and produces marked growth anomalies. Proliferation of cartilage in the medullary substance of small bones of hands and feet producing globular swellings is multiple enchondromatosis. Differential Diagnosis: usually none; One has to be vizilant to look for a malignant transformation in one of the lesions - the more proximal the lesion is to the axial skeleton more are the chances of malignancy. Mechanical restriction of motion of a neighbouring joint or compression of a nearby nerve are to be looked into b) Investigation – Only plain x-ray is possible d) referral criteria – all cases to be referred to higher centres. Lesions very proximal to the axial skeleton should be excised prophylactically 11) Name of condition: Benign Aggressive tumour – Giant Cell Tumour (Osteoclastoma) I, Introduction:. A benign bone tumour arising from undifferentiated connective tissue cells of bone marrow. It is an aggressive tumour and the chances of recurrence following curettage are very high.

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