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By H. Leif. Hawaii Pacific University. 2018.

Perinatal mortality rate:- the total number of still-births plus the number of deaths under one week old proven zetia 10 mg, per 1000 birth or the sum of late fetal and early neonatal deaths discount 10 mg zetia overnight delivery. The causes of Perinatal mortality are generally attributed to trauma and stress of labor, toxemia ante partum hemorrhage, maternal disease (particularly malaria and malnutrition), congenital anomalies, infection and induced abortions. Rates and causes of perinatal mortality are less well documented in developing areas. Available data indicate that in some areas like Addis Ababa, Ethiopia, the perinatal mortality rate was documented as high as 66 per 1000 live births. Neonatal mortality rate: - The number of deaths under 28 days of age per 1000 live births. The neonatal death reflects not only the quality of care available to women during pregnancy and childbirth but also the quality of care available 7 Pediatric Nursing and child health care to the newborn during the first months of life. Approximately 80 % of infants who die within 48 hours of birth weigh less than 2500 g. Post-natal mortality rate: - The number of deaths over 28 days but under one year of age per 1000 live births. Infant mortality rate: - The number of infant under one year of age dies per 1000 live births. The primary cause is immaturity and the second leading cause is gastroenteritis, which can be prevented by putting the newborn immediately with the mother and advocating breast-feeding. Child mortality rate: - The number of deaths between 1 and 4 years in a year per 1000 children. This rate reflects the main environmental factors affecting the child health, such as nutrition, sanitation, communicable diseases and accidents around the home. It is a sensitive indicator of socioeconomic development in a community and may be 25 times higher in developing countries compared to developed countries. The reasons why they need special health care are: • Large numbers: constitute 15 – 20% of population in developing countries. The major causes of death in this group are due to malnutrition and infection, both preventable. C) Antenatal and deliver care: Every child begins as a fetus, and the months before delivery are some of the most important in his life. Pregnant mothers should be checked regularly and advised on their nutrition and any other difficulties they have. Finally, skilled help during labor and delivery will provide the final step for a good start in life. These methods of primary prevention are available and effective and should be given to every child. Some of these traditional practices are good for health, such as breast feeding or the acceptance of modern medicine, should be supported. Those traditional practices and beliefs, which are bad (cutting of uvula, female genital mutilation etc ) need to be gradually changed. This is another important area in which health workers can have a strong influence in improving health. Discuss the components of safe motherhood that can contribute to the reduction of neonatal morbidity and mortality. B) History of the present illness: this is a chronologic description and duration of the chief complaint. We try to answer the following questions; 13 Pediatric Nursing and child health care • Duration of disease onset • Severity • Aggravating and alleviating factors • Associated symptoms • Any treatment and response to treatment • History of contact with similar illness • Relevant pediatric history (like history of immunizations) related to chief complaints or history present illness C) Past medical history: this is made up of the illness the patient has had in the past. Past medical history section of pediatrics contains (Past illness, child hood illness, Prenatal history, birth history). Find out if your patient has been hospitalized previously and for what conditions. Do the symptoms he/she has now resemble the one he had in connection with these past conditions, if so then they might be due to the same illness. If a child has a rash now which resembles measles you do not have to worry about this condition if he has already had measles or if he has been immunized against measles. D) Social and family history: The social history should include the parents’ occupation as 14 Pediatric Nursing and child health care well as the current living condition. You may have to educate a poor mother with malnourished baby that the best treatment for her baby is to be breast-fed exclusively till the age of one or more. If a mother feeds the baby food containing unbilled water the baby may get diarrhea. E) Immunization status: Immunization is a way of protecting children against the major diseases of childhood, which harm, cripple or kill thousands of children. Ask the mother about immunization status and if he/she is not properly immunized, take the opportunity of a minor illness to prevent major diseases by advice and vaccination. No proper history can be obtained without observation of the child and the mother. Some rules in history taking: Be an intelligent observer (while you are waiting for the undressing of the child or while you are taking with the mother) Situation your action in history taking The very sick child try to find out quickly what is causes 15 Pediatric Nursing and child health care The Symptoms of disease (e. See how the proposed illness affects the general wellbeing or growth of the child.

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As a result zetia 10 mg without a prescription, endocrine signaling requires more time than neural signaling to prompt a response in target cells buy zetia 10 mg overnight delivery, though the precise amount of time varies with different hormones. For example, the hormones released when you are confronted with a dangerous or frightening situation, called the fight-or-flight response, occur by the release of adrenal hormones—epinephrine and norepinephrine—within seconds. What is the secondary messenger made by adenylyl cyclase during the activation of liver cells by epinephrine? The same hormone may play a role in a variety of different physiological processes depending on the target cells involved. It is also important in breastfeeding, and may be involved in the sexual response and in feelings of emotional attachment in both males and females. In general, the nervous system involves quick responses to rapid changes in the external environment, and the endocrine system is usually slower acting—taking care of the internal environment of the body, maintaining homeostasis, and controlling reproduction (Table 17. So how does the fight-or-flight response that was mentioned earlier happen so quickly if hormones are usually slower acting? It is the fast action of the nervous system in response to the danger in the environment that stimulates the adrenal glands to secrete their hormones. As a result, the nervous system can cause rapid endocrine responses to keep up with sudden changes in both the external and internal environments when necessary. Endocrine and Nervous Systems Endocrine system Nervous system Signaling mechanism(s) Chemical Chemical/electrical Primary chemical signal Hormones Neurotransmitters Distance traveled Long or short Always short Response time Fast or slow Always fast Environment targeted Internal Internal and external Table 17. The primary function of these ductless glands is to secrete their hormones directly into the surrounding fluid. The endocrine system includes the pituitary, thyroid, parathyroid, adrenal, and pineal glands (Figure 17. For example, the pancreas contains cells that function in digestion as well as cells that secrete the hormones insulin and glucagon, which regulate blood glucose levels. The hypothalamus, thymus, heart, kidneys, stomach, small intestine, liver, skin, female ovaries, and male testes are other organs that contain cells with endocrine function. Moreover, adipose tissue has long been known to produce hormones, and recent research has revealed that even bone tissue has endocrine functions. The ductless endocrine glands are not to be confused with the body’s exocrine system, whose glands release their secretions through ducts. As just noted, the pancreas also has an exocrine function: most of its cells secrete pancreatic juice through the pancreatic and accessory ducts to the lumen of the small intestine. Other Types of Chemical Signaling In endocrine signaling, hormones secreted into the extracellular fluid diffuse into the blood or lymph, and can then travel great distances throughout the body. An autocrine (auto- = “self”) is a chemical that elicits a response in the same cell that secreted it. Local intercellular communication is the province of the paracrine, also called a paracrine factor, which is a chemical that induces a response in neighboring cells. Although paracrines may enter the bloodstream, their concentration is generally too low to elicit a response from distant tissues. A familiar example to those with asthma is histamine, a paracrine that is released by immune cells in the bronchial tree. Another example is the neurotransmitters of the nervous system, which act only locally within the synaptic cleft. Endocrinologists—medical doctors who specialize in this field—are experts in treating diseases associated with hormonal systems, ranging from thyroid disease to diabetes mellitus. Endocrine surgeons treat endocrine disease through the removal, or resection, of the affected endocrine gland. Patients who are referred to endocrinologists may have signs and symptoms or blood test results that suggest excessive or impaired functioning of an endocrine gland or endocrine cells. The endocrinologist may order additional blood tests to determine whether the patient’s hormonal levels are abnormal, or they may stimulate or suppress the function of the suspect endocrine gland and then have blood taken for analysis. Some endocrine disorders, such as type 2 diabetes, may respond to lifestyle changes such as modest weight loss, adoption of a healthy diet, and regular physical activity. Other disorders may require medication, such as hormone replacement, and routine monitoring by the endocrinologist. These include disorders of the pituitary gland that can affect growth and disorders of the thyroid gland that can result in a variety of metabolic problems. Some patients experience health problems as a result of the normal decline in hormones that can accompany aging. These patients can consult with an endocrinologist to weigh the risks and benefits of hormone replacement therapy intended to boost their natural levels of reproductive hormones. In addition to treating patients, endocrinologists may be involved in research to improve the understanding of endocrine system disorders and develop new treatments for these diseases.

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If the infant does not require immediate treatment order 10mg zetia overnight delivery, the results should be plotted on the predictive (screening) nomogram to determine the risk of progression to severe hyperbilirubinemia buy zetia 10mg on line. Joseph’s has a reliable Transcutaneous Bilirubin meter which accurately and consistently measures serum bilirubin levels. Guidelines for detection, management and prevention of hyperbilirubinemia in term and late preterm newborn infants (35 or more weeks’ gestation). ClinicalPracticeG uideline:m anagem entof hyperbilirubinem iainthenewborninfant35orm oreweeksof gestation. G uidelinesfordetection,m anagem entandpreventionof hyperbilirubinem iainterm andlatepreterm newborninfants(35orm oreweeks’gestation). Joseph ’s h as areliable Transcutaneous B ilirubinm eterwh ich accurately and consistently m easures serum bilirubinlevels. Donottreatanear-term (35to38wk)infantasaterm infant;anear-term infantisatm uchhigherriskof hyperbilirubinem ia. Perform apre-dischargesystem atic assessm entonallinfantsfortheriskof severehyperbilirubinem ia. Some rules intended to reduce the potential for medication errors: • Write orders clearly and concisely. R x Interactions:Ç levels of m idaz olam ,carbam az epine,theophylline,cyclosporine,phenytoin C larith rom ycin R x Interactions:theophylline,carbam az epine,cisapride,digox in,cyclosporine,tacrolim us. O totox icityandnephrotox icity m ayoccur,considerm onitoring trough levels (target<2m g/L )inpatients atriskfor nephrotox icity;septic shock,concurrentnephrotox ins,fluctuating renalfunctionorex tended treatm entcourses. F eeds,form ula,calcium ,m agnesium ,iron,antacids andsulcralfate reduce absorption,holdfeeds for1hourbefore and2hours afterdose. Aspergillus species andCandida kruseiare intrinsicallyresistant,Candida glabrata m ayrespondto higherdoses. A single dose greater than 150 mg/kg is generally considered to be toxic, but toxicity has been reported at lower doses (90-120 mg/kg/day). Morphine is the preferred oral opiate for the treatment of acute pain Morphine has important effectiveness and safety advantages and is preferred over codeine (which historically had been the most commonly used oral opiate at McMaster Children’s Hospital). Codeine is a weak opiate analgesic with minimal intrinsic analgesic activity; it must first be metabolized to morphine which provides most of the analgesic effect. Up to 10% of the population does not effectively metabolize codeine to morphine, resulting in poor pain control. To avoid the unpredictably variable analgesia and potential for toxicity, a simpler approach is to use morphine. Consider supplemental steroids at times of stress if patient has received long-term or frequent bursts of steroid therapy. Prolonged weakness may occur when corticosteroids are used concurrently with non-depolarizing neuromuscular blocking agents. Fast onset and short duration of action with single doses, duration of action prolonged with continued use. Epinephrine (Racemic) Post-extubation stridor/croup: Use 1:1000 epinephrine(racemic 2. Higher doses may be required if administered through a ventilator due to loss of drug in the circuit. Consider supplemental steroids at times of stress if patient has received long-term or frequent bursts of steroid therapy. Prolonged weakness may occur when corticosteroids are used concurrently with non-depolarizing neuromuscular blocking agents. With continuous infusions measure blood glucose q1h initially, adjust dose as required based on blood glucose measurements. Higher doses may be required if administered through a ventilator due to loss of drug in the circuit. Give in water or juice, do mix with fruit juices with high potassium content such as orange juice. Consider supplemental steroids at times of stress if patient has received long-term or frequent bursts of steroid therapy. Prolonged weakness may occur when corticosteroids are used concurrently with non-depolarizing neuromuscular blocking agents. Extrapyramidal reactions occur more commonly in children and may be treated with diphenhydramine. Use with caution in non-ventilated patients due to potential for respiratory depression. To prevent withdrawal, avoid abrupt cessation following high doses or long duration of therapy (> 5 days). Improving the treatment of pain at McMaster Children’s Hospital Morphine is the preferred oral opiate for the treatment of acute pain Morphine has important effectiveness and safety advantages and is preferred over codeine (which historically had been the most commonly used oral opiate at McMaster Children’s Hospital). Codeine is a weak opiate analgesic with minimal intrinsic analgesic activity; it must first be metabolized to morphine which provides most of the analgesic effect. Up to 10% of the population does not effectively metabolize codeine to morphine, resulting in poor pain control. To avoid the unpredictably variable analgesia and potential for toxicity, a simpler approach is to use morphine.

Zetia
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