By W. Bradley. Southwestern College, Kansas.
Britain was then engaged in a major war in the Crimea order 160 mg diovan with amex; reports were coming back that more men died of wounds in the hospitals than on the battlefield diovan 80mg for sale. When she arrived at the front discount diovan 40 mg amex, Nightingale found that conditions in the military hospitals were abominable generic 40mg diovan free shipping. The absence of sewers and laundry facilities, the lack of supplies, the poor food, and the disorganized medical services 5 Basic Clinical Nursing Skills contributed to a death rate of more than 50% among the wounded. The school was organized around three components: 1) a trained matron with undisputed authority over all members of the staff, 2) a planned course of theoretical and practical training, and 3) a home attached to the hospital in which carefully selected students were placed in the care of “sisters” responsible for their moral and spiritual training. Her school prepared nurses for hospital care (where they were called “ward sisters”) and for supervisory and teaching positions. Nightingale also set up a program for preparing “district” nurses, the public health/visiting nurses of England. She wrote that these district nurses needed additional education because they would be working more independently than the hospital staff members. Nightingale’s strong statements about the role of nurses and their need for lifelong education are still quoted widely today. Perhaps 6 Basic Clinical Nursing Skills she, more than anyone else, can be credited with establishing nursing as a profession. Before the development of modern nursing, women of nomadic tribes performed nursing duties, such as helping the very young, the old, and the sick, care-dwelling mothers practiced the nursing of their time. As human needs expanded, nursing development broadened; its interest and functions through the social climates created by religious ideologies, economic development, industrial revolutions, wars, crusades, and education. The dynamic change in economic and political situations also influenced every corner of human development including nursing. She also contributed to the definition of nursing “to put the patient in best possible way for nature to act. Around 1866 missionaries came to Eritrea, (one of the former provinces of Ethiopia) and started to provide medical care for very few members of the society. In 1949 the Ethiopian Red Cross, School of Nursing was established at Hailesellasie I hospital in Addis Ababa. In 1954 HailesellasieI Public Health College was established in Gondar to train health officer, community health nurses and sanitarians to address the health problem of most of the rural population. In line with this, the Centralized school of Nursing formerly under Ministry of health and recently under Addis Ababa University Medical Faculty and Nekemit School of nursing are among the senior nurse’s training institutions. An additional higher health professional training institution was also established in Jimma(1983) to train health professionals using educational philosophy of community based and team approach. Additional public health professional training institutions were opened in Alamaya University and Dilla College of Teacher Education and Health Sciences (1996). Following further expansion of higher learning, Mekele University has started medical education and the former diploma offering university have upgraded to degree program in which nursing education is a part. In this line Hawassa University, College of Health Sciences also opened new medical education to the former existing health sciences programs. The Federal Ministry of Defense, established a University College under which the college of health sciences offering training for health professionals including nursing. The outputs of these training institutions are providing services all over the country not only to improve the health status of our society but also to ensure the attainment of millennium health development goals. It is a series of planned steps and actions directed toward meeting the need and solving problems of people and their significant others; it is systematic, scientific problem solving in action (Sorensen and Luckman, 1986) Purpose of Nursing Process: 1. Assessment – the systematic collection of data to determine the patient’s health status and to identify any actual or potential 10 Basic Clinical Nursing Skills health problems. Data collected about a client generally fall into one of the two categories: objective or subjective Objective data include all the measurable and observable pieces of information about the client and his or her overall state of health. Some times the client can communicate through body language: gesture, facial expressions and body posture. Methods of data collection Observation is an assessment tool that relies on the use of the five senses (sight, touch, hearing, smell and taste) to discover information about client.
A full term infant born to a normal and healthy mother and father generic diovan 40mg online, was observed to have a marked lack of pigmentation: had blue eyes and many white patches on his hair discount 160mg diovan with visa. Growing children and patients recovering from trauma buy cheap diovan 80 mg on line,surgery and major burns require more high quality protein rich in essential amino acids in addition they excrete less nitrogen than they consume buy 160 mg diovan. Patients with gastric or duodenal ulcer, or both, often experience chronic Recurrence, in these cases, what treatment would you choose? They are essential for the normal processes of metabolism, including growth and maintenance of health. It is known that the body is able to produce part or even all of its requirements for some of the vitamins, Example: Vitamin D from cholesterol and niacin from Tryptophan. The B- Vitamins are essential and must be provided through diet: these include: - Thiamine (Vit B1) - Riboflavin (Vit B2 ) - Niacin (Nicotinic acid (or Nicotinamide) - Pantothenic acid (Vit B5) - Vitamin B6 (Pyrodoxine,pyridoxal,& Pyridoxamine) - Biotin - Vitamin B12 (Cobalamin) - Folic Acid Thiamine (vit B1) 161 Thiamine is Vitamin B1. The latter is the reactive moiety - specifically, the rather acidic carbon between the sulfur and the nitrogen. This carbon forms a carbanion, which in turn, can attack the carbonyl carbon of -keto acids, such as pyruvate, This compound undergoes nonoxidative decarboxylation, with the thiazole ring acting as an electron sink, in forming a resonance- stabilized ene-amine. Sources: The good sources of Thamine are: Seeds, Nuts, Wheat, Legumenious plants (rich source) & lean meat. Wernicke Korsakoff syndrome which is frequently found in Alcoholics is associated with Thiamin deficiency. The ability of the ring system of riboflavin to exist as a semiquinone allows the flavin coenzymes to accept electrons either + + singly or in pairs. Erythrocyte enzyme activity measurements (Glutathione reductase) is used to determine Nutritional status of Riboflavin. Niacin Nicotinamide Nicotinic Acid Niacin is not a vitamin in a strictest sense of the word, since it can be synthesized from Tryptophan. However, conversion of Tryptophan to Niacin is relatively inefficient (60 mg of Tryptophan is required to produce 1mg of Niacin) and occurs only after all the body requirements for Tryptophan is met. The requirement increases with increased intake of calories, illness, severe injury ,infection ,burns, high corn (maize) diet, pregnancy and lactation. The patient develops gingivitis and stomatitis (Tongue gets swollen) General effects of deficiency are Failure of growth, loss of weight and anemia. Vit B6 (Pyridoxine) Pyridoxine Pyridoxal Pyridoxamine Exists in three forms: Pyridoxine, Pyrodoxal & pyridoxamine and their corresponding phosphates. All pyridoxal phosphate-requiring enzymes act via the formation of a Schiff base between the amino acid and coenzyme. A cation (a metal or a proton) is essential to bridge the phenolate ion of the coenzyme and the imino nitrogen of the amino acid. The most important catalytic feature of the coenzyme is the electrophilic nitrogen of the pyridine ring, which acts as an electron sink, drawing electrons away from the amino acid and stabilizing a carbanion intermediate. It is an essential component of Glycogen phosphorylase;it is covalently linked to a lysine residue and stabilizes the enzyme. Deficiency: usually is not common, but may result due to intake of drugs like Isoniazid and contraceptives. Biotin Biotin Is a vitamin and a coenzyme commonly associated with enzymes performing carboxylation reactions. Avidin, a glycoprotein in egg white binds tightly to biotin and makes it unavailable for the necessary carboxylation reactions. The symptoms in this case are: Dermatitis, Glossitis, Muscle pain, depression, alopecia (Loss of hair), Loss of appetite and Nausea. Figure: Structure of Cobalamin The metal cobalt in vitamin B12 is coordinated with a tetrapyrrole ring system, called a corrin ring, which is simiilar to the porphyrin ring of heme compounds. The cyanide attached to the cobalt in the structure is an artifact of the isolation and is replaced by water or a hyrdoxyl group in cells. Only two reactions occur to a significant extent in mammalian metabolism: the synthesis of methionine from homocysteine 167 B12- requiring reactions involve either (1) methyl group transfer or (2) adenosylcobalamin- dependent isomerizations. Gastric tissue secretes a glycoprotein called intrinsic factor, which complexes with ingested B12 in the digestive tract and promotes its absorption through the small intestine into the blood stream. Outlines a probable explanation for why failure to absorb B12 leads to the deficiency of red blood cells that define anemias.
Rabies Defnition: Rabies is a deadly viral infection that is mainly spread by infected animals buy diovan 80mg cheap. Snakebites and Venom Defnition: Poisonous snakes inject venom using modifed salivary glands The venom apparatus Venomous snakes of medical importance have a pair of enlarged teeth diovan 160 mg generic, the fangs cheap diovan 80mg on line, at the front of their upper jaw order diovan 40 mg line. Tese fangs contain a venom channel (like a hypodermic needle) or groove along which venom can be introduced deep intp the tissue of their natural prey. If a human is bitten, venom is usually injected subcutaneously or intramuscularly. Spitting cobras can squeeze the venom out of the tips of their fangs, producing a fne spray directed toward the eyes of an aggressor. Symptoms may Envenomation include renal failure, coma and death 216 Surgery Clinical Treatment Guidelines Chapiter 9: Bites and Stings of Animals and Insects Complications of snake bites - Te injection of even highly purifed serum carries a risk of untoward reactions. Te most common is serum sickness which may occur about ten days afer the injection but sometimes sooner. It is characterized by itching rashes and sometimes a rise in temperature and joint pains. Te risk of this type of reaction in a healthy person is very slight but those with an allergic disposition, in particular a history of asthma or infantile eczema, should not receive serum unless it is absolutely necessary and then only with the greatest caution. If there is no untoward reaction within 30 minutes, 0,2 mL of undiluted serum could be given in the same way, to be followed, if necessary, by the full dose if no reaction occurs to this trial dose - Where possible, whenever serum is to be injected, the patient should be kept under observation for at least 30 minutes afer the injection, and adrenalin and corticosteroid kept in readiness for emergency use 218 Surgery Clinical Treatment Guidelines Chapiter 9: Bites and Stings of Animals and Insects Summarized chart for management of snakebites Venom type Cytotoxic Neurotoxic Mixed cytotoxic and Haemotoxic neurotoxic Puff adder, Gaboon Rinkhals, berg adder, adder, spitting cobras Peringuey’s adder, (Mozambique, black Black and green desert mountain Boomslang, vine snake Snake species necked, black, zebra), mamba, non-spitting adder, garter snakes, (eastern and savanna) Stiletto snakes, night cobras (snouted, Cape, shieldnose adders, horned and Forest, Anchieta’s snake many horned adders, lowland swamp viper. Artifcial respiration may be necessary § Hospitalisation Take the patient to Take the patient to Take the patient to Take the patient hospital hospital hospital to hospital Supportive treatment Intravenous fuids Protect the airway. See cytotoxic and Blood or blood Elevate bitten limb Oxygen by mask or neurotoxic component therapy Analgesia ventilation. Antivenom may be Puff adder, spitting Boomslang necessary for threat cobras, Gaboon All species Rinkhals to limb or life adder See Algorithm 3 Antivenom type Polyvalent Polyvalent Polyvalent Boomslang monospecifc Suggested dose 50ml : puff adder and 80 ml (40 – 200 ml) by intravenous Small doses may lead 50 ml 10 – 20 ml injection spitting cobras to a recurrence of 200ml : Gaboon adder symptoms. Percentage bites in which antivenom is < 10% 50 – 70% < 10% 80 -100% indicated Surgery Clinical Treatment Guidelines 219 Chapiter 9: Bites and Stings of Animals and Insects 9. Insect Stings Defnition: A sting is usually from an attack by a venomous insect such as a bee or wasp, which uses this as a defence mechanism by injecting toxic and painful venom through its stinger. Insect bites and stings can be divided into 2 groups namely: venomous and non- venomous. Non-venomous insect bites pierce the skin to feed on blood, this usually results in intense itching. Spider Bites Defnition: Spider bite is the puncture wound produced by the bite of a spider. Signs and symptoms Generalized muscle spasm is the most prominent physical fnding. Delayed presentation is no barrier to satisfactory outcome in the management of open fractures. If you wish to refer to this guideline, please use the following reference: Verma R, Alladi R, Jackson I, et al. Summary 1 Day surgery is a continually evolving speciality performed in a range of ways across different units. Re-use of this article is permitted in accordance with the Creative Commons Deed, Attribution 2. Since the previous guideline was published in 2005, the complexity of procedures has increased with a wider range of patients now considered suitable for day surgery. Ten years on, the advancement of minimally invasive surgery is allowing more procedures to be performed as day surgery and even higher rates should be possible. There was a major drive to promote day surgery around the turn of this century, but the political focus moved on before all of the lessons learned were fully implemented. Nevertheless, the recent drive to reduce length of stay and improve the quality of postoperative recovery has ensured that day surgery principles are fundamental to modern patient care.