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By X. Mamuk. DeVry University. 2018.

Sometimes this mechanism does not function properly and insteady of a barrier the chronically infected tonsils and adenoids become a focus of infection Clinical features 1 cheap kamagra effervescent 100mg visa. In case of marked adenoids purchase 100 mg kamagra effervescent otc, snoring, sleeping with open mouth, nasal speech, and pus from infected adenoids driping into the trachea causing cough 115 Pediatric Nursing and child health care 3. General symptoms of chronich infection (tiredness, poor appetite are common Indication for Adenoidectomy or /and tonsilectomy (over 3 years only) a. Assessment of ear problem Ask Look - Does the child have ear - Look for pus draining pain? Signs - Pus drainage from Pus draining from the ear - Tender swelling behind the ear <2 weeks or 2 weeks or more the ear ear pain or red immobile ear drum Mastoiditis Acute ear infection Chronic ear infection Treatment - Give oral antibiotic - Dry the ear by wicking - Refer urgently to - Dry the ear by - Paracetamol for pain hospital wicking treat fever - Give first dose or - Reassess in five antibiotic days - Paracetamol for pain, - Treat fever if present treat fever - Paracetamol for pain 117 Pediatric Nursing and child health care Study Questions 1. What steps would you take for a child with a very severe disease or sever pneumonia before referral? If you think the mother will not take the child who need referral or if the referral will be delayed, what steps will you take? Diarrheal disease is among the leading causes of morbidity and mortality among children < 5 years of age in Ethiopia. Diarrhea is most common in children, especially those between 6 months and 2 years of age. Acute diarrhea causes death because of dehydration Dysentery causes death because of a number of severe and potentially fatal complications occurring during dysentery such as Intestinal perforation - Toxic mega colon - Convulsions - Septicemia - Prolonged hyponatremia - Diarrhea is worse in person with malnutrition. Diarrhea can also cause malnutrition and make it worse because - Nutrients are lost from the body during diarrhea - Nutrients are used to repair damaged tissue rather than for growth 120 Pediatric Nursing and child health care - A person with diarrhea may not be hungry - Mothers may not feed children during diarrhea or even for some days after diarrhea stops To prevent malnutrition, food should be given to children with diarrhea as soon as, they eat it. Less water and salts pass into the blood, and more passes from the blood into the bowel. Thus, more than the normal amount of water and salts passed in the stool results in dehydration. Dehydration also can be caused by a lot of vomiting, which often accompanies diarrhea. Treating Diarrhea: The most important measures in treating diarrhea are to: - Prevent dehydration from occurring if possible - Treat dehydration quickly and well if it does occur - Feed the child 121 Pediatric Nursing and child health care 9. Mix well with a clean spoon until the powder is dissolved - Taste the solution so that you would know its taste like salt - Then give the child frequent small sips out of a cup or spoon. If the answer to either question is ‘yes’, use the following management chart to assess, classify and treat the child Calcifying Dehydration: - There are three possible calcifications of dehydrations for a child with diarrhea. If there is Falciparum malaria in the area and the child has any fever (38 or above) or history of fever in the past 5 days give anti-malarial treatment according to malaria program recommendation in your area 128 Pediatric Nursing and child health care 9. Treatment of Diarrhea Decide on appropriate treatment: After the examination, decide how to treat the child - if the child has any of the signs in the column labeled “for other problems” specific treatment is needed in addition to treatment given for dehydration - if there is blood in the stool and diarrhea for less than 14 days, the child has dysentry and appropriate antibiotics should be given - if there is diarrhea for longer than 14 days with or without blood in the stool and/or if there is severe under nutrition, continue feeding the child and refer for treatment. Determine the degree of dehydration Look at the upper row, the assessing and classifying chart. What important measures should be taken to prevent dehydration in children with diarrhea? What important pieces of advice would you give to the mother for home treatment of diarrhea? Older children are more likely to have acquired heart diseases such as rheumatic fever, endomyocardial fibrosis. Cyanosis can best be detected under the fingernails or on the mucus membranes of the mouth (lips, under side of the tongue). One of the main causes of this is chronic under saturation of the blood with oxygen. Signs of Cardiac Failure: ƒ Tachycardia-rapid pulse ƒ Tachyponea-rapid respiration ƒ Dyspnea-shortness of breath ƒ Edema and other signs of raised venous pressure ƒ Fatigue and failure to thrive ƒ Arrhythmia-irregular heart beat ƒ Systolic and more frequently diastolic murmurs ƒ Cough ƒ Orthophea Management: Any child with congestive heart failure should be referred to hospital whenever possible. In all cases where you have to start treatment: - check weight of the child ,record the pulse and respiration carefully at 2 hours intervals and indicate the exact time of any drugs given. Digitalization is most important In order to achieve effective blood levels quickly a digitizing dose is calculated and given over 24 hours. The only known cause is damage to the fetus by rubella Virus, when the mother is one to three months pregnant, or by chromosomal abnormality in children with Down’s syndrome. 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, 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.

Two trials (19 percent of patients reporting this outcome) reported treatment 117 119 effects of 0 kamagra effervescent 100mg low cost. To determine the impact of 117 discount 100mg kamagra effervescent visa, 119 these two trials on the pooled estimate, we added both to the meta-analysis with assumed standard deviations equal to half the mean change in score in each treatment group. The fourth trial reported a treatment effect of zero (and therefore smaller than both the pooled estimate [0. The body of evidence in support of a conclusion of equivalence of intranasal corticosteroid and nasal antihistamine for this outcome is therefore considered precise. One trial (4 percent of patients reporting this 118 outcome) showed no treatment difference, and the eighth trial (5 percent of patients reporting this outcome) reported a treatment effect favoring nasal antihistamine. This treatment effect was not statistically significant and its magnitude was not reported. A meta-analysis of four good quality trials (N=1791; 73 percent of patients reporting this outcome) yielded a statistically nonsignificant pooled effect estimate of 0. Of four trials not included in the meta-analysis, treatment effects favoring intranasal corticosteroid were 116, 117, 119 116 119 reported by three. One trial reported a statistically nonsignificant treatment effect favoring nasal antihistamine but did not report the magnitude of effect. Statistical heterogeneity in a meta-analysis of four trials 121 (73 percent of patients reporting this outcome) that favored intranasal corticosteroid was low. The fourth trial reported a treatment effect of unknown size favoring nasal antihistamine, but this trial represented 5 percent of patients reporting this outcome. Of four trials not included in the meta-analysis, one showed a treatment effect in the opposite direction (favoring nasal antihistamine) but did not report the magnitude of effect. Because this trial represented 5 percent of patients reporting this outcome, the reduction in the pooled estimate if this trial were included in the meta-analysis 117 likely would be minimal, unless the treatment effect was unexpectedly large. One trial (12 percent of patients reporting this outcome) showed a treatment effect (0. Change in the pooled estimate likely would be minimal if this trial 116, 119 116 119 were included in the meta-analysis. To determine 116, 119 the impact of these two trials on the pooled estimate, we added both to the meta-analysis with assumed standard deviations equal to half the mean change in score in each treatment group. The body of evidence in support of a conclusion of equivalence of intranasal corticosteroid and nasal antihistamine for this outcome is therefore considered precise. A meta-analysis of four good quality trials (N=1791; 75 percent of patients reporting this outcome) yielded a statistically significant pooled effect of 0. Of three trials not included in the meta-analysis, two 119 117 reported treatment effects of 0. Eighty-eight percent of patients reporting this outcome were in good quality trials. Treatment effects consistently favored intranasal corticosteroid in all trials, and statistical heterogeneity of a meta-analysis of four 115, 121 trials (75 percent of patients reporting this outcome) was low. Of three trials not included in the meta-analysis, one did not report the magnitude of the treatment effect, but this trial represented 5 percent of 117 patients reporting this outcome. One trial (13 percent of patients reporting this outcome) 80 showed a treatment effect (0. The third 119 trial (7 percent of patients reporting this outcome) showed a treatment effect of 0. To determine the impact of this trial on the pooled estimate, we added it to the meta-analysis with an assumed standard deviation equal to half the mean change in score in each treatment group. The body of evidence in support of a conclusion of equivalence of intranasal corticosteroid and nasal antihistamine for this outcome is therefore considered precise. Five reported treatment effects favoring intranasal corticosteroid, and two reported treatment effects favoring nasal antihistamine. A meta-analysis of five good quality trials 121 (N=2097; 93 percent of patients reporting this outcome) yielded a statistically significant pooled effect estimate of 0.

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El cuadro clínico se resolvió en el tiempo límite de la isquemia muscular purchase 100 mg kamagra effervescent visa, unas 6-8 horas buy 100mg kamagra effervescent overnight delivery. Quedó la anatomía de la extremidad, pero se perdió su función por músculos pétreos, contraídos definitivamente, no funcionales. Es fácil comprender que la extracción demorada de un émbolo del interior de una gruesa arteria, hará que al restituirse la circulación de los músculos isquémicos durante horas, entren en circulación numerosas sustancias producto del metabolismo anaeróbico, que son vasoactivas y pueden ocasionar si no se tienen en cuenta las medidas necesarias, un estado de choque que puede ser irreversible. No existe una relación exacta entre la masa muscular isquémica y la intensidad del choque o la insuficiencia renal. Existe la tendencia generalizada de que en los “problemas circulatorios” debe elevarse la extremidad. Aplicar calor aumenta el metabolismo que no puede ser compensado por el oxígeno que no llega y se produce fácilmente una quemadura que hace perder la extremidad. Mejor es abrigar la extremidad para que no pierda más calor y sobre todo para que no se golpee con los movimientos del traslado. Sólo existen unas escasas 6 a 8 horas desde el inicio del cuadro, para resolverlo. Las siguientes medidas no son posibles en todos los consultorios, dispensarios o policlínicos, pero las que se puedan, deben iniciarse cuanto antes por parte del médico que hace el diagnóstico para reducir secuelas, amputaciones y muertes y por supuesto están orientadas a los cuadros de insuficiencia arterial aguda por embolia o trombosis. Es lógico que los traumatismos arteriales y el hematoma disecante se traten de acuerdo con esas circunstancias particulares: - Suero “vasoactivo”: Solución salina fisiológica 500 ml Papaverina (500 mg) Procaína 2% (200 mg) A goteo muy lento, de 6-8 gotas por minuto. La arteria que ha aprisionado el émbolo, puede liberarlo y dejarlo pasar a un lugar donde ya la incompatibilidad de tamaños hace imposible que continúe su migración distal. Realizar al menos la primera inyección mientras se logra trasladar al enfermo a un lugar especializado. Los hematomas disecantes de la aorta son muy graves y las indicaciones de las diferentes posibilidades tienen esquemas complejos y difíciles, al tiempo que se necesita cirugía con circulación extracorpórea. Cada vez se utilizan con mejores resultados, los caros y aún lejanos stents de implantación endovascular para los hematomas disecantes. Rehabilitación Se encamina a devolver al paciente a la comunidad y que realice sus labores habituales, con énfasis en el tratamiento de las secuelas, principalmente las neurológicas. Mencione algunas posibilidades de tratamiento médico en diferentes lugares de asistencia médica. Conocer los dos elementos necesarios para el desarrollo de estas graves infecciones. Enfatizar en las cuatro formas clínicas clásicas, con interés en la contaminación simple. Otorgar la mayor importancia a los elementos de prevención de estas sepsis como la mejor forma de tratamiento. Enfatizar que en el período de estado el único tratamiento salvador es el quirúrgico. Su evolución ha ido cambiando en cuanto a número de casos, ya que mantiene una tendencia al descenso. Sin embargo, los pacientes que las presentan, si bien han tenido nuevas posibilidades dados los conceptos mejorados, los modernos antibióticos y quimioterápicos, la introducción de la oxigenación hiperbárica y otros adelantos, sufren aún de elevados índices de mutilaciones de sus extremidades o vísceras, y lo que es peor, de mortalidad. Resulta entonces oportuno, recopilar lo que de ellas se conocen para lograr una actualización del tema y una remodelación de conceptos que nos permitan una real comprensión, así como mejores resultados en la atención de estos infelices enfermos que aunque contados, presentan una elevada mortalidad. Ellos afectan el tejido celular subcutáneo, pero principalmente a los músculos (mionecrosis clostridiana, miositis clostridiana o gangrena gaseosa propiamente dicha), aunque también algunos órganos internos. En general antecede un traumatismo o cirugía, aunque también puede presentarse de forma aparentemente espontánea, sin trauma previo, pero con enfermedades y factores generales condicionantes bien establecidos. Las zonas más frecuentemente involucradas son las extremidades afectadas por traumas u operaciones, las heridas abdominales y el útero. De igual manera existen formas viscerales, a las que se les ha dado preferentemente el apellido de enfisematosas, como colecistitis enfisematosa, pielonefritis enfisematosa y otras. Características de los clostridios que enferman tejidos blandos Los clostridios de los tejidos blandos, al igual que otros como los del botulismo y del tétanos, son bacilos, Grampositivos, esporulados y miden de 1-5 micras de largo por 0,5 de ancho. Son anaerobios estrictos y movibles, aunque esta característica se pierde rápidamente, en pocos segundos, ante la presencia de pequeñas cantidades de oxígeno. Los clostridios y las esporas que contienen en su interior, pueden ser evidenciados con relativa facilidad, en pocos minutos, al realizar una tinción de Gram a una extensión de las secreciones de la zona enferma. También se han demostrado en las biopsias de los tejidos extirpados, así como cultivados en anaerobiosis.

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