All About Business & Information: Nursing Tutorial

Showing posts with label Nursing Tutorial. Show all posts

Showing posts with label Nursing Tutorial. Show all posts

Immunizations During Pregnancy

As a rule,immunizations are best avoided during oregnancy. Several factorsenter into the decision about imunizing a pregnant woman against an infectious discase, including the possibility of disease exposure, the effect on woman and fetus if the disease is contracted, susceptibility to the disease, and risk to the fetus from the immunization. Immunoglobins, toxoids, and killed or inactivated be given during pregnancy unless the risk of exposure and illness clearly outweighs the risks of the vaccine itself.

The live virus MMR vaccine (measle, mumps, and rubella) is contraindicated during pregancy. There is a well-established risk from these disease. About 10% of reproductive age women are suspectible to rubella, either because they were never vaccinated or their immunity has waned. The centers for disease Control have monitored fetal effects of rubella vaccination since 1971. In over 300 susceptible women who were immunized within 3 months of conception and whose pregnancies went to term , there were no fetal abnormalities (Cunning-ham et al.1993). pregnancy should be avoided for 3 months after rubella vaccination , even though there is no documentation of congenital rubella syndrome (CRS:Scott et al. 1993).
Pregnant women with chronic cardiac, pulmonary, or metabolic diseases should be evaluated carefully for immunization against influenza and pneumonia.

The nurse advises the pregnant women to minimize expsure to infectious diseases when travelling. Any febrile illness or rash should be reported to the physicians without delay.
Clients are educated about updating immuzations after delivery to reduce future risk. After receiving live organism vaccinations, clients are advised to avoid conception for recommended time.
Taken from : assesment and management in the antepartum period book

Tag : Pregnancy Immunizations, Immunizations for Pregnancy

Definition of Hyperemesis Gravidarum

Hyperemesis gravidarum is vomiting occur until the age of 20 weeks of pregnancy, in which all what to eat and drink in spill which affected the general condition and daily work, weight loss, dehydration, there was acetone in the urine, not because of diseases such as Appendisitis, pielitis and forth.

The cause of hyperemesis gravidarum is not known with certainty. Anatomic changes in the brain, heart, liver and nervous system caused by lack of vitamins and other substances from inanisi.

Nausea is a result of increased estrogen levels, since this complaint occurred in the first trimester. Psychological influence of estrogen hormones is not clear, probably derived from the central nervous system or due to reduced gastric emptying. Adjustment occurs in most pregnant women. Although nausea and vomiting that can last for months.
source : catatan kuliah

The Client with a Brain Abscess

A brain abscess is an infection with a collection of purulent matenal within the brain tissue. Approximately 75% of brain abscesses are found in the cerebrum; 25% are found in the cerebellum. Approximately 40% of all brain abscesses extend into the brain by traveling from middle ear and mastoid infections along the wall of the cerebral veins. Sinus infections, direct trauma to the brain, and neurosurgery allow immediate access and are responsible for approximately 10%. The remaining 50% are the result of infections in other sites within the body that cause septic emboli to travel via the bloodstream to the brain. Common sources of septic emboli include the lungs (lung abscess), the heart (bacterial endocarditis), the pelvis (pelvic abscesses), skin infections, and complications associated with some forrrts of meningitis.

Pathophysiology

A brain abscess results from the presence of microorganisms in the brain tissue. Occasionally the abscess does not become encapsulated; instead, it spreads through the brain tissue to the subarachnoid space and ventricular system. If the abscess is encapsulated, it has the ability to enlarge and, therefore, behave as a space-occupying lesion within the cranium. This predisposes the client not only to the systemic effects of the inflammatory process but also to the serious consequences of increased intracranial pressure.
Initialy, The clien exhibits The general symptoms associated with an acute infectious process, such as chills, fever, malaise, and anorexia. Because brain abscess generally forms after infection, the client may consider these signs to be an exacerbation of that illness. As the abscess enlarges. neurologic signs may increase.

Collaborative Care

Treatment of the client with a brain abscess focuses on the prompt initiation of the antibiotic therapy. Other manifestations are treated symptomatically-as with the client diagnosed with meningitis or encephalitis. If pharmacologic management is not effective, the abscess ma)’ be drained or, if it is encapsulated, removed.

Laboratory and Diagnostic Tests

Diagnosis of a brain abscess can present some difficulties because of the lack of definitive symptoms and a some-what confusing clinical picture. The following diagnostic tests may be helpful in identifying a primary cause:

• X-ray films of the chest, skull, and sinuses may help identify a primary source of infection.
• Lumbar puncture reveals a markedly elevated pressure (200 to 300 mm water), with elevated protein content and elevated white blood cell count. Glucose
content is normal, and culture and sensitivity are negative because the bacteria are encapsulated.

Pharmacology
Antimicrobial therapy is the primary treatment for brain abscess. Anticonvulsant medications may be given as prophylaxis against seizures.

Surgery
Surgical drainage of an encapsulated abscess is considered somewhat controversial. The decision to perform surgery is based on the client’s general condition, the stage of abscess development, and the site of the adscess.

Nursing Care
A careful history and nursing assessment is important to assist in identifying brain abscess. Nursing diagnoses and interventions are generally the same as those previously discussed for clients with meningitis and increased intracranial pressure.

Source:
Priscilla LeMone, Karen M. Burke. 1996. Medical-Surgical Nursing : Critical
Thinking in Client Care. California, Addison-Wesley Nursing.

What is colostrum? How does it benefit my baby?

Your breasts produce colostrum beginning during pregnancy and continuing through the early days of breastfeeding. This special milk is yellow to orange in color and thick and sticky. It is low in fat, and high in carbohydrates, protein, and antibodies to help keep your baby healthy. Colostrum is extremely easy to digest, and is therefore the perfect first food for your baby. It is low in volume (measurable in teaspoons rather than ounces), but high in concentrated nutrition for the newborn. Colostrum has a laxative effect on the baby, helping him pass his early stools, which aids in the excretion of excess bilirubin and helps prevent jaundice.

When your baby is breastfed early and often, your breasts will begin producing mature milk around the third or fourth day after birth. Your milk will then increase in volume and will generally begin to appear thinner and whiter (more opaque) in color. In those first few days it is extremely important to breastfeed your newborn at least 8-12 times each 24 hours, and more often is even better. This allows your baby to get all the benefits of the colostrum and also stimulates production of a plentiful supply of mature milk. Frequent breastfeeding also helps prevent engorgement.

Your colostrum provides not only perfect nutrition tailored to the needs of your newborn, but also large amounts of living cells which will defend your baby against many harmful agents. The concentration of immune factors is much higher in colostrum than in mature milk.
Colostrum actually works as a natural and 100% safe vaccine. It contains large quantities of an antibody called secretory immunoglobulin A (IgA) which is a new substance to the newborn. Before your baby was born, he received the benefit of another antibody, called IgG, through your placenta. IgG worked through the baby's circulatory system, but IgA protects the baby in the places most likely to come under attack from germs, namely the mucous membranes in the throat, lungs, and intestines.

Colostrum has an especially important role to play in the baby's gastrointestinal tract. A newborn's intestines are very permeable. Colostrum seals the holes by "painting" the gastrointestinal tract with a barrier which mostly prevents foreign substances from penetrating and possibly sensitizing a baby to foods the mother has eaten.
Colostrum also contains high concentrations of leukocytes, protective white cells which can destroy disease-causing bacteria and viruses.

The colostrum gradually changes to mature milk during the first two weeks after birth. During this transition, the concentrations of the antibodies in your milk decrease, but your milk volume greatly increases. The disease-fighting properties of human milk do not disappear with the colostrum. In fact, as long as your baby receives your milk, he will receive immunological protection against many different viruses and bacteria.

Your breasts produce colostrum beginning during pregnancy and continuing through the early days of breastfeeding. This special milk is yellow to orange in color and thick and sticky. It is low in fat, and high in carbohydrates, protein, and antibodies to help keep your baby healthy. Colostrum is extremely easy to digest, and is therefore the perfect first food for your baby. It is low in volume (measurable in teaspoons rather than ounces), but high in concentrated nutrition for the newborn. Colostrum has a laxative effect on the baby, helping him pass his early stools, which aids in the excretion of excess bilirubin and helps prevent jaundice.

When your baby is breastfed early and often, your breasts will begin producing mature milk around the third or fourth day after birth. Your milk will then increase in volume and will generally begin to appear thinner and whiter (more opaque) in color. In those first few days it is extremely important to breastfeed your newborn at least 8-12 times each 24 hours, and more often is even better. This allows your baby to get all the benefits of the colostrum and also stimulates production of a plentiful supply of mature milk. Frequent breastfeeding also helps prevent engorgement.

Your colostrum provides not only perfect nutrition tailored to the needs of your newborn, but also large amounts of living cells which will defend your baby against many harmful agents. The concentration of immune factors is much higher in colostrum than in mature milk.
Colostrum actually works as a natural and 100% safe vaccine. It contains large quantities of an antibody called secretory immunoglobulin A (IgA) which is a new substance to the newborn. Before your baby was born, he received the benefit of another antibody, called IgG, through your placenta. IgG worked through the baby's circulatory system, but IgA protects the baby in the places most likely to come under attack from germs, namely the mucous membranes in the throat, lungs, and intestines.
Colostrum has an especially important role to play in the baby's gastrointestinal tract. A newborn's intestines are very permeable. Colostrum seals the holes by "painting" the gastrointestinal tract with a barrier which mostly prevents foreign substances from penetrating and possibly sensitizing a baby to foods the mother has eaten.

Colostrum also contains high concentrations of leukocytes, protective white cells which can destroy disease-causing bacteria and viruses.
The colostrum gradually changes to mature milk during the first two weeks after birth. During this transition, the concentrations of the antibodies in your milk decrease, but your milk volume greatly increases. The disease-fighting properties of human milk do not disappear with the colostrum. In fact, as long as your baby receives your milk, he will receive immunological protection against many different viruses and bacteria.

Vitamin and Mineral Supplements for Pregnancy

There is no universal agreement about the use of vitamin and mineral supplements during pregnancy . Ideally, the diet should supply all the nutriens needed so supplements are not necessary. Some physiciams prescribe a multivitamin and mineral supplement as a precaution against deficiencies. The Subcommitee on Dietary Intake and Nutrient Supplements During Pregnancy of the Food and Nutrition Board (Institute of Medicine, 1990) considers supplements During pregnancy an intervention to be used oly when specifically indicated. They point out that supplementation can create imbalances.

Because increasing one nutrient often hanges the requirement for other nutrients. There also may be unidentified essential nutrients. There also may be unidentified essential nutrients that supplementation could affect adversely.

Iron and folacin the most frequently recommended supplement, because they are difficult to obtain by diet alone. The subcommittee for an Implementation Guide (Institute of Medicine, 1992) recommends a low-dose supplement of 30 mg /d of elemental iron for the woman who is not anemic. For the anemic woman, a supplement of 60 to 120 mg/d is recommended. Iron tablets taken between meals are absorbed more completely than those taken with food. Because large doses of iron appear to depress plasma zinc in preganant women, zinc supplementation may be needed when a supplement of more than 30 mg/d of elemental iron is taken. If zinc is given, the Subcomitee recommends the addition of a 2-mg copper supplement

to offset zinc’s depressive effect on copper absorption (Institute of Medicine, 1992).

Folic acid is recommended for 4 weeks prior to conception and during the first 3 months of pregnancy (Institute of Medicine, 1992). Suplementation prior to in early pregnancy has been found to protect against neural tube defects in women who had a previously affected pregnancy (MRC Vitamin Study Research Highlight). If there is any evidence of an inadequate dietary intake, folic acid may be given throughout the pregnancy.

Certain conditions or habits of the pregnant woman may increase requirements fo certain nutrients. For example, women who are carryng more than one fetus or who smoke cigarettes, drink alcohol, or use illicit drugs may require additional supplementation. Special attention also needs to be given to the adequacy of calcium and vitamin D intake for pregnant women younger than 25 years, because their bon mineral density is still increasing (Institute of medicine 1990). Calcium Supplements might be advised for women who drink little or no milk, and Vitamin B12 might be needed by the vegan who eats no animal protein (Williams, 1993). If any vitamin or mineral supplements are used, it is important for the woman to understand that these are in addition to, not stead of, her recommended dietary intake
(taken From Assesment and Management in the Antepartum Period Book)

Nature of the nurse’s Work – Registered Nurse (RNs) work to promote health, prevent disease, and help patients cope with illness.

Registered Nurse (RNs) work to promote health, prevent disease, and help patients cope with illness. They are advocates and health educators for patients, families and communities. When providing direct patient care, they observe, assess, and record symptoms, reactions and progress I patients; assist physicians during surgeries, treatments and examinations; administer medications; and assist in convalescence and rehabilitation. RNs also develop and manage nursing care plans, instruct patients and their families in proper care, and help individuals and groups takes steps to improve or maintain their health. While State laws govern the tasks that RNs may perform, it usually the work setting that determines their daily job duties.
Hospital nurses form the largest group of nurses. Most are staff nurses, who provide bedside nursing care and carry out medical regimens. They also may supervise licensed practical nurses and nursing aides. Hospital nurses usually are assigned to one department, such as surgery, maternity, pediatrics, the emergency room, intensive care, or the treatment of cancer patients. Some may rotate among departments.
Office nurses care for outpatients in physicians offices, clinics, ambulatory surgical centers and emergency medical centers. They prepare patients for, and assist with, examinations; administer injections and medications; dress wounds and incisions; assist with minor surgery; and maintain records. Some also perform routine laboratory and office work.
Nursing care facility nurses manage care for residents with conditions ranging from a fracture to Alzheimer’s disease. Although they often spend much of their time on administrative and supervisory tasks, RNs also assess residents, health, develop treatment plans, and perform invasive procedures, such as starting intravenous fluids. They also work in speciality-care departments, such as long-term rehabilitation units for patients with strokes and head injuries.

Home health nurses provide nursing services to patients at home. RNs assess patients home environments and instruct patients and their families. Home health nurses care for a board range of patients, such as those recovering from illnesses and accidents, cancer and childbirth. They must be able to work independently and may supervise home health aides.
Public health nurses work in government and private agencies, including clinics, schools, retirement communities, and other community settings. They focus on populations, working with individuals, groups, and families to improve the overall health of communities. They also work with communities to help plan and implement programs. Public health nurses instruct such as preventive care, nutrition and childacre. They arrange for immunizations, blood pressure testing, and other health screening. These nurses also work with community leaders, teachers, parents, and physicians in community health education.
Occupational health nurses, also called “industrial nurses” provide nursing care at worksites to employees, customers and others with injuries and illnesses. They give emergency care, prepare accident reports, and arrange for further care if necessary. They also offer health counseling, conduct health examinations and inoculations, and assess work environments to identify potential or actual health problems.
Head nurses or nurse supervisors direct nursing activities, primarily in hospitals. They plan work schedules and assign duties to nurses and aides, provide or arrange for training and visit patients to observe nurses and to ensure that the patients receive proper care. They also may ensure that records are maintained and equipmemnt and supplies are ordered.
At the advanced level, nurse practitioners provide basic, primary healthcare. They diagnose and treat common acute illnesses and injuries. Nurse practitioners also can prescribe medications-but certification and licensing requirements vary by state. Other advanced practice nurses include “clinical nurse specialist, certified registered nurse anesthetists and certified nurse midwives. Advanced practice nurses must meet educational and clinical practice nurses must meet educational and clinical practice nurses must meet educational and clinical practice nurses must meet educational and clinical practice requirements beyond the basic nursing education and licensing required of all RNs.
Taken from partially from: U.S. Department of Labor, Bureau of Labor Statistics –
EPN Jakarta

What should be done if you have Hypertension

You should normally have your blood pressure measured every 3 to 5 years;you should also know what the reading was the last time it was measure, what the figures mean and weather your blood pressure is low or close to the range at which treatment might be recommended. It is important to steer a middle course between ignoring the possibility of hypertension and worrying too much about it. If however, you are taking the contraceptive pill or estrogens. You had better have your blood pressure checked more frequently.
Further investigation varies according to age and the need to make sure that a given case is either essential or secondary hypertension. To determine whether your heart has become enlarged, you have to undergo a course of X-ray examination. To check if you have any kidney problem you needs to get furher information about your kidney, your kidney ought to be X-rayed after a dye injection, a method known as intravenous urography (IVU), or an ultrasound scan of the kidneys may be performed.
Self-Help Tips
The problem of secondary hypertension will usually be resolved if and when the primary cause is satisfactory dealt with. In many cases, a thorough sel-examination of your weight, diet and lifestyle can lead to satisfactory lowering of the blood pressure without the use of drugs. In particular :
1. If you smoke, you have to give it up, or at least to cut down as much as possible. Although cigarette smoking is not a cause of hypertension , people who already have hypertension and who smoke have a greater risk of developing complications (malignant hypertension). Furthermore, there is a link between smoking and coronary artery disease, especially in people under 45 years of age. Since we know that the chances of heart trouble are increased by both cigarettes and high blood pressure, why not halve the risk instead of doubling it?

2. If you are overweight, you’d better choose a reducing diet to lose weight, stick to it until you reach a suitable weight for your age, sex and height and then you must stay there. Again, there is o firm evidence that hypertension is kept under control by weight reduction alone but slin people are hypertensive less often than those who are overweight, and slim people suffer less from certain serious diseases that are linked hypertension.
3. You’d better use less salt and give up salt-rich foods such as salami, pickles and salted fish.
4. You must try to make your work schedule and recreation less demanding avoid strenuous exercise and learn to avoid crises. A person who is always pressing ahead to the next objective, talks rather than listens and constantly looks at hir or her watch is at greater risk of all heart and circulatory diseases.
5. You’d better drink alcohol in moderation or not at all. Some people maintain that small quantities of alcohol help to lower blood pressure. There is no hard evidence that this is so . furthermore, alcohol adverse effects on the brain and liver.
6. Mild hypertension can often be treated without drugs, by relaxation techniques such as mediation , yoga, biofeedback. Before tryng relaxation therapy, you should consult yor doctor . he or she may be able to advise you about where to go for training;whichever relaxation method you choose, it must be used daily (just as patients being treated with drugs must take their medication every day). Yout doctor also needs to monitor your blood pressure to make sure that relaxation sure that relaxation theraphy has lowered it to a safe level.

Patient Diagnostic with Angina Pectoris(Diagnosa Pasien dengan Angina Pectoris-Patienten mit Angina pectoris-Diagnostik)

Angina is not a disease in its own right but is the name given to pain arising when the muscular wall of the heart becomes temporarily short of oxygen.
What are the symptoms?
The main symptom is pain in the centre of the chest. The pain can spread to the throat and upper jaw, he back and the arms (mainly the left one). It is a dull, heavy, constricting pain, which characteristically appears during exercise and fades when exercise stops. Less commonly , the pain may occur only In the arms, wrists or neck but you can recognize it as angina if you know that it arises whenever you are abnormally active or excited and disappears after the activity or excitement has stopped. It is often made worse by cold weather, walking into a wind or after a heavy meal. Additional symptoms that can often nausea and dizziness. There are, however, other causes of central chest pai, such as spasm in the muscles of the esophagus, and tests may be needed to establish the diagnosis with certainly.

What test should be done?
After examining you, the doctor may take a blood specimen for tests to identify thyroid disorder,anemia or other possible causes of chest pain. It may be advisable to find the level of lipids (fats) in your blood, I which case the blood must be taken in the morning before you have eaten, a urine test will determine whether or not you have diabetes (diabetics are more susceptible to heart disease).
There are numer of test that can be performed to get more information bout a patent’s angina. The first is a electrocardiogram (ECG). This is normally done whilst the patient is suffering from a chest pain.
There is also something called a stress test which is done while the patient walks on a treadmill so that it is possible to see how the heart is performing when the patient exercises.

Diagnostic test such as X-ray examination may be included. X-rays of the heart that is taken before and after exercise can show if an area of the heart is not getting enough blood. If this happens it may mean that arteries supplying blood to the heart are blocked . another test is cardiac catheterization. This is a test in which a long thin tube is inserted through the artery in an arm or a leg and then guided into the heart. Dye is then injected into the arteries around the heart is then x-rayed to see if any of the arteries are blocked.
In addition, both a CT scan and an MRI scan may occasionally be used to obtain clear pictures of the heart structure. Your doctor may arrange for some or most of these tests to be carried out , depending on his or her assessment of the probable severity of your coronary heart disease, your age and the type of treatment most likely to be suitable for you. However, in general , extensive testing is recommended only for patients who are willing to udergo surgery, if it should prove to be necessary.
Modern treatment for angina is very effective but the powerful drugs used have to be taken exactly as prescribed, and you may need to consult your doctor about upleasant side-effects they may produce, such as dizziness or lack of energy (EPN Publisher Jakarta)

Juvenile-onset diabetes and maturity-onset diabetes

Diabetes was first recorded in ancient Egypt in 1500 BC. The word “diabetes” is greek and means ‘fountai’ referring to the large amounts of urine produced by the disease in its early stages. Diabetic urine produced by the disease in its early stages. Diabetic urine smells sweet and its alternative name-‘mellitus’ comes from the Latin word for ‘honey’. Doctor can often find ususpected diabetes by finding sugar in urine tests. The urine of diabetic attracts ants looking for sugar and early methods of detecting diabetes included testing the urine for sweetness.

There are two major forms of diabetes

Type 1 (insulin-independent) diabetes known as juvenileonset diabetes is caused by a failure of the insulin-producing cells of the pancreas. It can begi at any age but is most common in younger people. The Insulin treatmen, a severe and dangerous disturbance of carbohydrate, fat and protein metabolism can occur within days or even hours.

Type 2 (non-insulin-dependent) diabetes or maturity-onset diabetes, usually affects people over the age 40 years . In most, the body is resistant to insulin, in association with obereating and hence obesity, and the prancreas cannot produce enough insulin to overcome this resistance.this failure usually worsens with age. The mechanism underlying this failure are not understood but there are strong genetic (hereditary) and environmental factors. The major manifestation is of high levels of blood glucose and disturbance of blood-fat levels. There are strong associations with high blood pressure and heart disease.

The risks
People with type 1 diabetes risk developing a metabolic acidosis (ketoacidosis), which can progress to unconsciousness. Ketoacidosis is caused by too little insulin, allowing fat breakdown and the production of poisonous acids-ketones. This may happen before the diagnosis of diabetes, as a result of the stress or infections of ant kind or major surgery, or from neglect of self-treatment.

The commonest risks are diabetic eye damage (diabetic retinopathy, kidney damage (nephropaty and nerve damage (neuropathy). The nerve damage can give rise to serious foot problems and impotence.
People with type 2 diabetes and those with Type 1 diabetes with poor glucose levels or kidney damage, are at particular risk of damage to the arteries. This can result in stroke , angina and heart attacks, or leg pain on walking , and gangrene, according to the arteries affected. Many such people also have high blood pressure and abnormal blood fat levels.

How to treat the diabetic and you will require lifelong treatment . this is largely self administered, so its effectiveness depends mainly on you.
Many people with diabetes learn how to measure their blood sugar values at home;others rely on urine testing. Whichever method you choose, you should maintain a close watch on how your diabetes responds to diet and other treatments.
Type 1 diabetes A diabetic person have to retain diet and daily injections of insulin to replace the missing hormone. Many people with established good control on an older insulin have continued to use the preparation that suits them.

Insulin can be taken only by injection; any insulin taken by mouth is destroyed by digestive juices before it is absorbed into the bloodstream. You will be shown how to use a syringe or pen injector to inject yourself just under the skin of your thigh , arm or abdomen. Most people learn how to do this efficiently within a few days. Parents will need to administer the injections to their diabetic children.

Type 2 diabetes A good diet alone can control this form or diabetes in one-third of affected people, and is a cornerstone of management in the rest. The aim is to control calorie intake in order to reduce the energy load on the body and to lose weight, to reduce intake of free sugar in order to smooth out absorption of glucose into the blood and to lower the intake of the fats most associated with damage to the arteries. Inpractice , this means following the type of healthy eating diet advised for everyone else but applying it more vigour. Avoidance of high calorie, high fat foods (for example, fried foods, biscuits, cakes, nuts, pastries, red meat and chocolate) is important with controlled intake of sugar-containing drinks and confectionery. Higher-fibre food, fruit and fresh vegetables are desirable and can protect against arterial disease.

The long term prospects
If the patient treat his diabetes sensibly, he can expect to lead a full and healthy life. However, patient with insulin dependency may find shift work problematic, as it can interrupt the regularity of diet and injections. Also, the diabetics must not work at heights, or drive public service or heavy-goods vehicles, because of the risk that they might become.

Hypoglycaemic
Even if the diabetics develop complications, the effect of these can be minimized by regular medical check-ups and hence early treatment. (taken from EPN Consultant Jakarta)

TONSILITIS AND PHARYNGITIS IN CHILDREN

The two tonsils at the back of the throat are part of the ring of lymph glands that guard the entrance to the respiratory and digestive systems. Very small at birth, they enlarge gradually, reaching maximum size at age 6 or 7 years. Thereafter, they shrink but do not disappear, as adenoids do.

The tonsils are relatively large at early school age, when the respiratory tract begins to be attacked by a variety of new microbes; the tonsils are thought to act to keep the microbes away from the lower respiratory tract. Both tonsilitisand pharyngitis are bacterial or viral infections of the back of the throat that cause soreness, and they are often associated-particularly in children. Sore throats may also be part of a more generalized respiratory infection, such as influenza.

What are the symptoms?
Tonsilitis starts suddenly with sore throat and difficulty in swallowing;within a few hours, the child becomes feverish and may seem quite ill. The painful irritation in the throat makes some children often complain of stomach pain. Glands on either side of the neck and in the angle of the jaw may swell and become tender. They can be felt as small, knob-like protuberances. Sometimes , the swellings persist for several weeks after the main symptoms have subsided.

How common is the problem?
Virtually every child has one or more attacks of tonsillitis which is very contagious. Frequent attacks of tonsillitis, which is very contagious. Frequent attacks usually lessen after age of 7 years as resistance develops.

What are the risks?
Before the advent of antibiotics , tonsillitis could lead to rheumatic fever or some form of glomerulonephritis, but such complications are rare today.

What should be done?
Try the self-help measures recommended in the next paragraph. If the child is clearly uncomfortable, consult your doctor, who will examine the child’s tonsils and determine whether the condition is present.

What is the treatment?
Self-help the child should be kept indoors 9but not in bed, unless he or she request otherwise) in a warm-not overheated-room. Symptoms can usually be relieved by giving paracetamol and plenty of fluids, which should be sipped regularly. Don’t force the child to eat or drink. If he or she asks for cold desserts to cool the throat, there is no harm in giving these. Frequent sponging of the face with tepid water may comfort the child . in most cases, children with tonsillitis responds swiftly to these measures.

Professional help the doctor will probably prescribe an antibiotic drug; ensure your child takes the full course as instructed. The tonsillitis should clear up in a few days.
If attacks of tonsillitis are so severe and frequent that they affect general health, then surgical removal of the tonsils may be the only answer. This operation was performed frequently in the past but most doctors today recommend it only as a last resort. Severe sore throats with similar symptoms when the tonsils have already been removed can clearly not be tonsillitis and are more likely to be pharyngitis.(taken from EPN Consultant Books

THE WARDS IN HOSPITAL

The patient stays in a ward during hospitalization. A good hospital Will provide well-planed wards. The wards will be elaborated with pleasant, safe and comfortable equipment for patient and staff. Bright colors have been used to create a therapeutic atmosphere in the ward, and furniture has been designed to suit the different needs of patients.

A hospital gives the best accommodations with beds and bedroom that provides as much as privacy, natural light, fresh air as possible. The beds are arranged with adequate space between them to prevent cross-infection. The adequate spaces between the beds allow the nurses to carry out bedside procedures comfortably.
“most wards have a number of cubicles or side wards –usually six for a thirty bed ward and two of these have their own hand basins and lavatories. Infectious patient will be placed in separated room. A day room is available for patients who will enjoy various recreation, such as watching television, playing games without disturbing patients who are confined to bed.

Lavatories and bathrooms are sufficiently spacious to allow nurses to assist old and disabled patients. Doorways are set to allow wheelchairs patients or trolley to enter and exit with ease. The rooms are usually fitted with grab-rails, shelves and hooks, and a patient to nurse alarm system is provided. It is important that lavatories flush quietly and efficiently.
There is also a clinical area where the medical professionals carry out the treatment for the patient. In this clinical are, surgical dressing, investigations and other sterile procedures can be carried out under optimal condition. This clinical area is always kept with minimal risk of cross-infection.

Next to the treatment room, you can find “clean and thirty annex”. The (or preparation room) is a room where the sterile equipment is stored. If there is no C.S.S.D, equipment and instruments are sterilized there too. While the dirty annex, is where the used equipment is kept for collection by C.S.S.D.
Near the dirty annex, there is usually a sluice room. It has facilities for cleaning and sterilizing bedpans, urinals, sputum mugs and so on, and for disinfecting soiled bed linen.
Can you make a diagram of wards according to the passage above?/he2x…

The consent Form - Responsibility for making sure

Responsibility for making sure that the person or the parents of a child have all the information needed for them to give informed written consent rests with the health practitioner (usually doctor or nurse) who is undertaking the procedure or operation . this information will include :

- Information about the procedure /operation
- The benefits and likely results
- The risks of the procedures/operation
- The other treatments that could be used instead
- The patient/parent can consult another health practitioner.
- That the patient/parent can change their mind

Young people can sign the consent from once they reach the age of 16 years and/or have the metal capacity to understand full all that is involved. If the young person cannot sign the form, the parent or legal guardian may sign it. If an adult lacks the mental capacity, either temporarily or permanently, to give or deny consent, no person has the right to give approval for a course of action. However, treatment may be given if it is considered to be in the person’s best interests, as long as an explicit (clear) refusal to such action has not been made by the person in advance.

Doctors do most invasive procedures and operations, but nurses in the UK are extending their practice to include many procedures that were previously done by doctors. You may work with nurses who do procedures such as endoscopic examination, so it is becoming more common for nurses to obtain informed consent. The patient or parent and the healthcare practitioner both sign the consent form.

When your patients are due to have any invasive procedure, always check their level of understanding before it is scheduled to happen. If you are not sure about answering a question, ask the healthcare practitioner who is doing the procedure to see the patient and explain again. It is essential that the consent form is signed before the patient is given a sedative or other pre-medication drugs.

Recurrent Cough and Cold-When to consult your doctor?

It (am-is-are) quite normal for a young child to have several coughs and colds in winter, and they (am-is-are) nothing for you to worry about. Most children keep catching colds during the start of school life (Some actually spend more time ill at home than at school), because at school the child (am-is-are) exposed to all kinds of new viruses. Gradually , however, the child acquires increasingimmunity to them and has far fewer colds.
A childs cold often accompanied by a cough-chiefly because, instead of blowing mucus into a handkerchief , he or she tends to sniff it down into the throat. The mucus irritates the throat, so in an attempt to get rid of it, the child coughts. Quite often, a child with a cold has some abdominal pain and he or she may vomit.
When to consult your doctor?
In rare cases, recurrent coughs and colds a symptom of aserious underlyng disorder. Insuch illnesses, the child appears generally unwell for most of the time, and when this happens, consult your doctor.
In some children , cold symptoms caused not by a cold but by an allergy. If your child sneezes and has a runny nose and watering eyes during the summer months, he or she probably has hay fever- an allergy to pollen. If the symptoms occur throughout the year, the child may be allergic to dust or pet hair.
If a recurrent cough not accompanied by a cold ,or if it accompanied by wheezy breathing –which may indicate asthma or, in rare cases, cystic fibrosis-you should consult your doctor.
Certain symptoms indicate that complications may have set in. see your doctor I f a baby with a cold cries continually, refuses to feed, is restless and has a hot skin. Consult the doctor also if your child has a cold and then develops earache or pain in the face of forehead, or runs a high fever-above 39 °C (102°F) – or is persistently hoarse, along with having a nagging, dry, painful cough.
What you can do for recurrent coughs and colds?

In some cases, a child with recurrent colds will cough a lot at night. This may be because the room too cold and the air is irritating the throat, or because the room too cold and the air is irritating the throat, or because it too warm and the air making the throat, or because it too warm and the air making the throat dry. Adjusting the temperature of the room may solve the problem.
Babies with colds some times have trouble feeding. This no cause for concern if the feeding difficulty lasts only a day or two. You can help by keeping the baby’s nose clear of obstructing mucus, to allow easy breathing.
Try giving an older child a hot drink before bed, to help clear the back of the nasal passages. Your doctor may prescribe a cough mixture or you may buy one from your pharmacy, but it may not be very effective.
(Vocabulary & Gramar in use for Nursing – EPN consultant Jakarta page 1-3)

Did You Know about Head Injury?

The first 24 Hours after a head injury are the most important, although after effects may appear much later. It is important, although after effects may appear much later. It is important that a responsible person awakens the patient every 2 hours for the first 24 hours and watches for the following symptoms. If any of these occurs, call your doctor or return to the emergency department.
1. Persistent headache, nausea or vomiting more than twice.
2. Weakness, numbness or paralysis of the arms or legs.
3. Blood or clear fluid from the ears or nose.
4. Blurred vision; unequal pupils (one larger than the other).
5. Convulsions.
No Alcoholic beverages.
Take nothing stronger than aspirin or tylenol for pain.
Instruction : write question for number 1,2,3,4 to check the patient condition.

Back and Neck Injury

1. Use heat or cold on the injured areas whicever feels better.
2. Rest as much as possible until you are improved
3. Avoid positions and movement that make the pain worse.
4. Avoid lifting anything heavy and automobile travel.
5. Relax emotionally, if you are tense the problem will only be worse
6. Sleep on a firm mattress or place boards under your mattress, if it is soft.
(taken from English for The Profesional Nurses 2 – EPN Consultant Jakarta)

Sprains, Severe Bruises, Minor fractures

1. Elevate the injured part for 24-48 hours or until the swelling decreases.
2. Apply ice for the first 48 hours.
3. Limit activity to the use of crutches for ambulation
- Non-weight bearing - Partial weight bearing
4. Wear the splint or bandage as ordered Rewrap if too tight or too loose.
5. If the injured part becomes extremely swollen, cold, blue or numb, or the pain increases markedly, call your doctor immediately.
(taken from English for The Profesional Nurses 2 – EPN Consultant Jakarta)

Cast/Splint Care

1. Don’t apply any weight or pressure on a new cast or splint for the first 24-48 hours.
2. Keep the cast/splint clean and dry.
3. Elevate the injured part for 48 hours on pillows above your heart
4. Don’t put foreign objects inside the cast
5. Wiggle your fingers or toes inside the cast every hour
6. If your fingers or toes become extremely swollen, cold, blue or numb, or the pain increases markedly, loosen the ace bandage of the splint, or if a cast, call your doctor or return to the Emergency Department.
7. (taken from English for The Profesional Nurses 2 – EPN Consultant Jakarta)

The first step for Vomiting and Diarrhea

1. Donot Give a person with nausea or vomiting anything by mouth until 2 hours after the last vomiting
2. If no nausea or vomiting give clear liquid you can see through (water, tea, soft drinks, bouillon, jelly, Popsicles) in small amounts
3. Don’t give dairy products (milk, butter, eggs, cheese) or citrus fruit.
4. If vomiting occurs shortly after eating wait two hours before attempting to eat again
5. If your child has
a. High fever
b. Decreased urination
c. More than 8-10 stools in a 24 hour period
d. Stools that are very foul smelling or bloody
e. Persistent vomiting
Call your doctor or return to the Emergency Department

First for the fever

Fever
1. Take your temperature with a thermometer
2. Drink Plenty of liquid
3. Take Tylenol according to directions. Avoid giving aspirin to children.
4. Sponge bath as with lukewarm water for temperature over 102 for 15-20 minutes.
5. Dont use alcohol or ice for sponging
6. If your fever is not down in 48 Hours , return to your family doctor or the mergency department. (taken from English for The Profesional Nurses 2 – EPN Consultant Jakarta)

About High Blood Pressure (HYPERTENSION)

What are the symptoms?
Hypertension is nearly always a syrnptomless disease,; a hypertensive person can feel fine, without the slightest indication of inner trouble. Such symptoms as headaches, palpitations and a general feeling of ill health usually occur only when the pressure is dangerously high. So it is risky to wait for treatment until symptoms develop. People who have malignant hypertension are more likely to suffer from these symptoms.
You should always he aware of the possibility that you may have high blood pressure, especially if you are over 40 years of age, if there is a history of hypertension in your family and if you are overweight.

How common is the problem?
Hypertension is extremely common., especially in the Western world. In Scotland, for example, 15 per cent of all adults are thought to have some degree of high blood pressure. And one US study suggests that I in 10 Americans is hypertensive; the incidence rises steeply with age and appears to be twice as high among black people as among whites. The study also indicates that men are more at risk than women, whose chances of having high blood pressure are only about one-half to three-quarters as great. And around 95 per cent of all investigated cases, apart from those resulting from pregnancy or the use of oral contraceptives, turn out to be cases of essential rather than secondary hypertension. Malignant hypertension, fortunately, is a rare form of the disease. (Taken from English For The Professional Nurses 2 - Published by EPN Consultant Jakarta)