Fluoxetine

By Q. Harek. Hiram College.

Coldness of the extremities is well marked and the child is miserable but apathy when anorexia and/or diarrhea set in purchase 20 mg fluoxetine otc, there is loss of weight in spite of edema buy 10 mg fluoxetine with amex. This marsmic stage may be due to mal absorption rather than deficiency in caloric intake. Chronic cases show depigmentation of skin and hair, with the hair losing its luster, becoming straight, dry and sparse. Marasmus: This condition, seen in children whose weight is markedly 91 Pediatric Nursing and child health care below normal for their length is described as state of starvation. A general deficiency of protein and energy has occurred, leading to severe wasting of subcutaneous fat and muscle tissue. The marasmic child appears as a wizened old man in appearance, with loss of most fatty tissue, shriveled buttocks and emaciated limbs. Many of the signs of kwashiorkor, such as edema, skin rash and hair discoloration are absent. If a child is to be cured, he must be able to eat high protein and energy diet and his family must have enough food for him. If he does not want to eat, we have to feed him through a tube in health facilities. The danger signs that show that a malnourished child needs treatment quickly are edema, apathy and not eating well. Prevention of malnutrition The following are some of the important approaches in prevention of malnutrition in children. Classification of malnutrition: Signs classification Severe visible wasting or Severe palmer pallor or severe malnutrition/severe Edema on both feet anemia Some palmer pallor or Very low wt. Since the body doe not manufacture vitamins small amounts must be included in the diet. Some are soluble in fat and are ingested in dietary fat (vitamin A, D, E and K), and some are water soluble (Vitamin B complex and Vitamin C). Vitamin A Normal growth, normal vision, normal reproduction Maintenance of epithelial cell structure and function Immunity to infection 95 Pediatric Nursing and child health care Deficiencies results in: • xerophthalmia, (night blindness, conjunctiva dryness, Bitot spots, Keratomalacia, and even eyeball perforation and blindness) • Increased risk of infections (Viral is more). Excess results in: • Raised intracranial pressure, irritability,dry skin, hair loss, brittle bones 2. Parasthesia, weakness, gastrointestinal symptoms • Dry beriberi (peripheral neuropathy, mental confusion,nystagmus) • wet beriberi ( biventricular cardiac enlargement, systemic venous hypertension, bounding pulse) • Infantile beriberi (acute cardiac failure) 3. Riboflavine (B2) • Coenzyme in oxidative –reduction reaction 96 Pediatric Nursing and child health care Deficiency results in; • Angular stomatitis, cracking and fissuring of lips • Glositis, papillary atrophy • Scrotal or vulvae dermatitis • Photophobia, corneal vascularisation • Anaemia, hair loss , ataxia • Personality changes, retarded intellectual development 4. Niacin (nicotinic Acid) • Oxidative –reduction reactions , fat synthesis, glucolysis • Deficiency results in: Pellagra (dermatitis, diarrhea, dementia) • loss of weight, poor appetite, sore mouth, indigestion • insomina, confusion • skin erythema, pruritus, discoloration, flaking 5. Pyriodoxine (B6) • Coenzyme in amino acid metabolism and • Muscle glucogen phosphorylase Deficiency results in: Infants: hyperirritability, convulsions, weakness anemia, and dermatitis 6. Ascorbic Acid (vitamine C) • Formation of collagen, amino-acid metabolism • Iron and copper metabolism • Protection against free radicals (oxidents) Deficiency results in: Scurvy • ulceration ,poor wound healing, anemia • Scurvy: irritability , unproductive cough, bone tenderness, sub-periosteal hemorrhages 8. Vitamin D: • Calcium and phosphate homeostasis • Normal mineralisation of bone and teeth Deficiency result in: • Rickets, Osteomalacia Excess result in: • Hypocalcaemia, ectopic calcification • Failure to thrive 98 Pediatric Nursing and child health care 9. Vitamin E (tocopherol): • Antioxidant (protects against free radicals) • Preserve cell membrane integrity Deficiency result in: • Hemolytic anemia, skin changes • Encephalomalacia 10. Vitamin K Synthesis of coagulation factors Deficiency results in: • Coagulophathy: haematuria, hematomas, and heamorragic disease of newborn • Hemolytic anemia may be caused by the water soluble form of vitamin K Iron deficiency Anemia: Anemia refers to a deficit of red blood cells or hemoglobin in the blood. Nutritional deficiency • Iron deficiency • Folic acid deficiency 99 Pediatric Nursing and child health care Vitamin B12 deficiency b) Decreased erythrocyte production: • Pure red cell anemia • Secondary hemolytic anemia’s associated with infection, renal disease, and chronic disorders Aplastic anemias Invasion of bone marrow by A, Leukemia B, Tumors 3. Assessment of the child’s condition Building resistance to infection Administering blood transfusion as ordered Nursing management: 1. Assist parents to select iron rich foods that are affordable and culturally acceptable 5. Teach parents how to administer medications 101 Pediatric Nursing and child health care Study Questions 1. How can a nurse contribute to decrease morbidity and mortality among under five children? During growth monitoring intervention what important points should be considered to promote normal growth and development? Acute respiratory infections are anatomically divided into Acute Upper and Acute Lower Respiratory infections. Present evidence indicates that bacteria play a great role as causes of pneumonia in children. Streptococcus pneumonia and Homophiles influenza accounts for more than 2/3 of all bacteria isolates. Pneumoniae and H-influenza can prevent deaths from pneumonia in children with a substantial decrease on pneumonia mortality. Fast- breathing helps to categorize children with cough into two groups with high and low probability of pneumonia and it is a better predictor of pneumonia than auscultatory findings (stethoscope). As pneumonia progresses and becomes more severe, lung elasticity is gradually reduced and chest in 104 Pediatric Nursing and child health care drawing develops.

Sampling strategies for monitoring of drug resistance include: • countrywide generic 10mg fluoxetine, continuous surveillance of the population discount 10mg fluoxetine amex; • surveys with sampling of all diagnostic centres during a specified period; • surveys with randomly selected clusters of patients; • surveys with cluster sampling proportional to the number of cases notified by the diagnostic centre. In surveillance settings, a combination of smear and culture was used for initial diagnosis. The majority of laboratories used Löwenstein-Jensen (L-J) culture medium, and some used Ogawa medium. Drug resistance tests were performed using the simplified variant of the proportion method on L-J medium, the absolute concentration method, the resistance ratio method,60,61 or the radiometric Bactec 460 method. Resistance was expressed as the percentage of colonies that grew on critical concentrations of the drugs tested (i. The criterion used for drug resistance was growth of 1% or more of the bacterial population on media containing the critical concentration of each drug. Proficiency testing and quality control of survey results are two components of externala quality assurance. The percentage of isolates sent for checking is determined before the beginning of the survey. Additionally, there are now efforts to standardize the panels circulated to countries for easier interpretation of results between countries and over time. It was recommended that special groups likely to have higher levels of resistance, e. In almost all settings, with the exception of Australia, Kinshasa, Democratic Republic of Congo, and Scotland, data were divided by treatment status. In some European countries, “unknown” was a category of treatment status; though this category is not displayed individually the cases are captured in the combined column. In geographical areas where people may be reluctant to reveal treatment status, verification of treatment status plays a particularly important role. All data files and epidemiological profiles have been returned to countries for verification before publication. The Global Project requests that survey protocols include a description of methods used for the quality assurance of data collection, entry, and analysis. However, to date there has been no systematic procedure to ensure that the methods described are actually employed at the country level. The data checking was not restricted to the third report, but included also the first and second reports. Inconsistencies and errors have been corrected if the available evidence allowed it. Where the analysis of the trends showed irregularities, verification was requested from the reporting parties. Arithmetic means, medians and ranges were determined as summary statistics for new, previously treated, and combined cases, for individual drugs and pertinent combinations. For geographical settings reporting more than a single data point since the second report, only the latest data point was used for the estimation of point prevalence. Chi-squared and Fisher exact tests were used to test the null hypothesis of equality of prevalences. Ninety-five percent confidence intervals were calculated around the prevalences and the medians. Reported notifications were used for each country that conducted a representative nationwide survey. For surveys carried out on a subnational level (states, provinces, oblasts), information representing only the population surveyed is included where appropriate. In order to be comprehensive, all countries and settings with more than one data point were included in this exercise; thus some information from the second phase of the global project is repeated. In geographical settings where only two data points were available since the start of monitoring, the prevalences were compared through the prevalence ratio (the first data point being used as the base for comparison), and through error bar charts, representing the 95% confidence interval around the prevalence ratio. For settings that reported at least three data points, the trend was determined visually as ascending, descending, flat or “saw pattern”. Where the trend was linear, the slope was tested using a chi-squared test of trend. The variables included were selected in function of their presumed impact on resistance and their potential for retrieval. A conceptual framework was developed that structured the retained variables along three axes: patient-related, health-system-related, and contextual factors. Several countries did not report on specific ecological variables, thus reducing the impact of the analysis. Ecological analysis was performed at the country level, thus the indicators reflect national information. The significant variables were retained for the multivariate analysis and a multiple regression technique was used. The arcsin transformation of the square root of the outcome variables was carried out as a normalization procedure to safeguard the requirements of the multiple linear regression modelling.

Prescription incompatibility: In competency or careless of the prescriber results incompatable prescription discount 10mg fluoxetine free shipping. It may lead to failure of desired therapeutic goal buy 10mg fluoxetine overnight delivery, may prove harmful or even death to the patient. Patient’s compliance: A matter of concern for prescriber with regard to prescription is patient’s noncompliance i. Noncompliance includes taking of inadequate doses, improper timing, preterm discontinuation of drug. Criteria for rational prescribing: Rationa prescribing should meet the certain criteria such as appropriate diagnosis, indication, drug, patient, dosage, duration, route of administration, information and monitoring. Irrational prescription: Over use of antibiotics, indiscriminate use of injections, excessive use of drugs, use of anabolic steroids for growth and use of tonics and multivitamins for malnutrition are some of irrational practices. Produced in collaboration with the Ethiopia Public Health Training Initiative, The Carter Center, the Ethiopia Ministry of Health, and the Ethiopia Ministry of Education. Important Guidelines for Printing and Photocopying Limited permission is granted free of charge to print or photocopy all pages of this publication for educational, not-for-profit use by health care workers, students or faculty. All copies must retain all author credits and copyright notices included in the original document. Under no circumstances is it permissible to sell or distribute on a commercial basis, or to claim authorship of, copies of material reproduced from this publication. Except as expressly provided above, no part of this publication may be reproduced or transmitted in any form or by any means, electronic or mechanical, including photocopying, recording, or by any information storage and retrieval system, without written permission of the author or authors. This material is intended for educational use only by practicing health care workers or students and faculty in a health care field. Part one includes the following five chapters: Principles of physiology, Excitable tissues (nerve and muscle), physiology of blood, Cardiovascular physiology and Respiratory physiology; Part two contains the following seven chapters: physiology of the renal system, physiology of the gastrointestinal system, physiology of the endocrine system, physiology of the reproductive system, Neurophysiology, physiology of the Special senses and the Autonomic nervous system. We express sincere appreciation to the secretaries for meticulous computer type settings of the teaching material. Concentration and permeability of ions responsible for membrane potential in a resting nerve cell. Both structure and function must be studied at all levels from the cellular to the molecular to the intact organism. There is immense genetic diversity, as a result of small spontaneous change in individual genes, called mutation, occurring from time to time. The natural selection concept of Charles Darwin emphasizes the predominance of the genes in the population that favors survival of the fittest and reproduction in a particular environment. Early with life on earth cells developed the ability to react with oxygen and carbon compounds and use the energy released by these chemical reactions. With complexity of development cells evolved structure called mitochondria for efficient energy production. The efficiency of oxidative phosphorylation was maximized in natural selection of the best. Some aspects of human physiology may be rapidly changing on the evolutionary scale of time. The brain capabilities are probably still rapidly evolving as new pressures are faced. For pain with injury, a warning signal results in sudden withdrawal of the injured part, protecting it from further injury. But step-by-step sequence of events starts with the injury and eventually ends with the contraction of group of muscles that flex the injured limb - stimulus, receptor, electric signals, spinal cord, flexor muscles. The circuit that creates this response is genetically determined and is formed during early development of the nervous system. Levels of structural organization: From single cell to organ system cells are the basic units of living organisms. Humans have several levels of structural organizations that are associated with each other. The chemical level includes all chemicals substances essential for sustaining life. The diverse chemicals, in turn, are put together to form the next higher level of organization, the cellular level. The different types of muscle tissue are functional adaptation of the basic contractile system of actin and myosin. Skeletal muscles are responsible for movement of the skeleton, cardiac muscle for the contraction of the heart that causes blood circulation; smooth muscle is responsible for propelling contents within soft hollow organs, such as the stomach, intestine, and blood vessels. Cardiac muscle fibers branch but are separated into individual cell by continuity of the plasma membrane, the intercalated discs. Nervous System- Conducting signals This tissue is specialized for conduction and transmission of electrical impulses and the organization of these nerve cells or neurons is the most complex of any of the tissue.

First discount 20 mg fluoxetine otc, the perceived importance of educating the public about shaken baby syndrome differed among professionals buy generic fluoxetine 20mg on line. Some felt it was common knowledge that shaking an infant was dangerous, while others routinely gave advice to shake apneic infants. Second, it was believed that the impulsive act of infant shaking was not amenable to primary prevention through public education. Third, the risk factors associated with shaken baby syndrome were unclear, eliminating the possibility of targeted secondary prevention initiatives (Barron, 2003). Prevention-based research finally began in the United States in the mid 1980’s and has been steadily gaining momentum world-wide. After a 1989 survey by Showers demonstrated that 25 to 50% of adults and adolescents were unaware of the dangers of violent infant shaking, prevention efforts in the form of media campaigns, public education initiatives, male-targeted parenting classes, baby-sitting training courses, and hospital-based programs began to appear. Unfortunately, the impact these programs had on the incidence of shaken baby syndrome remained unknown because the programs were sporadic, fragmented, and unevaluated. In the long term, the total cost of comprehensive medical 12 13 care for a single shaken infant can exceed $1 million (Showers, 1998). These figures do not even begin to capture the hidden costs of shaken baby syndrome, when one considers each victim’s loss of societal productivity and occupational revenue, the cost of prosecuting and incarcerating perpetrators, the cost of foster care and child welfare agency involvement, and the on-going mental, physical, and educational therapy that each victim requires (Dias & Barthauer, 2001, August). Financial costs aside, shaken baby syndrome has devastating effects on the personal lives and emotional health of victims and affected families. Clearly, the hidden costs of treating victims of shaken baby syndrome far exceed the costs of implementing a prevention program. Health professionals, administrators, law enforcement officers, politicians, and affected families have taken a proactive stance in disseminating information about shaken baby syndrome. The conferences provide a unique opportunity for professionals from fields including medicine, 13 14 nursing, law, policing, social work, and psychology to share new research findings, discuss prevention strategies, and educate each other about shaken baby syndrome. On a local level, many shaken baby syndrome prevention initiatives are in operation across North America. The program has been implemented in multiple prisons in the United States, Canada, and Australia; however, its quantifiable effectiveness in reducing the incidence of shaken baby syndrome has never been examined (Dutson, Dulfano, & Nink, 2003). In Wisconsin, the Shaken Baby Association began educating Milwaukee police officers about shaken baby syndrome in 2001. That same year, 18 Milwaukee radio stations simultaneously broadcast a public service announcement urging parents to “Never, ever shake a baby”. Following the announcement, a three month period ensued without a single reported case of shaken baby syndrome. The programs target parents, babysitters, and health professionals in a variety of educational formats, including videos, posters, information cards, pamphlets, and refrigerator magnets (Calgary Injury Prevention Coalition, 2003). Regional public health departments and the Saskatchewan Institute on Prevention of Handicaps have been instrumental in developing and disseminating educational materials to the Canadian public. Although some programs are over 14 15 six years old, however, none have been evaluated with regard to their effect on the incidence rate of shaken baby syndrome. These were complemented by a series of television commercials in 2000, urging parents to “Stop before you cross that line" when coping with a crying infant. Without evidence of effectiveness, the impetus for governments to mandate, fund, and implement prevention programs across large jurisdictions has been minimal. He had extensive experience treating infants with shaken baby syndrome and had conducted a retrospective study in serial radiography for shaken baby syndrome patients. When his own son was born in 1997, Dias experienced firsthand the frustrations that parents are faced with in caring for an inconsolable infant (Lewandowski, 1999, October 14). He realized the ease with which exasperated parents or babysitters could 15 16 impulsively direct their frustrations onto a crying child. Dias resolved to share his expertise in inflicted infant head injuries with new parents to provide them with the necessary knowledge and coping skills to prevent a bout of frustration from resulting in a case of shaken baby syndrome. Dias’ original study provided six years of reliable incidence data for shaken baby syndrome cases in Western New York. The Children’s Hospital of Buffalo, the sole tertiary referral centre for pediatric neurosurgical cases in the region, provided an ideal location for launching his envisioned program. It was to be a comprehensive, hospital-based, universal prevention program that educated parents at the time of the infant’s birth about the dangers of violent infant shaking. Outcome measures were defined as the regional incidence rate of shaken baby syndrome, the number of parents reached by the program, and parental pre and post-program knowledge about shaken baby syndrome. This format was intended to improve upon the multitude of fragmented, unevaluated programs previously in operation. It was also unique in being the first to determine whether improved public knowledge could translate into a reduction in the incidence rate of shaken baby syndrome. Dias’ original study revealed that a total of 33 infants were diagnosed with shaken baby syndrome at the Children’s Hospital of Buffalo between 1992 and 1998, with an average incidence rate of 7. This data, along with Dias’ experience in treating infants with shaken baby syndrome, shaped the following hypotheses that guided the ultimate program design: 16 17 1. Shaken baby syndrome differs from other forms of child abuse in that it seems to result from impulsive acts of adult rage due to infant crying that may be modifiable with timely parental education.