H1N1 tips to prevent transmission.. Swine flu @nursesoutlook

Novel H1N1- it is new type of virus recently occurred as a flu pandemic on 2009.it is also called as swine flu.it is similar flu virus seen in pigs of north america.
Tips to Prevent H1N1

The only portals of entry are the nostrils and mouth/throat. In a global epidemic of this nature, it's almost impossible to avoid coming into contact with H1N1 in spite of all precautions. Contact with H1N1 is not so much of a problem as proliferation is.

While you are still healthy and not showing any symptoms of H1N1 infection, in order to prevent proliferation, aggravation of symptoms and development of secondary infections, some very simple steps, not fully highlighted in most official communications, can be practiced (instead of focusing on how to stock N95 or Tamiflu):

1. Frequent hand-washing (well highlighted in all official communications).

2. "Hands-off-the-face" approach. Resist all temptations to touch any part of face (unless you want to eat, bathe or slap).

3. * Gargle twice a day with warm salt water (use Listerine if you don't trust salt)... * H1N1 takes 2-3 days after initial infection in the throat/ nasal cavity to proliferate and show characteristic symptoms. Simple gargling prevents proliferation. In a way, gargling with salt water has the same effect on a healthy individual that Tamiflu has on an infected one. Don't underestimate this simple, inexpensive and powerful preventative method.

4. Similar to 3 above, * clean your nostrils at least once every day with warm salt water. * Not everybody may be good at Jala Neti or Sutra Neti (very good Yoga asanas to clean nasal cavities), but * blowing the nose hard once a day and swabbing both nostrils with cotton buds dipped in warm salt water is very effective in bringing down viral population. *

5. * Boost your natural immunity with foods that are rich in Vitamin C (Amla and other citrus fruits). * If you have to supplement with Vitamin C tablets, make sure that it also has Zinc to boost absorption.

6. * Drink as much of warm liquids (tea, coffee, etc) as you can. * Drinking warm liquids has the same effect as gargling, but in the reverse direction. They wash off proliferating viruses from the throat into the stomach where they cannot survive, proliferate or do any harm.

DISASTER MANAGEMENT-TRIAGE PLAN,,,@,...NURSESOUTLOOK

Triage in disaster

Purposes

In general, triage can be defined as the prioritization of patient care based on severity of injury/illness, prognosis, and availability of resources. For those responsible for the triage of patients arriving in the emergency department, the purpose of triage is to determine to which predesignated patient care area the patient should be sent. The location to which patients are "triaged" establishes priorities for care. For example, some patients may need immediate decontamination as they arrive, regardless of their severity of injury. Those needing immediate care (e.g., respiratory failure, shock) are taken to resuscitation areas ("crash" rooms), while the dead are moved directly to the morgue. The severely but less critically injured are taken to the major trauma–medical area described earlier, where they are further assessed and initial treatment commenced. The walking injured are directed to the minor surgery–primary care treatment area, often located in outpatient clinic areas.

Personnel

A team consisting of a physician (preferably an emergency physician or a surgeon), an emergency department nurse, and a medical records or admitting clerk should receive every patient. In extraordinary situations, several triage teams may be required to handle the casualty load. The physician performing hospital triage should be acknowledged as being in command of the triage area, should be clearly identified by a specially colored vest or other garment, and must understand all triage options.

If a physician is not available, an emergency nurse with training in the concepts of casualty triage and disaster patient assessment can be designated as the triage officer.

Responsibilities

Although likely triaged at the scene, patients should undergo a second process of triage upon arrival at the hospital, preferably at the ambulance entrance to the emergency department. Responsibilities of members of the triage team include:

1. Assigning disaster patients to appropriate treatment areas (e.g., resuscitation room, major surgical, minor surgical) according to the assessment of their immediate needs and the availability of resources.

2. Instituting the most basic of life-support measures, such as inserting oral airways, cardiopulmonary resuscitation, and the external control of haemorrhage.

Assessment of severity of injury should be accomplished by conducting a rapid primary survey supplemented by obtaining prehospital information from the patient or pre-hospital personnel. The triage team communicates information on number of casualties, severity of injuries, and the need for additional resources to both the emergency department and the hospital disaster control center. If phones are tied up, this notification can be accomplished by using runners, cellular phones, or portable radios. Likewise, triage personnel need to be informed about the capability of the various treatment areas (e.g., major and minor surgery) to handle additional casualties or special problems such as eye injuries or burns. They also need to know about the establishment and location of patient overflow areas.

The triage physician should also be aware of the location of a family waiting and public relations area within the institution, because family, friends, and the media will otherwise attempt to enter the triage area.

The admitting clerk's role as part of the triage team is to complete tags, attach them to victims, and retrieve valuables and clothing for bagging. The admitting clerk then tags the bag and completes the triage area casualty log.

Principles of Triage

The approach to patient evaluation and treatment is quite different under disaster situations resulting in large numbers of casualties.26 In mass casualty situations, one no longer has the luxury of concentrating all resources on the management of a single critical patient. To accomplish the most good for the most number of patients, the triage team should evaluate all patients arriving at the ED doors and classify their conditions with regard to severity of injury and need for treatment. Some principles of medical care must be altered to achieve the best overall result. There clearly is no role for resuscitation or definitive care at this stage. Care should be limited to manually opening airways, and controlling external hemorrhage.

The most common triage classification in the United States still involves assigning patients to one of four color-coded categories (red, yellow, green, or black), depending on injury severity and prognosis (Table 6-2). In addition to the nature and urgency of the patient's systemic condition, triage decisions should be sensitive to factors affecting prognosis, such as age, general health, and prior physical condition of the patient, and the qualifications of the responders and availability of key supplies and equipment.

Table 6-2 Triage Categories

Red    First priority   Most urgent   Life-threatening shock or hypoxia is present or imminent, but the patient can likely be stabilized and, if given immediate care, will probably survive Yellow    Second priority   Urgent   The injuries have systemic implications or effects, but patients are not yet in life-threatening shock or hypoxia; although systemic decline may ensue, given appropriate care, can likely withstand a 45- to 60-min wait without immediate risk Green    Third priority   Non-urgent   Injuries are localized without immediate systemic implications; with a minimum of care, these patients generally are unlikely to deteriorate for several hours, if at all Black    Dead   No distinction can be made between clinical and biologic death in a mass casualty incident, and any unresponsive patient who has no spontaneous ventilation or circulation is classified as dead. Some place catastrophically injured patients who have a poor chance for survival regardless of care in this triage category

Catastrophically injured patients who have a minimal chance for survival despite optimal medical care should be classified as "expectant" (i.e., "black": e.g., burns involving 95 percent body surface area, patients in full cardiac arrest, anthrax-infected patients in septic shock). Spending time on patients who are not likely to live leaves other patients who are truly salvageable awaiting care. If too much time intercedes, these patients also may become non-salvageable. The goal with these "expectant" patients should be adequate pain control and the opportunity to be with friends and family.

Immediate Newborn Care..@..nursesoutlook

IMMEDIATE NEW BORN CARE

IMMEDIATE NEWBORN CARE

CARE AT BIRTH:

1. Soon after the delivery of the baby, it should be placed on a tray covered with clean dry linen with the head slightly downwards (15 ⁰). It facilitates drainage of the mucus accumulated in the tracheo-bronchial tree by gravity. The tray is placed between the legs of the mother and should be at a lower level than the uterus to facilitate gravitation of blood from the placenta to the infant.

2. Air passage should be cleared of mucus and liquor by gentle suction.

3. Apgar rating at 1 minute and at 5 minutes is to be recorded.

4. Clamping and ligature of the cord-The cord is clamped by two Kocher’s forceps, the near one is placed 5 cm away from the umbilicus and is cut in between. Two separate cord ligatures are applied with sterile cotton threads 1 cm apart using reef- knot, the proximal one being placed 2.5 cm away from the naval. Squeezing the cord with fingers prior to applying ligatures prevents accidental inclusion of embryonic remnants. Leaving behind a length of the cord attached to the navel not only prevents inclusion of the embryonic structure, if present, but also facilitates control of primary haemmorrhage due to a slipped ligature. The cord is divided with scissors about 1 cm beyond the ligatures taking aseptic precautions so as to prevent cord sepsis.

5. Delay in clamping for 2-3 minutes or till cessation of the cord pulsation facilities transfer of 80-100 ml blood from the compressed placenta to a baby when placed below the level of uterus. This is beneficial to a mature baby but may be deleterious to a pre term or a low birth weight baby due to hypervolaemia. But early clamping should be done in cases of Rh- incompatibility or babies born asphyxiated or one of a diabetic mother.

6. Quick check is made to detect any gross abnormality and the baby is wrapped with a dry warm towel. The identification tape is tied both on the wrist of the baby and the mother. Once the management of third stage is over(usually 10-20 minutes), baby is given to the mother or to the nurse.

CARE IN NURSERY:

Observation- The infant should be examined systematically beginning from the head followed by inspecting the whole body to detect any congenital abnormality.

To estimate the gestational age- This may be made soon after delivery. A baby is delivered at 39 weeks or more presents with the following features: (1) Sole covered with creases. (2) breast nodule diameter of 7 mm. (3)Scalp hair- coarse and silky. (4) Ear lobule- stiffened by thick cartilage. (5) In male, scrotum is full with testes with extensive rugae.

General care- The baby is placed in a cot where neutral thermal condition is maintained. Hypothermia must be avoided. The baby should be flat on the cot with the head slightly lowered. Handling should be gentle and be kept to a minimum. Temperature should be frequently recorded until it is stabilized.

Hypothermia(cold stress): -peripheral vaso constriction –increased O2 consumption –shivering –hypoxia –hypoglycemia –anaerobic metabolism –metabolic acidosis.

Baby bath- Routine bath is delayed until the baby is able to maintain the body temperature and has started breast feeding. The excess vernix, blood or meconium are wiped off from the skin by using sterile moist swabs and then make the skin dry by using towel. The water for baby bath should be at body temperature and a separate bath tub should be earmarked for each baby.

Weight- Immediately following bath or cleaning, the baby should be weighed naked.

Care of the umbilical cord- The cord is to be inspected once more for evidence of slipping of ligature. The cord is left exposed to the air, without any applicable of dusting powder, it dries up and falls off. Daily cleaning with spirit and use of antibiotic powder is usually done.

Clothing- The dress should be appropriate for the climate. The extremities should be free from movements. A napkin is applied which should be changed periodically.

Care of eyes: Eyes are kept clean with cotton wool soaked with sterile isotonic saline. As a prophylaxis against ophthalmic neonatorum and Chlamydia trachomatis, application of gentamicin ophthalmic ointment or erythromycin (0.5%) ophthalmic ointment every 6 hours may be used.

Medications- (a) Intramuscular administration of vitamin K 1 mg is given as a routine to minimize haemorrhagic disease. (b) Prophylactic antibiotic therapy is considered in: (i) Delivery following premature rupture of the membranes. (ii) Instrumentation

Close observation for at least 4-8 hours- to note: (i) Any excessive mucus secretion from the mouth. (ii) Any bleeding from the umbilical cord stump. (iii) Hourly temperature until it stabilizes and remains above 36 ⁰ c.

DAILY OBSERVATION AND CARE OF NEWBORN:

            As the majority of complications occur during the first 24 hours, close observation is mandatory during this period, noting specially the cardio- respiratory function. The infants are observed and cared for as follows:

·        Respiration is regular, smooth and quiet,, the rate being 40/ minute.

·        Temperature is to be taken twice daily.

·        Weight is to be taken every 3 rd day.

·        Feeding schedules as describes later are to be followed and difficulties if any, are to be noted.

·        Eyes are to be inspected for evidenced of early infection suggested by discharge.

·        The mouth should be inspected daily for detection of early evidence of thrush.

·        The umbilical cord is to be inspected daily and cared as outlined earlier.

·        Bath- cleaning the skin may be repeated daily as required, specially the buttocks, to remove the meconium. A daily bath is prescribed when the women is at home.

·        Rooming in- Soon after birth if the mother is otherwise fit, the baby is kept in a cot by the bed side of the mother. This not only establishes the mother child relationship but the mother is conversant with the art of baby care so that she can assume full care of the baby when at home.

·        Number and character of stools and rough estimation of the amount of urine passed daily are to be noted. Napkins should be changed immediately following soiling and the local parts should be cleaned dry.

·        Any abnormal behaviours and features should be promptly detected and corrected.

  Reflex behaviors

 The following reflexes are normal for a new born infant:

1)     Rooting reflex: A normal infant when touched on the cheeks, turns eagerly towards the stimuli and opens the mouth for a feed.

2)      Glabellar reflex: tap gently over the forehead and the eyes will blink.

3)     Grasp reflex: Place a finger in the palm of the infant and the infant will grasp the fingers.

4)     Moro’s reflex: Support the infant behind the upper back with one hand then drop the infant back 1 cm or more to- but not on the mattress. Then there is a sudden abduction of both the arms and extension of the fingers followed by slow abduction and flexion.

5)     Sucking and swallowing reflexes: A normal infant starts sucking when something touches the palate. Baby swallows when the mouth is filled with milk.

UNIVERSAL PRECAUTIONS- HIV,,,@,,NURSESOUTLOOK

                                  UNIVERSAL PRECAUTIONS IN HIV

Universal precautions are intended to prevent parental, mucus membrane, and non-irritant skin exposure to health care workers to prevent  blood borne pathogens. Universal precautions apply to blood and  body fluid containing visible blood, semen, vaginal secretions, cerebro-spinal fluid, synovial fluid, plural fluid, peritoneal fluid, pericardial fluid, and amniotic fluid. 

Universal precaution do not apply to faeces, nasal secretions, sputum, sweat, tears, urine, and vomit-us, unless they contain visible blood.

BARRIER GUIDELINES FOR HIV TRANSMISSION

  

  v Disposable gloves should be worn when I contact or when there is potential for contact with   blood, body fluid, or other fluids that may contain human immunodeficiency virus. Gloves should be removed after each client contact. Rubber gloves can be used for equipment cleaning

  

  v Hand should be washed between clients, after any exposure, and after removal of gloves.

  v Protective eye wear, face shields, or masks, or a combination should be worn during procedures that may aerosolize blood 

  v Impervious gowns should be worn when there is potential for exposure to large quantities of blood, such as in labour and delivery area or emergency room.

      

         NEEDLE PRECAUTIONS

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   v Needle should be never be recapped after use, keep in mind that most needle sticks are the result of missed needle recapping

              

  v Do not cut, break, or bend needles after use this may aerosolized blood from the needle shaft

  

  v Do not leave used needles lying around.

  

  v Do not dispose of needles in ordinary receptacles, instead, use appropriately labelled, impermeable needle containers. 

Nursesoutlook: Weaning for infants information for mothers @@@ nu...

Nursesoutlook: Weaning for infants information for mothers @@@ nu...: Breast feeding is alone adequate& sufficient to maintain optimum growth & development of an infant up to 6 months after which it i...

Weaning for infants information for mothers @@@ nurses outlook

Breast feeding is alone adequate& sufficient to maintain optimum growth & development of an infant up to 6 months after which it is necessary to introduce more concentrated energy rich nutritional supplements as breast feeding alone is not sufficient to meet the energy requirements of the growing child so weaning is preferred

Weaning:-

It is a process of gradual & progressive transfer of the baby from breastfeeding to usual family diet.

Weaning food must be:-

·       Liquid at the starting then semisolid & solid foods to be introduced gradually.

·       Clean fresh & hygienic, so that no infections can occur.

·       Easy to prepare at home with the available food items & not costly.

·       Easily digestible, easily acceptable & palatable for the infants.

·       High in energy density& low in bulk viscosity & contains all nutrients necessary for the baby.

·       Based on cultural practices & traditional beliefs

·       Well balanced, nourishing & suitable for the infant.

Principles of introduction of weaning foods:-

·       Milk is the main food for the infant so additional foods must provide extra requirements as per the needs of the baby that must be obtained from good quality food items & should be handmade.

·       Small amount of new foods to be given in the beginning & gradually the amount should be increased in a week.

·       New food to be placed on the tongue of the baby so that the baby can feel the taste & consistency. The baby may spit the food out but with patience the feed must be given again to get accustomed with it. A single weaning food is added at a time.

·       Additional food can be given in the day time. Initially it can be given once then twice or thrice.

·       New food to be given when the child is hungry but do not force foods.

·       Observe the problems related to weaning process. The infant may have indigestion, pain in abdomen, weaning, diarrhea, skin rash, especially in case of food allergy & psychosocial upset of the baby.

·       Weaning to be started at 4-6 months of age but breastfeeding to be continued till 2 yrs or beyond.

·       Delayed weaning results in malnutrition & growth failure.

Complimentary food items:-

The word complimentary literally means “in addition to something to improve the gross result”. Thus complimentary food items are those food stuff which are given in addition to breast feeding to increase the net caloric intake necessary for the optimum growth of the child.

4-6 months:-

| To be introduced by fruit juices like grape juice

| Within one or two weeks new foods to be introduced like suji , biscuit soaked in milk, vegetable soup, mashed banana, mashed boiled potato.

| Each food should be given with one or two teaspoons at first for 3-6 times per day. The food should not be over diluted& within 3-4 weeks the amount should be increased to half a cup.

| Breast feeding should be continued.

6-9 months:-

| Food items to be given in this period includes mixture of rice & dal khichdi , pulses, mashed & boiled potato, bread or roti soaked in milk or dal, mashed fruits like banana, mango, papaya, stewed apple, etc.

| Egg yolk can be given from 6-7 months onwards.

| Curd & khir can be introduced from 7-8 months.

| By the end of 6-9 months the infant can enjoy to bite biscuits, a piece of carrot or cucumber.

| The infant can have these foods for 5-6 times a day & the amount can be increased gradually.

| Breast feeding should be continued.

9-12 months:-

| More variety of house hold foods should be added.

| New food items like fish, meat, chicken, can be introduced during this period.

| The infant can eat anything cooked up at home but spices & condiments to be avoided.

| Feeds need not be mashed but should be soft &soft well cooked.

| Breast feeding should be continued.

12-18 months:-

| The child can take all food items cooked at home & needs half the amount of mothers diet.

| Number of feeds can be four or five according to the child’s needs.

| Breast feeding should be continued especially at night.

6-8 MONTHS

Daily requirements(6-8months):-     

              Weight = age in months + 9 kg

                              2

               =8+9/2 kg

            =8.5kg

               According to Segar,s

           Upto 10kg, 100 Kcal/kg

           Caloric requirements = 100KCal/kg body weight

= 100û8.5

=850 Kcal

             Protein requirement = 2.8gm/kg body weight

= 19.6gms