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

Renal failure:Acute renal failure@@@Nursesoutlook

RENAL FAILURE
CENTRAL OBJECTIVE

On completion of the class, the client and his family will be able to explain about  renal failure

SPECIFIC OBJECTIVES

Define renal failure

Enlist the classification of renal failure

Define acute reneal failure

Enlist the causes of acute renal failure

Describe the pathophysiology of acute  renal failure

Explain the clinical manifestation of  acute renal failure

Enlist the diagnostic evaluation of the acute renal failure

Explain the management of the acute renal failure

INTRODUCTION

Renal failure is severe impairment or total lack of kidney function. Renal failures results when the kidney cannot remove the bodies metabolic waste or perform their regulatory function.



Definition

Renal failure is a systemic disease in which the kidney cannot excrete metabolic waste, electrolytes, and fluid from the body leading to acid base imbalance.



The renal failure is classified into two type

• Acute Renal Failure


• Chronic Renal Failure

                            Acute Renal Failure



Definition

Acute Renal Failure is a clinical syndrome characterized by rapid decline in renal function with progressive azotemia. Acute Renal Failure is usually associated with decreased urine output less than 400ml per day (oliguria ).



Etiology

There are three major categories of condition causes Acute Renal Failure

• Prerenal


• Intrarenal


• Postrenal

Prerenal

Volume depletion 

Impaired cardiac efficiency 

Vasodilatation



Intra renal Failure

Prolonged renal ischemia resulting from

Nephrotoxic agents

Infectious process

Post renal failure

Urinary tract obstruction

PATHOPHYSIOLOGY

The possible pathologic process involves in acute renal failure are following



Renal vasoconstriction : Hypovolemia and decreased renal blood flow stimulate rennin release , which activates the angiotensin –aldesterone system and resulting into the constriction of  the peripheral arteries and renal afferent arterioles. Due to the decreased blood flow and decreased pressure glomerular filtration rate is reduced



Cellular edema :  Ischemia  causes anoxia, which leads to endothelial edema . cellular edam rises tissue pressure above capillary flow pressure. These inadequate renal blood flow further depress the GFR.

Decreased Glomerular  Capillary Permeability: Ischemia alters glomerular epithelial cells and thus decreases glomerular capillary permeability.



Intratubular  obstruction : when tubules are damaged interstitial edema occurs, and necrotic epithelial cell accumulate in the tubules. This accumulated debris also lowers the GFR by obstructing the tubules and increasing intratubular pressure



Leakage of glomerular filtrate : Glomerular filtrate leaks back into plasma through holes in the damaged tubular membrane, which decrease intra tubular fluid flow

CLINICAL PHASES OF ACUTE RENAL FAILURE



There are four clinical phases of ARF

• Initiation


• Oliguria


• Diuresis


• Recovery

Initiation phase : This phase is begins with initial insult and ends when oliguria develops.

The manifestation of oliguric phases are

• Urinary changes


• Fluid volume excess


• Metabolic acidosis


• Sodium imbalance


• Calcium deficit and potassium excess


• Nitrogenous product accumulation

Diuretic phase : The diuretic phase begins with a gradual increase in daily urine output of 1 to 3 L per day. In this phase kidneys have3 recovered their ability to excrete wastes but not to concentrate the urine.

The manifestation of this phase are

• Uremia


• Hyponatremia


• Hypokalemia


• Dehydration

Recovery phase : The recovery phase begins when the GFR increases so that BUN and serum creatinine levels start to stabilize and then decrease. It may take 3 to 12 months

CLINICAL MANIFESTATION

• ↓ urinary output


• Proteinuria


• ↓Specific gravity


• ↓Osmolarity


• ↑Urinary sodium


• Dysarrythmia


• Pulmonary edema


• ↑BUN


• ↑Creatinine


• ↑Posttasium


• ↓pH


• ↓bicarbonate


• ↓calcium

DIAGNOSTIC EVALUATION

• History and physical examination


• Blood studies Serum creatinine and BUN level


• Serum electrolytes


• Urine analysis


• Renal scan


• Renal ultrasound


• CT / MRI scan

MANAGEMENT

Therapeutic management

Acute Renal failure is potentially reversible. The primary goal of the treatment is to maintain the patient in as a normal state as possible while the kidneys are repairing themselves

To management is focused on controlling the patient symptoms and preventing complications.

• Maintain fluid balance : Fluid balance is based on the body weight,serial measurement of central venous pressure and serum and urine concentration , fluid loss, blood pressure of the patient


• Avoid excessive fluid : It can be detected by clinical findings like dyspnea, tachycardia and distended neck vein . Mannitol , frusemide may be prescribed to initiate a diuresis and to prevent subsequent renal failure


• Performing dialysis : It is may be initiated to prevent serious complication of ARF such as• Metabolic acidosis
  • Reduced level of consciousness
  • Nausea and vomiting
  • Diabetes insipidus, nephrogenic
  • Pyruvic acid levels raised (blood)
  • Urea levels raised (plasma or serum)
  • Pericarditis
  • Immune deficiency
  • Hypermagnesaemia
  • Bicarbonate levels low (plasma)
  • Oedema
  • Weight gain
  • Creatinine levels raised (plasma or serum)
  • Acute confusional state
  • Pulmonary oedema
  , severe metabolic acidosis, pulmonary oedema

Pharmacological management

Insulin administration  IV  :  Pottasium moves into cells when insulin is given concurrently to prevent hypoglycemia.

Sodium Bicarbonate : Therapy can correct acidosis and causes shift to potassium into cells

Calcium Gluconate : Therapy is given IV and is gernallry used in advanced cardiac toxicity. Calcium raises the threshold for dysrhymias.

Sodium Poly styrene sulfonate ( kayexalate) : therapy is removes 1mEq of potassium sorbitol to produce osmotic diarrhea .



PREVENTION OF ARF

1. Provide adequate hydration to patients at risk for dehydration


2. Prevent and treat shock promptly with blood and fluid replacement


3. Continuously assess renal functions when appropriate


4. Prevent and treat infections promptly , infection can produce progressive renal damage

To prevent toxic drug effects, closely monitor dosage , duration of use , and blood level of all medication metabolised or extracted by the kidney



NUTRITIONAL THERAPY

Dietary intervention is necessary with deterioration of renal function and include careful regulation or protein intake, fluid intake to balance fluid losses, sodium intake

to balance sodium losses and some restriction of potassium. At the same time adequate caloric intake and vitamin supplementation must be ensured

Protein restriction : the recommended protein intake is 1.2 to 2 g/kg of IBM, depending on the individual needs of the patients

Water restriction: water intake depends on the daily urine output. The fluid allowance is 500 to 600 mL more than the previously day’s 24 hours urine output.

Sodium potassium restriction : the amount of sodium and potassium restriction depends on the ability of the kidneys to excrete these electrolyte. Depending on the degree of edema  and hypertension, the average daily intake of sodium is 3g to 7gm. The patient should avoid foods known to be high in sodium such as cured meats, pickled food, salad dressing.

Potassium restriction is range from 1500gm  to 4000gm. The food with high potassium level that should be avoided are dried fruits, orange, bananas, deep green and deep yellow vegetables, beans and peas.

FOOD ALLOWED      

Bread, salt, free butter, grape fruit juice, low protein puddins



FOOD AVOIDED

Protein concentrates, pulses, excess conception of milk, egg and meat

COMPLICATIONS

Complications and sequelae of Acute Renal Failure from the Diseases Database include:

• Water overload


• Hyperphoshatemia


• Hyperkalaemia


• Hypocalaemia


• Metabolic acidosis


• Reduced level of conciousness


• Nausea and Vomiting


• Diabetes insipidus


• Increased urea level


• Pericarditis


• Immune deficiency


• Oedema


• Weight gain
• 
  

OXYGEN ADMINISTRATION,,,Nursesoutlook

OXYGEN ADMINISTRATION

 INTRODUCTION

     

     Oxygen is a basic need and is required to sustain life. The nurse often encounters clients who are unable to independently meet oxygen needs; the nurse must understand cardiac and respiratory physiology.  Insufficient oxygen and also too much oxygen supply both are equally harmful for patients. So the nurse who is administering oxygen should have a through knowledge about the procedure.

DEFINITION

           Oxygen administration is the method of administering oxygen to a patient through  a specific device which helps the patient to gain a normal oxygen saturation in the body.

INDICATIONS OF OXYGEN THERAPY

Ø Obstruction of air passage.

Ø Bronchial asthma.

Ø Pneumonia .

Ø Cardiac insufficiency.

Ø Peripheral circulatory failure.

Ø During operations…etc…

METHODS OF OXYGEN ADMINISTRATION

    Ø Oxygen administration through cannula method.

    Ø   Oxygen administration through mask method.

    Ø Oxygen administration through tent method.

OXYGEN ADMINISTRATION THROUGH CANNULA METHOD

            

It is a method by which oxygen is administered in low concentration through a cannula which is a disposable plastic device with two protruding prongs for insertion into the nostrils.

The purposes are:

·       

     To relive dyspnea.

·       To administer low concentration of oxygen to the patients.

·       To allow uninterrupted oxygen supply to patients while eating drinking etc..

SPECIAL PRECUATIONS

·        

      Never deliver more than 2-3 ltr of oxygen to patients with chronic lung diseases.

·          Check frequently that both prongs are in patient’s nares.

OXYGEN ADMINISTRATION THROUGH  FACE MASK

            

  Administering oxygen to the patient by means of ( simple/venturi) according to requirement of  patients.

The purposes are:

·       

      To relive dyspnea.

·        To administer higher concentration of oxygen.

  

 SPECIAL CONSIDERATIONS

·         

     The dosage of oxygen may be ordered as an FiO2 (fraction of inspired oxygen) which is expressed as liters per minute.

·       The venture mask will have colour-coded inserts that list the flow rate necessary to obtain the desired percentage of oxygen.

ADMINISTERING OXYGEN THROUGH TENT METHOD

            

     Process of administering oxygen by means of a tent ,usually for infants which gives maximum comfort and most satisfactory results.

            An oxygen tent consist of a canopy over the baby’s bed that may cover the baby fully or partially connected to a supply of oxygen. The canopy’s transparent and helps the nurse to observe sick baby.

ADVANTAGES

·Provides an environment for the patient with controlled oxygen concentration,temperature regulation and humidity control.

·       It allows freedom of movement on bed.

DISADVANTAGES

·       It creates a feeling of isolation.

·       It requires high level of oxygen.

·     Loss of desired concentration occurs every time when the tent is opened to give care for the infant.

·       There is an increased chance of hazards due to fire .

·       It requires much time and effort to clean and maintain the tent.

SPECIAL PRECAUTIONS

   Ø Mist is prescribed with oxygen therapy to liquefy secretions.

   Ø Electrical equipments used near the tent should be properly grounded.

   Ø It is preferable to monitor the SpO2 of the patient properly.

   Ø Avoid use of volatile inflammable materials near the tent. 

  Ø For the baby in the oxygen tent toys selected should be such that they will not        produce static electricity.

ASSESSMENT OF OXYGEN SATURATION USING A PULSE OXIMETER

           

Monitoring the oxygen saturation of the patient especially who are in oxygen therapy is very essential .

            

A pulse oximeter is a non invansive method which has a selected wavelength of light passed to a vascular bed to estimate arterial oxyhemoglobin saturation. The pulse oximeter uses infrared light and a process known as spectrophotometer to measure the amount of oxygenated hemoglobin in arterial blood.

PURPOSE

·       

     To measure the capillary blood saturation.

·       To detect the presence of hypoxemia before visible signs develop.

·       To assess the response to therapy.

·       To assess the need to decrease the number of arterial blood gas specimens drawn.

INDICATIONS

·       

     Patients who are in oxygen therapy.

·       Patients who experience sudden changes in blood oxygen level.