Paps Stenosis Case Study

Paps Stenosis Case Study
Owen is a 2 month old male with the above mentioned cardiac history. He was brought to our clinic
for first visit after being discharged from PICU. His bilateral PAs stenosis improved significantly
after having PA branches balloon angioplasty and LPA stenting 6/6/2017. His echo today showed
max pressure gradient of 23 mmHg across the LPA stent and 17 at the distal RPA and RVH with
mild dynamic RVOTO when he bears down. In addition, he had moderate pulmonary valve
regurgitation with minimal gradient across his RV–PA conduit. In the future, Owen will likely
require further intervening on the narrowed LPA and RPA as well as on his RV–PA conduit. Timing
to be detirmend by his longitudinal follow up. In term of PACs, it is currently well–controlled
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Process Improvement Initiative: Improving Patient Care
This process improvement initiative is directed at improving patient care by standardizing the care
of infants by decreasing the variation in treatment by providers. During, weekly discharge rounds
every Tuesday in UAB's RNICU & CCN, the lack of standard care for NAS was identified as a
potential problem affecting the LOS & DOS. The team comprised of the nurse managers, assistant
nurse managers, social services, Utilization Management (UM), NNPs, the discharge coordinator
and UAB Police discussed the LOS & DOT issues. Because the process of weaning the methadone
is crucial, questions would arise about which day of weaning the infants was on and whether the
infants needed to be monitored 3–5–7 days off methadone before discharging infants. There

Summary: Understanding Calf's Feeding
Understanding the Calf's Feeding Process A person should wean a calf gradually using specific
types of feeds. It is dangerous to use feeds for the mature animals since they can have adverse
effects on a calf. Takaninifeeds.co.nz shares the following tips to wean a calf in an effective way
Understanding rumen development The calf's rumen digests feed using fermentation; a process that
calls for a development of bacteria in the rumen. This process takes three weeks after the calf weans,
after which the amount of bacteria available in the rumen becomes able to ferment enough energy–
giving feeds that the calf requires. Giving a calf quality grains and free–choice water helps its rumen
to develop in a better way. Weaning age In as much as

Baby Led Weaning Book Report
I chose to read, Baby–led Weaning: the essential guide to introducing solid foods and helping your
baby to grow up a happy and confident eater by Gill Rapley and Tracey Murkett for my parenting
book report. Baby–led weaning (BLW) is essentially giving the baby the control to choose when,
how, and what they want to eat. According to the authors BLW has many benefits that include: its
enjoyable for both parents and babies, its natural, babies learn about foods, learn how to eat safely,
learning about the world, reaching their potential with hand eye coordination, gives babies
confidence to make their own decisions, trusting food, allows babies to be apart of family meals,
helps with appetite control, better nutrition, long–term health, learning ... Show more content on
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First of all, I think it could be difficult to have babies eat with the whole family because the focus it
is not on the baby. This could be good in that the baby is not always getting attention or learning
they will get all the attention whenever they want it, but also could be dangerous if the baby does
decide to swallow food before they figure out chewing first. Time could be an issue as well, most
families are busy and do not have the time to sit and wait for their babies to play with their food.
Infants are starting to explore their sensorimotor skills and need the time to do so. According to
Piaget's six sub stages of sensorimotor development, from the 1to 4 months' babies are in the first
habits and primary circular reactions stage in which they repeat a body sensation that was first
experienced by chance. The stage babies will start BLW is secondary circular reactions. In this stage
the infant becomes more object–oriented, moving beyond self–preoccupation, and the repeated
actions bring the infants fascinating or satisfying results. The BLW seems to promote this stage of
sensorimotor development through exploration of different

My Consumption Of Soda By Coca Cola
I grew up in a home where nothing artificial was allowed, only organic and natural. If it came from a
garden or a field it usually made it to our table. We drank hot tea every day, there was never any
popcorn, pizza, or soda. I still remember the first time I had a slice of pizza and an ice cold glass of
Coca–Cola in 1990. It was like a whole new world had opened up before me. I had fallen in love
with soda. I loved the sugary sweet stuff, with its carbonation dancing down your throat sip by sip.
It was heavenly. From that day on, no more hot tea, only soda all the way the colder the better. As
the years past my fondness of soda grew into an obsession. Somewhere in a twenty–year span it
became normal for me to go to Walmart and buy 14–20 two liters of Coca–Cola ever week and yes I
did drink that much soda every week.
My consumption of soda was so extreme that my friends and family regularly made fun of me for
having Coca– Cola in my veins instead of blood and teasing me often by asking me if I wanted
water to thin it out some. It all came to ahead in the summer of 2010. I had just finished mowing the
grass and I was worn–out and exhausted. I drank my soda with a lot of ice and started to feel even
worse. That is how my family found me on the couch, exhausted and white as a sheet. The only
thing I could do was look up at them, my limbs felt like lead. Both of my daughters, Jessica and
Eileen, insisted I drink the glass of water they had handed to me. My best friend, Trae,

Mechanical Ventilation
Running head: ACCOUNTABILITY OF NURSING PROFESSIONALS: WEANING
Accountability of Nursing Professionals: Weaning from Mechanical Ventilation
Samantha Madrid
Grand Canyon University
Abstract
This paper will discuss the weaning of patients off of a mechanical ventilator. It will look at the
problems associated with prolonged intubation vs. premature extubation, and what healthcare
professionals can do to assess a patients readiness to begin the weaning process. A patient care
scenario will be given and an explanation of how nursing practice can evolve with the knowledge
from this study will be shown. The accountability of the nursing professional in regards to
mechanical ventilation will be visited as well.
Accountability of Nursing ... Show more content on Helpwriting.net ...
The nurse should assume responsibility and accountability for their patient's health. This requires the
nurse to research ways to assist a patient off ventilation, collaborate with physicians, and be aware
of the patient's condition and readiness to wean.
"For some investigators, 'weaning success' is defined as sustained spontaneous, unassisted breathing
with or without an artificial airway, and for others it is defined as sustained extubation" (Cook
2000). Whatever the nurse and physician see as the definition to weaning is far less important than
ensuring their patient is weaned at the correct time. Allowing a patient to remain intubated and on
mechanical ventilation when it is no longer needed, only puts the patient at risk for problems beyond
the reason for initial intubation.
Nurses should frequently monitor signs of a patient that is able to take spontaneous breaths.
Assessing levels of anxiety and diaphoresis along with frequent monitoring of vital signs can signal
to the nurse that the patient may no longer need the amount of assistance he is currently receiving.
The nurse may begin to wean the patient by decreasing the amount in mechanical support, in a slow
and gradual manner.
The study shows the decrease in mechanical support can be effected by increasing periods of
unassisted breathing, alternating unassisted breaths with mechanical breaths, and reduction of the
support delivered

Essay on Meat and Milk Factories by Peter Singer and Jim...
After the visit to "Wayne Bradley's" farm, Peter Singer and Jim Mason share some very important
information on the experience with farming. Singer and Mason together examine negative impacts
that individual Americans food choices have upon farmers, they believe should be the basis of
dietary basics. The negative effects of much agriculture on animals, human health, and our
environment as they have little faith that the American government will actually take the initiative to
force the food industry to change without a lot of pressure, with this being said consumers, such as
Mr. Bradley, force for reformed market behavior through demand for the food product, animals.
Singer and Mason spend considerable time at Mr. Bradley farm to expose the ... Show more content
on Helpwriting.net ...
So they question Mr. Bradley about what about the cutting of their teeth. Mr. Bradley as farmer
explains, that it's not abuse, is for their own good, when they are nursing the sharpness of their teeth
is described as being painful to their mother, "the pig's needle teeth can cut their mother nipples and
they can cut each other in fighting over nipples". In all reality, I can agree with Mr. Bradley on this
reasoning when farming, we all knows that's the only way babies are brought up from nurturing of
the parent.
The next question in the abuse of animals that Singer and Mason were concerned about was the
castrating of the animals without any anesthetic. Wayne explains that they are cut immediately after
birth, (10 days), "Consumers drives that". He goes into details to explain the taste that is one very
likeable. But still in my opinion this not reason enough for the animals to be put in such pain
without anything to help numb the process in the process. However I do understand that the reason
they are castrated is for the health of Americans when eating the meat, but the animals endure much
pain for this process. However the question from Singer and Mason is still would there be any other
way of this process, Wayne explains how up to the age of 22, how his visits to the dentist was
without any pain medicine.
Next as they move along the farm, they find pregnant, which they see through a small window. This
is

The Weaning Process: How To Stop Breastfeeding
After months of breastfeeding your baby, you're probably an expert at nursing him or her while you
are partially asleep, pumping while you are busy at work and don't bat an eye when you are
shopping and your little one wants to eat in public. But, eventually, the day will come that you (or
your baby) will be ready to stop breastfeeding. This process is known as weaning, and it's normal to
feel a range of emotions when it's time for it to occur.
How to Know if Your Baby is Ready to Wean
The American Academy of Pediatrics recommends exclusively breastfeeding infants for the first six
months of life and then to supplement solid foods with breastfeeding until the baby is two. Most
moms in the United States, however, choose to wean when their ... Show more content on
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It's not a good idea to stop breastfeeding "cold turkey" while you are away for the weekend as this
can be traumatic for your baby and can cause blocked ducts or painful engorgement in you.
Different Methods for Weaning Your Baby
There is no one "right way" to wean your baby. Depending on individual needs and situation, choose
a method that is right for both you and your little one. Popular weaning methods include:
Baby–Led Weaning
In baby–led weaning, moms are encouraged to give their baby "real" food in bite–sized portions
instead of baby food. Babies feed themselves in baby–led weaning rather than being spoon–fed.
This process begins at approximately six months of age and is done in addition to supplementation
from the breast. Slowly, the baby will transition from getting all of their nutrition from breastfeeding
to eating regular meals. Most moms continue to nurse in the morning, at night and before naps,
allowing their baby to dictate the weaning

How Does Vaccination Affect Beef Cattle
Beef Cattle
Vaccinations – Vaccinations occur throughout all stages of life for a beef cow. Shortly after a calf is
born, the calf is separated from its mother and restrained in order to receive vaccinations that
prevent sickness and disease in the early stages of life. Following the shots, the calf rejoins its
mother. Shots continue to occur as needed throughout the animal's life.
Sickness – Sickness can occur at any stage of the animal's life. Sickness can have numerous effects
on a beef cow, ultimately leading to a changed appetite, decreased energy, and if not treated could
spread to the rest of the herd or lead to death.
Extreme Weather – The weather can affect beef cattle during all stages of life. When extreme heat of
extreme cold set in, animals will experience different reactions. In hot weather, there may be a
decrease in appetite due to the heat. On the opposite end, there will be an increased desire for food
in cold weather to ... Show more content on Helpwriting.net ...
Overcrowding livestock in a pen does leave adequate room for the cows to move freely, causing
claustrophobic conditions.
Farm Equipment – The use of farm equipment near or around beef cattle can cause stress on all
livestock, regardless of age. If the livestock are unfamiliar with the equipment or the sounds, they
are likely to be spooked from the sounds and sights of the machinery.
Pests – Pests like flies, ticks, lice, and mosquitos can all cause stress on beef cattle during any stage
of life. Pests, like lice, can cause irritation to a cows hide. Lice can cause hair loss and rashes
ultimately leaving the animal uncomfortable.
Weaning – Weaning in beef cattle can occur when the calf is between 4–7 months. Weaning affects
calves and their mothers. When the calf is separated from the mother, both experience anxiety as
they cannot locate one another and be together as they previously have

Motivation to Breastfeed
The motivation to breastfeed: A fit to the opponent–process theory? from the Journal of Personality
and Social Psychology (Myers & Siegel, 1985). I This chose this article because I wanted a
psychology article on breastfeeding. I have ideas of breastfeeding research I want would like to do
for my senior thesis (if I get into the honors psychology program), and down the road for my
dissertation. I selected this article from other breastfeeding ones because it uses data, and because it
talks about the motivation behind breastfeeding. As a lactation consultant I encounter times when I
can tell that the mother comes to me because "breastfeeding is just what you do," but really doesn't
want to do it; so the information from the article can give me an idea how to better help my clients.
This article compared the act of breastfeeding to addictive behaviors. It talked about how the bliss
experienced while breastfeeding, the stress right before breastfeeding, and the withdrawal during
weaning. I enjoyed reading this because this is some of the reasons that I went into psychology. I
want to understand breastfeeding from an intellectual stand point; to define it as behaviors and break
it down it ways that creates an environment compatible with success. One thing I took from the
article is ways to study breastfeeding that allows for control groups. They took surveys from both
breastfeeding women, and from women who have never breastfed. They were asked them what they
thought the

Extubation: A Case Study
Thank you for your power point presentation. As far as readiness for extubation is concerned, at my
place of employment, spontaneous breathing test is preformed every morning (for patients that are
ready) and based on the results of arterial blood gases, doctors make decisions to either extubate or
keep the patient on mechanical ventilation. I personally never witnessed the involvement of an acute
care nurse practitioner in decision making regarding extubation. In this post, I would present the
results of international studies regarding weaning readiness. The authors presented following
(Thille, Richard, & Brochard, 2013): The ideal weaning readiness test would exhibit perfect
accuracy in predicting the tolerance of unassisted spontaneous breathing after extubation by
mimicking the postextubation physiological conditions. Thus, all patients passing the ideal weaning
test would be able to maintain adequate ventilation after extubation. A standard test for extubation
readiness is the SBT performed using the T–piece by disconnecting the patient from the ventilator
and providing additional oxygen. Another weaning test is performed without disconnecting the
patient from the ventilator by using a low level of pressure sup– port (PS) with or ... Show more
content on Helpwriting.net ...
T–piece test results may be too conservative if the clinicians are very cautious and/or if the
prevalence of extubation failure is low (e.g., in postoperative patients). On the other hand, the low–
PS test may underestimate the risk of extubation failure, especially if the clinician is overop–
timistic or if the prevalence of extubation failure is high (e.g., in patients under prolonged
mechanical ventilation or having ICU– acquired polyneuromyopathy). Keeping PEEP during the
test may increase the rate of extubation failure due to lung or heart

Palliative Sedation And Terminal Weaning For Refractory...
Palliative Sedation and Terminal Weaning for Refractory Symptoms Death is one of the most
significant life events people experience. Most people want to die a peaceful death and desire the
same outcome for their family and friends. Medical advancements have resulted in people living
longer lives with chronic illnesses. Despite the advancements in medicine and the available
treatments of today, sometimes the patient is still unable to escape intolerable suffering; the patient's
quality of life diminishes. Symptoms that are unrelieved after all treatment options have been
exhaustion are called refractory, or intractable, symptoms (Knight & Espinosa, 2010). When
refractory symptoms are present, palliative sedation (PS) should be considered ... Show more
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Second, the patient needs to have refractory symptoms (Knight & Espinosa, 2010). A third
requirement is a "Do Not Resuscitate" order (Knight & Espinosa, 2010). Lastly, the patient must be
expected to die within the next few hours or days (Knight & Espinosa, 2010). Informed consent
must be obtained either by the patient, or if the patient is unable to do so, a legal surrogate before
palliative sedation is initiated (Knight & Espinosa, 2010). Knight and Espinosa recommended
receiving a second opinion as to whether the patient is an appropriate candidate for palliative
sedation. Terminal weaning is when mechanical ventilation is discontinued for a patient expected to
die without its support (Knight & Espinosa, 2010). One of the most common methods of
discontinuation is through slowly reducing the fraction of inspired oxygen (Knight & Espinosa,
2010). Terminal extubation is the removal of the endotracheal tube, and this can be done "during or
after a terminal weaning process" (Knight & Espinosa, 2010, p. 527). Removal of life–supporting
interventions is the cause of most deaths in critical care units (Knight & Espinosa, 2010). Knight
and Espinosa (2010) discussed palliative sedation and terminal weaning in the same chapter because
the two topics go together. Ethical Considerations & Nursing Several important ethical
considerations exist surrounding the ideas and practices of palliative sedation and

Psychosexual Stages And Societal Structure
Psychosexual Stages and Societal Structure
Nathanael D. Evans
Montana State University – Billings Abstract
This paper assumes that Sigmund Freud's theory of psychosexual stages in childhood development
is accurate. Given the information we have on Freud's idea of fixations, and their causes, I will
explore how societal structure would need to shift towards an acute focus on childhood in order to
eliminate as much abnormality as possible from the adulthood of all individuals that make up a
society. I will also speculate on ideas for streamlining childhood development, by treating it as an
assembly line process. My points will be highly figurative, as the implementation of the ideas
contained herein would not be possible without removing rights from the populace. However, we
must assume, in the spirit of this exercise, that implementation can occur, and that the theories being
examined are accurate in all cases of abnormality. Psychosexual Stages and Societal Structure
If we are to assume that the earliest experiences of an individual influence their later personality
traits, then it should be assumed that the structure of our society should revolve around a universal
set of guidelines for child–rearing, so as to avoid abnormality in the individual in later life. On the
larger scale, if all individuals are raised in identical fashion, societal structure would be uniform.
Sigmund Freud referred to the stages of childhood development as psychosexual stages. Freud
believed

Protective Role Of Garlic Oil Against Oxidative Damage...
Protective role of garlic oil against oxidative damage induced by furan exposure from weaning
through adulthood in adult rat testis Gehan El–Akabawy,⁎ Neveen M. El–Sherif Menoufia
University, Department of Anatomy and Embryology, Faculty of Medicine, Menoufia, Egypt 1.
Introduction Heat–induced food contaminants, including furan, have attracted considerable attention
recently (Becalski et al., 2010; Terrell et al., 2014; Churchwell et al., 2015). Surveys performed by
various health agencies, including the U.S. Food and Drug Administration (FDA, 2007), Health
Canada (Becalski et al., 2010), the European Food Safety Authority (EFSA, 2011), and the Swiss
Office of Public Health (Zoller et al., 2007), have reported that furan is present in a wide range of
foods, including roasted coffee, baby foods, cereal products, fruits juices, canned vegetables, cooked
and canned meats, beer, and wheat breads. The FDA estimated human exposure to furan according
to concentration data posted through spring 2007 and reported a mean and 90th percentile of 0.26
and 0.61 μg furan/kg–bw/day for the 2+– year–olds from the consumption of adult food, and 0.41
and 0.99 μg furan/kg–bw/day for the 0– to 1–year–olds from the consumption of infant foods
(Dinovi and Mihalov, 2007). The EFSA reported that brewed coffee was the major contributor to
furan exposure for adults, while the major contributors to exposure in toddlers and other children
were fruit juice, milk–based products, and cereal–based

Evolution By Natural Selection
Evolution is the change of traits of a species over several generations. A famous biologist named
Charles Darwin, theorized that evolution happens by natural selection. Many people believe that
evolution requires millions of years but scientists believe that evolution can occur rather quickly. In
Today's world, we have better health care, food, shelter and hygiene. Some might question if our
advanced medicine and technology can lead to a stop in evolution, but in fact we are still evolving
according to some scientists (Neild). There has been much debate and controversy over this
statement but there is no concrete proof to say that humans are not evolving. In fact, there is
evidence that evolution is happening at this very moment. For example, ... Show more content on
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Over the past 30,000 years, human brains have decreased about ten percent which is said to be
equivalent to a tennis ball. Wilkens states, "Based on skulls found in Europe, Asia, and the Middle
East, the human brain was about 1,500 cubic centimeters 30,000 years ago, and now it's down to
about 1,359 cubic centimeters." It might seem like a slow process but losing that much brain mass
can surely affect humans one way or another. Although some people might think that humans are
getting dumber because of the shrinking of the brain, some scientists strongly believe that is not the
case. There are several theories that explain why this phenomenon is happening. One theory states
that humans now tend to rely more on society and smaller brains help us work together. It also states
that smaller brains cause humans to be less aggressive, giving us many social advantages
(Hullinger). Another and more interesting theory states that the reason behind the loss of the human
brain mass is because, " Domestication leads to smaller brains." (Alban) Humans learned how to
cultivate, find food and shelter. People no longer need to learn survival skills like our ancient
ancestors once did which means that that location in our brain in no longer being used. A good
example of this are domestic animals. Pet owners provide their animals with food, shelter and love.
They are no longer out in the wilderness

Tonsil Case Study
You have a patient who has been on a ventilator for 3 weeks. What should be you highest
assessment priority that needs to be obtained before beginning the weaning process? 1. Baseline
arterial blood gas results 2. Intake and output over the past twenty–four hours 3. Results of any prior
weaning attempts 4. The results of an electrocardiogram Rationale: Correct Answer is 1 – Arterial
blood gases measure the pH, oxygen and carbon dioxide in arteries and gives us important
information regarding the patient's gas exchange and acid–base status (McCance & Huether, 2015,
p. 1243). Measuring intake and output is an important process throughout the patient's entire
hospital stay. Prior weaning attempts do not have any importance to a current weaning ... Show
more content on Helpwriting.net ...
You examine the Palatine tonsils and document that they are 2+. What does this rating size mean? 1.
The tonsils are barely seen past the tonsillar pillars 2. The tonsils are touching each other 3. The
tonsils touch the uvula 4. The tonsils are in between the uvula and the tonsillar pillars Rationale:
Correct Answer is 4 – Palatine tonsils are part of your immune system are considered a type of
lymph node that trap germs that you breathe in and are important for fighting infections, such as
strep. Size one tonsils are barely visible, size two are between the uvula and tonsillar pillars, size
three are touching the uvula and size four is where the tonsils are touching (Hay, Levin, Deterding,
& Abzug, 2014, p. 529). Yesterday, your nine–year–old patient was in to the office with complaints
of fatigue and restless legs, especially at night. Laboratory tests were ordered and today the results
showed that your patient has iron deficiency anemia. Iron replacement therapy is prescribed. All of
the following could potentially interfere with iron absorption except: 1. Ascorbic Acid 2. Eggs 3.

Process Summary: Whelping And Weaning
Whelping and Weaning Dog owners would be able to tell you that puppies can bring a lot of
excitement to your home. By making use of a few simple tips, the process of raising your puppies
can be a lot easier.
To begin with, see how packs of dogs bring up their puppies. With this you will be able to know
how to create successfully an atmosphere that will let the mother of your puppies correctly nurture
her offspring. Select a room in your house that can be used by your dog for at least a month to whelp
her puppies. This room must be kept dark for most of the time. Black or red light bulbs can permit
humans to check in on what is going on. A bright white light can cause some damage to the eyes of a
newborn puppy.
The whelping room that you

Weaning The Unweanable.aspx Ventilation Is A Modern...
Marrone, S. EdD, RN–BC, CTN–A, Eason, J. BS, RRT–NPS, McLeod, C. MSN, RN, Marriott, C.
BSN, RN, Alleyne, J. MHA, RN, Walker, D. RN, Bish, C. RN,. Weaning the 'Unweanable ' (2012,
March 1). Retrieved July 26, 2015. http://respiratory–care–sleep–
medicine.advanceweb.com/Features/Articles/Weaning–the–Unweanable.aspx
Biphasic cuirass ventilation is a method of external ventilation that is considered to be a modern
improvement of the iron lung. With this type of negative pressure ventilation it is possible for the
patient to acquire a large amount of tidal volume as well as a high respiratory rate. Most of the more
common methods of ventilation are determined by the elastic recoil of the chest which, in return,
restricts the respiratory rate. Complications, such as infections, that are usually associated with the
invasive method of ventilation can be avoided when using this non–invasive ventilation technique.
Instead of participating with one or the other, biphasic cuirass ventilation has the capability to utilize
both phases of respiration, the expiratory and inspiratory phases.
Sometimes when a patient is on the more common form of mechanical ventilation for an extended
time or if the patient has undergone respiratory failure, their respiratory muscles have a tendency to
become weak. With the use of this biphasic cuirass ventilation method they can have the opportunity
to build and strengthen those muscles which, in return, can allow them to be weaned from the
ventilator

The Role Of Uk Weaning Guidelines And The Sources Of...
In another mixed method study to explore the knowledge of the UK weaning guidelines and the
sources of weaning advice used by UK first–time mothers (Moore et al, 2012), findings were quite
similar to the first study. The use of elements from both quantitative and qualitative research
approaches have been found to contribute positively to the research process (Johnson et al. 2007).
This was the main methodological strength of this study together with its size although there
remains the argument that combining two methods of research can be difficult (Giddings and Grant,
2006). Gildea et al (2009) support the use of the internet in obtaining information on weaning. The
result showed 86% of the respondents had knowledge about the guidelines that related to weaning
which resulted in later weaning. A significant number of the mothers got weaning information from
different places, but health visitor advice had the most influence on the 26% of the mother's decision
to wean, while the internet attributed to 25% and books to 18% of mothers. Nevertheless, 56% still
attributed the source of conflicting advice to come from healthcare professionals. This supports
findings by Moore et al (2012) who found that Health Visitors were inconsistent with the advice
they gave on weaning guidelines and recommendations. This is despite the fact that they are the
largest number of health professionals who give advice to postnatal mothers in the UK. This
inconsistency in advice also contributes to

Hip Replacement Therapy
Question Answer
How do Osmotic diuretics work? Osmotic diuretics works by expanding extracellular fluid and
plasma volume, therefore increasing blood flow to the kidney. A typical diuretic that falls under this
category is Mannitol, which is frequently used for decreasing the intracranial pressure.
What is the ideal time interval when weaning clients from ventilator machines? Before a client can
be totally independent from ventilators, they need to undergo weaning or SBT(spontaneous
breathing trial). The nurse must prepare the client before the weaning procedure. Weaning is done
by plugging the opening of the tube for 5–20 minutes and can be repeated up to 4xaday. Depending
on the client's respiratory status, the length of weaning can be gradually increased. Do not plug the
tube for over ... Show more content on Helpwriting.net ...
Patients who underwent total hip replacement therapy must be cautioned not to flex hips over 90
degrees to prevent hip dislocation. Several instructions must be provided to clients like: use of
assistive devices like raise toilet seats, use of abduction pillows, elastic shoelaces and more.
Patient must not bend and squat. No crossing of legs and try not to sit for same position for over
40minutes. Any activity that may over flexed the hips must be avoided.
There are several tests which can be done to confirm the diagnosis of muscular dystrophy. This
include:
1. muscle biopsy – where a muscle tissue is removed using a biopsy needle. Results will reveal
deposits of fat and connective tissue that confirms the diagnosis of muscular dystrophy.
2. Genetic testing– determines the presence of gene mutation, specifically the lack of dystrophin
gene.
3. Blood tests– serum creatine kinase and serum aldolase. Results will reveal elevated levels that
signify muscle weakness. Such test would require additional evaluation for confirmation.
4. Imaging tests – MRI and ultrasound may also be one to evaluate muscle quality and

The Effects Of Life Support Technology On Nursing Practice
The use of life support technology to achieve work of breathing in patients is referred to as
mechanical ventilation. The author chose the topic of positive pressure mechanical ventilation to
explore the indications of use, complications, and safety concerns in relation to nursing practice.
Topics to be explored will include weaning protocols to reduce complications and patient suffering
and ventilator–associated pneumonia due to prolonged intubation. Fundamental nursing
interventions will be reviewed regarding ventilation and preventing complications. Patients who
require advanced monitoring, treatment, and nursing care due to injury or disease are cared for in the
intensive care unit (ICU). Approximately 50% of these patients need mechanical ventilation
(Tingsvik, Johansson, Martensson, 2015). A ventilator is a machine that supports breathing if the
patient is unable to do so. Some patients need ventilators for a short period of time, while others
require prolonged ventilation, which increases the risk of complications. Indications for mechanical
ventilation arise when the patient cannot uphold spontaneous ventilation to sustain life, which
include apnea, acute respiratory failure, severe hypoxia, coma, neuromuscular disease, and
respiratory muscle fatigue. There are two types of mechanical ventilation. Negative pressure
ventilation is non–invasive and doesn't require an artificial airway (Lewis, et al, 2014). The negative
pressure decreases intrathoracic pressures to

Major Causes Of Holiday Weaning
The time from Thanksgiving in late November to New Year's Day in early January is one of the
busiest times of the year. Preparing for family visits, shopping for gifts for little ones and constant
parties and get–togethers are fun traditions that can add stress and further time constraints on an
already–busy mom. This time of year can be particularly challenging for breastfeeding moms who
may experience inadvertent holiday weaning.
(–– removed HTML ––) What is Holiday Weaning? (–– removed HTML ––)
Holiday weaning occurs when your milk production decreases or your little one weans off of
breastfeeding altogether as a result of the busyness and stress of the holidays. Holiday weaning
differs from intentional weaning in that it occurs inadvertently or accidentally, surprising many
moms.
(–– removed HTML ––) Major Causes of Holiday Weaning (–– removed HTML ––)
(–– removed HTML ––) Nursing less often. (–– removed HTML ––) Breastfeeding or pumping
requires that you stop doing the million things on your to–do list and sit down. It can be tempting to
skip a feeding or pumping session here–or–there in order to tackle more items on your list.
Unfortunately, because your body makes milk based on "supply and demand," each skipped nursing
session results in your body making less milk.
(–– removed HTML ––) Your little one is distracted. (–– removed HTML ––) All of the attention
that your little one is getting from visiting family plus the excitement of the holidays can mean

The Role Of Live Weight
This paper defines the role of live weight, liveweight change and condition score in monitoring the
nutrition and performance of breeding ewes (including ewe lambs) in a pasture–based system.
Body condition scoring (BCS) is a subjective visual assessment of the level of fat or the level of
body reserves on the sheep which is independent of liveweight. It is a management tool that can be
used to assess its energy and nutritional status. Jefferies (1961) defined it on a scale of 5 points (1
very thin and 5 very fat) assessed by palpation of the lumbar region because the loin is the last part
of the growing animal to put on fat and the first to lose it (Figure 1). Russel et al. (1969) further
added to Jefferies work and showed that the BCS was more closely related to the chemical body fat
composition than liveweight. Fat distribution however may differ between sheep breeds (Taylor et
al., 1989) and comparison between breeds should be done with care. Generally, sheep breed for milk
production will deposit more fat in internal depots whereas meat breeds deposit more in carcass
depot (Frutos et al., 1995). In New Zealand, both meat and milk genetics has been used in the
development of all purpose breeds.
Since body condition is a consequence of the level of nutrition, comparing the animals BCS with
target values allows for decisions such as altering the plane of nutrition to be made.
Many of the productive parameters in a sheep enterprise are linked to its body condition score

Anterior Teats Research Paper
The anterior teats of a sow are generally preferred by piglets. On average, anterior teats yield more
colostrum which contain the antibodies needed to protect the newborn piglets from disease (Fraser
and Lin, 1983). Because colostrum is only produced by the sow for 24–48 hours and the
concentration of immunoglobulins decreases after birth, it is important for piglets to suckle and
obtain as much colostrum as possible (Wennberg, 2012). Previous studies have shown that piglets
suckling from anterior teats have greater chances of survival as well as larger weight gains (Orijuela
and Solano, 1995). A problem, however, is that with only a few anterior teats, there is competition
between littermates for the better teats. With competition present, the piglets rely on certain
advantageous traits that make them better able to compete for the better teat. The larger piglets have
an advantage over smaller piglets when competing for the best teats. During struggles for the
desirable teats, the bigger piglets have more victories and therefore suckle at the anterior teats more
than smaller piglets (Rosillon–Warnier and Paquay, 1984). In this fight for better teats, the ... Show
Accordingly, we will collect the weights and behavioral observations of the piglets. The weight,
amount of fighting, and teat occupied will be recorded for each piglet. My goal will be to understand
which piglet trait is a greater contributing factor to teat order. I will also study the correlation
between pre–weaning aggression and post–weaning fighting and if more frequent fighting while
nursing will indicate more fighting after weaning. My project will investigate the effects of piglet
size and aggression on teat order as well as the effects of pre–weaning piglet aggression on the
amount of post–weaning piglet

Weaning And Extubation
The Use of a weaning and extubation protocol to facilitate effective weaning and extubation from
mechanical ventilation in patients suffering from traumatic injuries: A non–randomized
experimental trial comparing a prospective to retrospective cohort.
The transition from Mechanical Ventilation support to spontaneous breathing define as a weaning
and extubation in Critical ill patient, most of the time determine the patient hospital length of stay in
intensive care unit, which leads most of the time to complications.
The objective of this study was to assess the outcomes of weaning and extubate patients suffering
from traumatic injuries, in terms of mechanical ventilation support day, Intensive Care Unit length
of stay using nurse and physiotherapist

How Do Rats Social Skills: Are They Helpful Or Harmful?
In this study researchers wanted to find out how rats social skills were affected when exposed less to
their mother and liter mates at a young age. Researchers expected to find that the way the rats are
raised preweaning will affect the adult's gregariousness rather than what they need or want at that
time in adulthood. To test this theory, they bred 76 rats and exposed them to 6 total different social
environments. The independent variables in this experiment were the multiple social environments
the rats were testing in which consisted of, separation daily from their mother and liter mates and
isolation at weaning, separation from just their mother and isolation at weaning, constantly with
their mother and liter mates and isolation at weaning,

Business Planning
ECV Turning up the Heat in the North East
The profitability of a beef suckler herd is directly related to the number of calves reared per cow
annually. Commercial suckler herds should aim for a tighter calving period with cows producing a
viable calf every 365 days.
The average calving period for lowland suckler herd is 21 weeks, compared to the 12 week target
and reducing the calving period from 21 weeks to 12 weeks can increase revenue from extra
weaning weight by more than £2000 for a 50 cow herd.
Tighter calving periods will increase profitability. If the weaning date on the farm stays constant
then a calf born in the first 3 weeks of calving will on average have a weaning age of 230 days
weighing 309kg. A calf born in the 18th ... Show more content on Helpwriting.net ...
This data is then collected, interpreted and analysed to deliver an accurate indication of breeding
potential. This data can also be used to give health and nutritional insights for the farmer in a user–
friendly format.
SCR Heatime works by monitoring the cow's activity with a unique motion–sensor tag which
records cow activity in 2 hour blocks, providing detailed data on the cow's activity levels and their
intensity.
The data is collected each time the cow passes under the ID unit, the data is transferred from the tag
to the Heatime control box using infra–red communication. This allows the base unit to be sited
close to water troughs and other well–used routes so the animal's activity data will be picked up
regularly.
The activity data is analysed by the system and separates the cow's day to day activity from oestrus
related activities. The screen shows obvious peaks when the cow is in heat and indicates the
optimum time for inseminating the cow.
In addition, SCR Heatime will highlight cows with low activity levels which can act as an early
indication that an animal requires attention. The home screen will flash up as a 'health alert' giving
the farmer early warning to possible ailments in the cow. The system also detects non–cycling cows,
allowing them to be investigated so that less fertile cows can be removed from the herd, thereby
decreasing costs.
The first SCR Heatime system has been installed through East Coast Viner's Animal

Merrimack Tractor Case Summary
1. What is the appropriate cow size for the herd using the 50% weaning rule? According to the
information provided, the most appropriate cow size for the herd using the 50% weaning rule would
be 1,100 pounds. Although any cow size would ultimately result in a loss for the farm at this point,
the cows at 1,100 pounds have a smaller financial burden than heavier cows. The 50% "rule" is not
very specific, as the case only specifies [calf weight] "...close to 50% of [the mother's] mature
weight", so it can be assumed that the 55.5% (585 pounds) is sufficient, which yields a marginal
revenue of $28.08. To a much lesser extent, around 1,200 pounds could also be less burdensome for
the farm than 1,300 or 1,400 pounds, but 1,200 is on the brink of barely breaking even at a marginal
revenue of $6.48. Once the weight exceeds the 1,200 increment, the marginal revenue dips ... Show
What are the drivers in a cow–calf operation? Is the revenue–expense calculation (see Exhibit 2)
clear regarding drivers? Why or why not? While there are several drivers in a cow–calf operation,
the accountant in the case specifies the driver for expenses as the number of cows –– due to the
information provided about the cattle–calf industry, I believe he is incorrect in this particular case.
Because many variables are dependent upon the weight of a cow and not simply the number of
cows, it would be much more useful and relevant if it were shifted from per cow calculations to per
pound. The revenue–expense calculation in Exhibit 2 of our case may be seen as a bit unclear,
because its calculations are per animal, despite the revenue and expense being highly dependent
upon the weight. Although the cow–focus could be very useful, it could also be confusing because
of the variation of weights and, consequently, their sale prices. I would personally prefer the
identification of fixed costs and variable costs in the calculation's construction as well, but
calculations based on weight would be

Weaning : A Critical Element
Weaning
Weaning is a critical element in the care of intubated patients that deals with the entire technique of
liberating the patient from mechanical ventilatory support as well as from the endotracheal tube. It is
the transition of ventilatory support to spontaneous breathing (30). Although it can be achieved
easily in many patients, it may prove to be difficult in up to 25% of critically ill patients who have
been on ventilation for a prolonged period of time (31–33). Shorter the time in MV, lesser would be
the complications associated with it by as much as 50%, with decrease in number of re–intubation as
well (34). Study by Esteban et al. suggested that mortality rate is related to increased duration of
mechanical ventilation wherein weaning period accounted for 40% of the ventilatory time (2).
Similarly study by Coplin further shows the relevance of timely extubation by relating the delayed
extubation with increased mortality rate of 27% against the rate of 12% in timely extubated patients
(3).
Although some researchers assessed that around 80% of intubated patients could discontinue
ventilatory support in a matter of hours (2,9,35), weaning could be complicated by abnormal lung
function or the presence of underlying disease (35). Other issues such as critical illness,
neuromyopathy, prolonged use of sedatives, overloading or underloading of respiratory muscles and
physician's hesitancy to identify weaning and extubation readiness may also delay the weaning

Old Mule Farms Case Study Essay
–––––––––––––––––––––––––––––––––––––––––––––––––
Case Study Memorandum
TO: Dr. Kathleen Sheehan, BECO 4310 – 003
FROM: Brian J. Walsh
DATE: 3/2/2015
RE: Old Mule Farms The Old Mule Farms is a cow–calf operation that provides calves for feedlots
to fatten up before being sent to packing houses and eventually sold as meet for consumers. The
current owners have been experiencing a problem with losses in revenue. The expenses that Old
Mule Farms incurred are veterinary bills, labor, nutritional supplements and minerals, and a variety
of forage. The forage is primarily grazed grasses but is supplemented with hay.
The owners of the farm have found a correlation between the weight of a cow, and the cost of
feeding it, in ... Show more content on Helpwriting.net ...
Taking into consideration that the weight of the cows is a key driver of calf weight, which in turn is
the key driver of revenue.
An Old Mule Farms average cow weight ranges between 1000 lbs. and 1400 lbs. My
recommendation is that if they were to eliminate the lighter and heavier 40% of cows respectively,
Old Mill Farms would have heavier calves to sell, resulting in higher revenues. This would also
reduce expenses each of the heavier cows has been causing. This recommended approach will
substantially reduce the expenses incurred by heavier cows, and increase the calf sell weight
produced by the lighter cows. The best approach to measuring the proper size of a cow is to use the
primary key driver of cow weight and compare the value of a calf to the cost of maintaining a cow.
The principle of diminishing marginal productivity states that as one input in the production process
is increased, there will be a point in which the addition of an input will result in smaller and smaller
benefit. We can relate this principle with the weight of cows. As more nutrients, minerals, and forage
is added to a cow the more a cow weighs. This in turn results in heavier calves. However, when a
cow begins to weigh over 1200 lbs. the weight of calves diminishes. When taking in to account the
principle of diminishing marginal utility, Old Mill Farms would be able to eliminate their losses by
restricting their cow weight to 1200

The Effect Of Fast Track Care On Length Of Stay Patients...
Running Head: FAST TRACK CARE
Review of Literature
The Effect of Fast Track Care on Length of Stay in Patients Undergoing Cardiac Surgery
Alisa Ruffner, BSN
Fall 2014
University of Tennessee Health Science Center: College of Nursing
NSG 819: Evaluation of Practice
Introduction Cardiac surgery is among the most frequently performed surgical procedures in the
United States. According to the American Heart Association, over 575,000 open heart surgeries were
performed in 2005. Until relatively recently, sedation and prolonged ventilatory support through the
first twelve to eighteen hours post operatively have been standard. This allowed adequate time for
the patient's hemodynamic, respiratory and coagulation physiological ... Show more content on
Helpwriting.net ...
How does fast track care compare to conventional care after cardiac surgery?
Methods
An electronic review of literature was conducted through PubMed, Clinicalkey, and MEDLINE
OVID databases. Key words and phrases searched included 'fast track', 'cardiac surgery', 'length of
stay', 'intensive care unit', and 'protocols'. The evidence in the articles were evaluated and examined
in the attached table. The evidence was also categorized for quality using the Grade model rating
from A to D.
Findings
The most significant publication found involving fast track care was a Cochrane review entitled
"Fast–track cardiac care for adult cardiac surgical patients". This review examined 25 trials and
included over 4,000 patients. The trails included in this review were randomized control trials "that
compared the use of low–dose opioid based general anesthesia versus high–dose opioid based
general anesthesia, and early extubation using time–directed protocols versus usual care for
extubation" (Zhu, Lee, & Chee, 2012). This review examined several outcomes including mortality,
post–operative complications, time to extubation, ICU length of stay, hospital length of stay, and

inpatient costs. The authors concluded, based on these studies, that fast track care was safe for
patients undergoing low to moderate risk cardiac surgery. The
combination of low dose opioid anesthesia combined with a rapid extubation protocol post
operatively is shown to decrease the time on

Rat Diet
Method Subjects The subjects were 10 Rattus norvegicus rats obtain from a local breeder and the
rats weighed between 200–400g at 12 months old in the beginning of the experiment (cite). Mice
were maintained in barrier cages 3 – 4 mice per cage in an environmentally controlled room with
filtered air (cite). The laboratory had a set light and a dark light room but majority were set to light
phase of 1500– 1800h (cite). The half of mice were on a feeding schedule of intermittent fasting and
time restricting fasting, but water was supplied threw out the experiment. Apparatus or material The
rodents were placed in a controlled roomed with five of them receiving time restricting calories
while the other five rodents receive intermittent fasting. Researchers report that energy–restricted
rats fed a "synthetic" diet consisting of 48% sucrose, 32% casein, 6% corn oil, and defined mineral
and salt mixes were given to five mice. While the other rats consumed ad libitum of the identical
diet of 1 kcal= 4.186kJ of healthy eating and proper macronutrients. Rodents consume ad libitum or
reduced calorie diets throughout the research. However, caloric restriction (CR) limited total food
consumption, feeding time of 12 hours every day, four – ... Show more content on Helpwriting.net
...
The mice were placed in the cages that were assigned and were given food throughout the
experiment but time–restricted feeding of limited to 12 daytime hours every day and the mice were
given access to food for only 8–9 hours during the active phase of the day. The rodents consume
three diets of ad lib, 105 calories. The ad lib diet and 105 calories/week diet appeared similar in
terms of their effects on body weight and survival, but as expected, the 60 calorie/week diet
consistently decreased body weight of . In the first cohort, mice were weaned at 21 days and then
provided either 105 calories/week or 60 calories/week (14 ≤ n ≤ 20 per diet per

The Dietary Protein Intake Is Associated With Body Mass...
The purpose of this assignment is to analyze a scientific article that provided by the instructor. The
article that will be analyzed is "Dietary protein intake is associated with body mass index and
weight up to 5 y of age in a prospective cohort of twins". The authors are Laura Pimpin, Susan Jebb,
Laura Johnson, Jane Wardle, and Gina L Ambrosini. The research problem of the article related to
the protein intake of kids during complementary feeding period and the overweight condition when
they grow up. Many studies showed that the rich amount of protein in formula milk is associated
with childhood weight gain. Moreover, when children started eating solid foods, it increased their
chances of protein intake. Therefore, authors studied the ... Show more content on Helpwriting.net ...
The result of this study was based on the massive data from the participants. The result of the study
is "... that higher protein intake at 21 mo is associated with higher weight gain and higher BMI (but
not height) between 21 and 36 mo and 21 and 60 mo, with no evidence of diminution over time"
(Pimpin et al., p.6). Authors were able to determine that there was a correlation between protein
intake and BMI. In addition, they provided more evidences. They say, "We observed greater
increases in BMI and weight up to 36 mo among children who consumed >15% of their energy from
protein...This supports the nutrition statement from the European Society for Pediatric
Gastroenterology, Hepatology, and Nutrition Committee that a .4–g/kg per day protein intake
between 18 and 24 mo (equivalent to w16% of %Epro) may be associated with increased obesity
risk" (Pimpin et al., p.7). Overall, the results supported the hypothesis of the study because they
were able to determine the relationship between protein intake after weaning and childhood obese.
There were some limitations in the study. Misreporting is one of them (Pimpin et al.). The variables
of the study were based on the parental reporting. Therefore, if they did not provide the accurate
information during the study, it would affect the result. Authors say, "Misreporting of food
consumption is a potential issue for all dietary assessment methods, although it is not known to what
extent

The Effects Of Opioid Addictions In Alabama
Alabama like most other states has seen the rise in opioid use and those infants that have NAS (see
Appendix C. Per Robert Moon, MD Chief Medical Officer Alabama Medicaid Agency the number
of cases of NAS covered by Medicaid in Alabama more than doubled from 255 cases in 2010 to 533
in 2015, (see Appendix C). As stated by the Insurance Journal, Alabama has the highest level of
prescription opioid use in the country (see Appendix). Alabama had more that 5.8 million opioid
prescriptions written in 2015. That equates to a rate of 1.2 prescriptions per person, the highest rate
in the country. By comparison, the national per capita was 0.71 in 2015 (2016). The University of
Alabama at Birmingham (UAB) a 1,179 bed hospital in Jefferson County ... Show more content on
Helpwriting.net ...
The infants LOS and DOT that were weaned off Methadone without a standardized treatment
protocol will be compared to those in the LOS and DOT of infants that received the standardized
weaning treatment protocol. The problem was discovered by Ashley Kilpatrick, NNP, Project
Manager of this process improvement initiative. Ashley saw the opportunity to improve patient care
by standardizing the care of the infants by decreasing the variation in care. I was made aware of the
problem in weekly discharge rounds that occur every Tuesday in RNICU/CCN with the nurse
managers, assistant nurse managers, social services, utilization management, UAB Police and the
discharge coordinator to talk about any financial or social barriers to discharge. During discharge
rounds, we discussed infants whose mother was addicted to drugs, whether prescription, illegal, or
opioid substitutions. We also discuss whether the infants are having withdrawals and receiving
Methadone. There would always be questions about weaning the Methadone, what day of weaning
were the infants on so they could be discharged. There would be questions whether we were
monitoring 3 –5–7 days off Methadone to send the infant home. This could ultimately be a safety
and quality issue for the organization. This project will focus on using Methadone as a
pharmacological treatment strategy as well as the normal non–pharmacological treatment strategies
to

Symptoms And Treatment Of Pediatric Intensive Care Unit
Introduction: As a student completing senior synthesis in the pediatric intensive care unit, I see
many patients, both chronic and acute, that require mechanical ventilation. I understand the many
risks involved with this life–saving procedure, but at the same time I often question why the patient
must remain on the ventilator for such extended periods of time. I based my PICOT question around
my observations of intubated patients. Nurses collaborate with respiratory therapists and physicians
to care for their patients, but have little to do with the respiratory management of intubated patients
besides being a patient advocate. I want to know if nurses could be more involved with the
management of mechanically ventilated patients to ... Show more content on Helpwriting.net ...
The apparent lack of research and evidence–based literature pertaining to mechanically ventilated
pediatric patients, and unique pediatric physiology, highlight the necessity for development of
protocols and guidelines specific to the population in order to reduce mechanical ventilation times.
You may ask why it is important to develop these pediatric protocols in an effort to reduce time of
mechanical ventilation. Since decreased time of mechanical ventilation has the potential to reduce
the incidence of harmful ventilator associated infections, and decreases the risk of acquiring such
infections, it is of utmost importance to the health and safety of these patients (Marelich, et al.,
2000; Randolph, et al., 2003). Furthermore, mechanical ventilation poses a great risk of tracheal
airway irritation and scarring (Randolph, et al., 2003). This can occur through the method of
endotracheal suctioning, duration of suctioning, frequency of suctioning pose, and length of time the
endotracheal tube is in place. All these factors can damage the patient's airway, compromise the
integrity of the endotracheal tube, and put the patient at risk for ventilator associated pneumonia
(Grap, 2009). There are several other aspects of care of the mechanically ventilated patient that
make reduced time of ventilation an important issue to consider. The management of mechanical
ventilation with sedation increases the need for skilled care in the ICU setting,

Protocolized Weaning: A Case Study
This assignment will critically appraise a paper by the Cochrane Anaesthesia Group, Protocolized
versus non–protocolized weaning for reducing the duration of mechanical ventilation (MV) in criti–
cally ill adult patients. It will systematically evaluate the work's effectiveness.
The nature of the study recommended in the paper was to assess the effects of protocolized weaning
from mechanical ventilation on the total duration of mechanical ventilation for critically ill adults
and ascertain differences between protocolized and non–protocolized weaning in terms of adverse
events, mortality, quality of life, weaning duration, intensive care unit (ICU) and hospital length of
stay (LOS) and explore the variation in outcomes by the type of ICU, type of protocol and approach
to delivering the protocol.
Within this systematic review, the RCT looked at results of 11 studies involving 1,971 critically ill
patients aged 18 or over. The author found that the use of weaning protocols was associated with
significant reduction in ... Show more content on Helpwriting.net ...
In this review, external validity was increased as all patients were assessed for eligibility (Rothwell
2005). However, over half the patients assessed for eligibility were excluded which limited external
validity. Exclusion bias was used as the trial did not involve children. Exclusions are not explained
and are not indicative of selection bias. Selection bias was reduced by including quasi–randomised
and randomised controlled trials of protocolized weaning verses non–protocolised weaning from
mechanical ventilation in critically ill adults. It is important to add that the trial was double blinded,
minimizing performance bias. The patient's baseline characteristics were similar. The lower ad–
verse events, mortality, quality of life, weaning duration and ICU LOS could reduce the risk of bias
benefiting protocolized weaning over standardized

If Mommy Was Breastfeed Essay
If Mommy is sick, can she breastfeed?
When you are sick, you and your baby will almost always benefit from continuing to breastfeed.
There are very few illnesses that require a mother to stop nursing.
Since most illnesses are caused by viruses that are most contagious before you even realize you are
sick, your baby has already been exposed before you even develop symptoms (such as fever,
diarrhea, vomiting, rash, runny nose, cough, etc). Continuing to breastfeed will help protect your
baby from the infection, because your body produces antibodies to the specific organism that is
causing the infection, and you pass them on to the baby in your breast milk. Often, a breastfed baby
will be the only member of the family who doesn't get sick. If ... Show more content on
Helpwriting.net ...
If you are diabetic, breastfeeding offers many advantages. It reduces your stress level, reduces the
risk of the baby developing diabetes
Mothers with epilepsy can nurse. The medications needed to control the seizures may cause sedation
and poor sucking in your baby.
Thyroid levels can change during pregnancy and lactation, even with mothers who never had
thyroid irregularities before.
An underactive thyroid can cause fatigue, poor appetite, and depression. Thyroid supplements taken
during lactation will not hurt your baby. An overactive thyroid can cause serious health problems. If
radioactive therapy is recommended, temporary weaning may be necessary. Keep in mind that all of
the OTC medications approved for use in nursing mothers are very safe, and in nearly all cases, the
risk of side effects on your baby is extremely small. You are not going to hurt your baby. Remember
all the advantages of human milk and how important breastfeeding is to you and your baby, and try
to find a supportive health care provider who believes that nursing is as important as you

Quality Indicator: Ventilator Associated Pneumonia
Quality of service is the process of measuring the characteristics of existing workplace culture, the
potential errors and improving those errors in the future. It assures the safety of the patients which
results the greater patient satisfaction. Quality care indicator is the method of analyzing the
outcomes of patients' conditions and nurses' performance while providing quality of service to the
patients. In this report, quality indicator: ventilator associated pneumonia (PAV) will be explored.
VAP is one of the nosocomial infection which is the most common infection in the intensive care
unit (ICU). Nosocomial infection is the infection that occurred in the hospital surroundings after
48hours of admission other than the disease for admitting ... Show more content on Helpwriting.net
...
In Egypt the incidence rate of VAP was 15.3% that increased the risk of mortality rate by 33% in
contrast to the patient without VAP which was just 24.3% (Timsit, Zahar and Chevret, 2011, p.469).
However, VAP independently cannot predict the death of the patient, there are other reasons
associated with the VAP such as severity of disease, and duration of ICU stay (Myny et al., 2014,
p.120). A study of Faisy et al.,(2011, p.1257) reveals that the risk factor associated with the VAP are:
history of lungs diseases, immune compromised state, nutritional deficiency. In order to reduce the
incidence rate of VAP in ICU settings, it is very necessary to follow the evidence based process
indicator as a quality indicator because it tries to find out the obstacle that had been faced in the past
and provides a proper guideline and feedback to improve the quality of service, in addition close
surveillance, monitoring the previous outbreak and feedback from results could help to reduce the
incidence rate (Wong, Mathieu and Williams, 2012, p.80). While working in ICU, the most patient
experiences the problem of weaning. A study of Prasad, Chaudhry and Khanna,(2009, p. 221)
reveals that patient experience the weaning failure at the time of extubate because of prolonged and
dependency on mechanical ventilation. Other reason behind the weaning failure are: old age,
increased minute ventilation, severe

Post Lumbar Discontinue: A Case Study
Discontinue, but gradual weaning is advised.
The claimant presented with chronic left lower limb radicular symptoms status post lumbar surgery
complicated by postoperative arachnoiditis. She had an ambulatory dysfunction secondary to a left
foot drop. Her physical examination revealed weakness, lower limb numbness, and a positive
straight leg raise test on the left. The claimant has been taking Topiramate since 2013. It was noted
that the symptoms failed to improve with Duloxetine. However, a significant improvement of
neurological symptoms from the prior use of Topiramate was also not mentioned in the submitted
report.
Therefore, the continued use of this drug is no longer supported. Gradual weaning is advised prior to
discontinuation to avoid possible severe withdrawal symptoms. ... Show more content on
Helpwriting.net ...
The claimant presented with chronic left lower limb radicular symptoms status post lumbar surgery
complicated by postoperative arachnoiditis. She had an ambulatory dysfunction secondary to a left
foot drop. It was also mentioned that the claimant had depression. Her physical examination
revealed weakness, lower limb numbness, and a positive straight leg raise test on the left.
However, a significant improvement in radicular pain was not documented. Furthermore, according
to NCBI, more placebo–controlled trials would be required for the complete confirmation of the
efficacy of lamotrigine, an antiepileptic mood stabilizer in the treatment of depression.
The continued use of this drug is not supported.
The injured worker is prescribed a total of 450 mg MEDs per day.
As such, Methadone was decreased to 2.5 mg.
Yes. The claimant has signed an opioid treatment agreement.
There was a mention that the claimant underwent random urine drug screening. However, the
official report was not submitted for

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