Neonatal Intensive Care Unit: Definition, objectives, major components, requirements, physical setup, admission criteria, space, location, baby care area, electrical outlet, ventilation, counselling, handwashing area, acoustic characteristics, personnel, equipments available in the NICU, services, levels of NICU
Important points in the organization of a NICU. The Aims and Objectives, Main components of NICU eg., physical facilities, personnel, equipment, laboratory facilities, procedure manual, transport of sick child and levels or grades of neonatal care.
organization of NICU
GENERAL OBJECTIVE: At the end of the this topic the students will be able to gain knowledge and understanding regarding the organization of NICU and apply this knowledge in theory and practical.
SPECIFIC OBJECTIVES:
At the end of the topic student will be able to,
Explain the introduction and define the NICU.
Discuss the aims and objective of NICU.
List out the basic facility.
Describe the component of NICU. Introduction:- A Neonatal Intensive Care Unit (NICU)—also called a Special Care Nursery, newborn intensive care unit, intensive care nursery (ICN), and special care baby unit (SCBU)—is an intensive care unit specializing in the care of ill or premature newborn infants.
NEONATAL CARE: The management of complex life threatening diseases, provision of intensive monitoring and institution of life sustaining therapies in an organized manner to critically ill children in a separate pediatric intensive care unit.
Briefly describe the management of nursing care.
Explain the level of NICU.
Discuss the environment of NICU. DEFINITION: Newborn or neonatal intensive care unit, is a intensive care unit designed for premature and ill newborn babies.
AIMS and OBJECTIVES: AIMS OF ORGANIZING OF NICU :
Reducing the neonatal mortality and improving the quality of life among the survivors
OBJECTIVES:
To save the life of the sick new born.
To prevent damage in infants with problems at birth and also reduce morbidity in later life.
To monitor high risk newborns so as to reduce mortality and morbidity in these babies.
BASIC FACILITIES: Adequate space
Availability of running water
Centralized oxygen and suction facilities
Maintenance of thermo- neutral environment
Availability of plenty of linen and disposables
Facilities for availability to treat common neonatal problems
MAIN COMPONENTS TO BE CONSIDER WHILE ORGANIZING A NICU: Physical Facilities
Personnel
Equipment
Laboratory Facilities
Procedure Manual
Transport Of Sick Infants
Cooperation Between The Obstetrician And Neonatologist
PHYSICAL FACILITIES: Location
Space
Floor plan
Lighting
Environmental temperature and humidity
Handling and social contacts
Communication system
Acoustic characteristics
Ventilation
Electrical outlets
LOCATION:Located as close as to labor room and obstetric care unit
Adequate sunlight for illumination
Fair degree of ventilation for fresh air
SPACE: Serve as a referral unit for the infants born outside the hospital.
Each infant should be provided with a minimum area of 100 sq. ft. or 10sq. meter
Space for promotion of breast feeding.
500-600 Gross square feet per bed.
Space includes patient care area, storage area, space for doctors, nurses, other staff, office area, seminar room area, laboratory area and space for families.
6 Feet gap between two incubators for adequate circulation and keeping.
The essential life-saving equipment. FLOOR PLAN: Open encumbered space.
The walls should be made of washable glazed tiles and windows should have...
Neonatal intensive care unit:
New born or neonatal intensive care unit, an intensive care unit designed or premature and ill new born babies.
NEONATAL CARE:
The management of complex life threatening diseases, provision of intensive monitoring and institution of life sustaining therapies in an organized manner to critically ill children in a separate paediatric intensive care unit.
INDICATIONS :
Babies less then 30 weeks
Very low birth weight babies of less then 1500 gm
Cardiopulmonary monitoring.
Surfactant therapy.
Convulsion
Sever birth asphyxia
Assisted ventilation
Total parenteral therapy
Major surgeries
aims:
Reducing the neonatal mortality and improving the quality of life among the survivors
basic facilities:
Adequate space
Availability of running water
Centralized oxygen and suction facilities
Maintenance of thermo- neutral environment
Availability of plenty of linen and disposables
Facilities for availability to treat common neonatal problems
EMPHASIS SHOULD BE LAID ON THEFOLLOWING:
Asepsis
Warmth and thermo neutral environment
Adequate nutrition with human milk
Non stimulating noise free ward
Safety from all biological, physical and chemical hazards.
NEONATAL CARE SERVICES
LEVEL - l NORMAL NEONATALCARE
LEVEL – II SPECIAL CARE NURSARY
LEVEL – III INTENSIVE NEONATALCARE UNIT
LEVEL - I
The minimal care
Provided by the mother under the supervision of basic health professionals.
Neonates weighting more than 2000 gm or having gestational age maturity of 37 weeks or more belong to this care.
This care can be includes care of delivery, provision of the warmth, maintenance of asepsis, and promotion of breastfeeding.
LEVEL - II
This care includes requirement for resuscitation, maintenance of thermo-neutral temperature, intravenous infusion, gavage feeding phototherapy and exchange transfusion.
10-15 percent of the newborn require this care
This care s is anticipated for the infants weighing in between1500 & 1800 gm or having gestational age maturity of 32 to 36weeks.
LEVEL - III
This care includes life saving support system like ventilator and best suited special intensive neonatal care.
Three to five percent of newborn require care of this level.
This level of care is for critically ill babies, for those weighing less than 1500 gm or having gestational age maturity of less than 32 weeks
TRANSPORT:
DEFINITION
Newborn transport is used to move premature and other sick infants from hospitals without specialist, intensive care facilities require for optimal care of the baby to hospitals with neonatal intensive care and other specialist services
Out born newborns:
A significant number of neonates require emergent transfer to a tertiary care center, often because of medical, surgical, or rapidly emerging postpartum problems. These are termed “out born” neonates, because they have been born somewhere besides the facility to which they’ve been transferred.
Neonatal Intensive Care Unit: Definition, objectives, major components, requirements, physical setup, admission criteria, space, location, baby care area, electrical outlet, ventilation, counselling, handwashing area, acoustic characteristics, personnel, equipments available in the NICU, services, levels of NICU
Important points in the organization of a NICU. The Aims and Objectives, Main components of NICU eg., physical facilities, personnel, equipment, laboratory facilities, procedure manual, transport of sick child and levels or grades of neonatal care.
organization of NICU
GENERAL OBJECTIVE: At the end of the this topic the students will be able to gain knowledge and understanding regarding the organization of NICU and apply this knowledge in theory and practical.
SPECIFIC OBJECTIVES:
At the end of the topic student will be able to,
Explain the introduction and define the NICU.
Discuss the aims and objective of NICU.
List out the basic facility.
Describe the component of NICU. Introduction:- A Neonatal Intensive Care Unit (NICU)—also called a Special Care Nursery, newborn intensive care unit, intensive care nursery (ICN), and special care baby unit (SCBU)—is an intensive care unit specializing in the care of ill or premature newborn infants.
NEONATAL CARE: The management of complex life threatening diseases, provision of intensive monitoring and institution of life sustaining therapies in an organized manner to critically ill children in a separate pediatric intensive care unit.
Briefly describe the management of nursing care.
Explain the level of NICU.
Discuss the environment of NICU. DEFINITION: Newborn or neonatal intensive care unit, is a intensive care unit designed for premature and ill newborn babies.
AIMS and OBJECTIVES: AIMS OF ORGANIZING OF NICU :
Reducing the neonatal mortality and improving the quality of life among the survivors
OBJECTIVES:
To save the life of the sick new born.
To prevent damage in infants with problems at birth and also reduce morbidity in later life.
To monitor high risk newborns so as to reduce mortality and morbidity in these babies.
BASIC FACILITIES: Adequate space
Availability of running water
Centralized oxygen and suction facilities
Maintenance of thermo- neutral environment
Availability of plenty of linen and disposables
Facilities for availability to treat common neonatal problems
MAIN COMPONENTS TO BE CONSIDER WHILE ORGANIZING A NICU: Physical Facilities
Personnel
Equipment
Laboratory Facilities
Procedure Manual
Transport Of Sick Infants
Cooperation Between The Obstetrician And Neonatologist
PHYSICAL FACILITIES: Location
Space
Floor plan
Lighting
Environmental temperature and humidity
Handling and social contacts
Communication system
Acoustic characteristics
Ventilation
Electrical outlets
LOCATION:Located as close as to labor room and obstetric care unit
Adequate sunlight for illumination
Fair degree of ventilation for fresh air
SPACE: Serve as a referral unit for the infants born outside the hospital.
Each infant should be provided with a minimum area of 100 sq. ft. or 10sq. meter
Space for promotion of breast feeding.
500-600 Gross square feet per bed.
Space includes patient care area, storage area, space for doctors, nurses, other staff, office area, seminar room area, laboratory area and space for families.
6 Feet gap between two incubators for adequate circulation and keeping.
The essential life-saving equipment. FLOOR PLAN: Open encumbered space.
The walls should be made of washable glazed tiles and windows should have...
Neonatal intensive care unit:
New born or neonatal intensive care unit, an intensive care unit designed or premature and ill new born babies.
NEONATAL CARE:
The management of complex life threatening diseases, provision of intensive monitoring and institution of life sustaining therapies in an organized manner to critically ill children in a separate paediatric intensive care unit.
INDICATIONS :
Babies less then 30 weeks
Very low birth weight babies of less then 1500 gm
Cardiopulmonary monitoring.
Surfactant therapy.
Convulsion
Sever birth asphyxia
Assisted ventilation
Total parenteral therapy
Major surgeries
aims:
Reducing the neonatal mortality and improving the quality of life among the survivors
basic facilities:
Adequate space
Availability of running water
Centralized oxygen and suction facilities
Maintenance of thermo- neutral environment
Availability of plenty of linen and disposables
Facilities for availability to treat common neonatal problems
EMPHASIS SHOULD BE LAID ON THEFOLLOWING:
Asepsis
Warmth and thermo neutral environment
Adequate nutrition with human milk
Non stimulating noise free ward
Safety from all biological, physical and chemical hazards.
NEONATAL CARE SERVICES
LEVEL - l NORMAL NEONATALCARE
LEVEL – II SPECIAL CARE NURSARY
LEVEL – III INTENSIVE NEONATALCARE UNIT
LEVEL - I
The minimal care
Provided by the mother under the supervision of basic health professionals.
Neonates weighting more than 2000 gm or having gestational age maturity of 37 weeks or more belong to this care.
This care can be includes care of delivery, provision of the warmth, maintenance of asepsis, and promotion of breastfeeding.
LEVEL - II
This care includes requirement for resuscitation, maintenance of thermo-neutral temperature, intravenous infusion, gavage feeding phototherapy and exchange transfusion.
10-15 percent of the newborn require this care
This care s is anticipated for the infants weighing in between1500 & 1800 gm or having gestational age maturity of 32 to 36weeks.
LEVEL - III
This care includes life saving support system like ventilator and best suited special intensive neonatal care.
Three to five percent of newborn require care of this level.
This level of care is for critically ill babies, for those weighing less than 1500 gm or having gestational age maturity of less than 32 weeks
TRANSPORT:
DEFINITION
Newborn transport is used to move premature and other sick infants from hospitals without specialist, intensive care facilities require for optimal care of the baby to hospitals with neonatal intensive care and other specialist services
Out born newborns:
A significant number of neonates require emergent transfer to a tertiary care center, often because of medical, surgical, or rapidly emerging postpartum problems. These are termed “out born” neonates, because they have been born somewhere besides the facility to which they’ve been transferred.
Organization, Transportation, Setting and Management of Neonatal Intensive Ca...Lipi Mondal
Neonatal Intensive Care Unit is a specialized are where newborn care is to be given as per need of the babies where each and every aspect is important in neonate's heath care management.
Organization, Transportation, Setting and Management of Neonatal Intensive Ca...Lipi Mondal
Neonatal Intensive Care Unit is a specialized are where newborn care is to be given as per need of the babies where each and every aspect is important in neonate's heath care management.
Title: Sense of Taste
Presenter: Dr. Faiza, Assistant Professor of Physiology
Qualifications:
MBBS (Best Graduate, AIMC Lahore)
FCPS Physiology
ICMT, CHPE, DHPE (STMU)
MPH (GC University, Faisalabad)
MBA (Virtual University of Pakistan)
Learning Objectives:
Describe the structure and function of taste buds.
Describe the relationship between the taste threshold and taste index of common substances.
Explain the chemical basis and signal transduction of taste perception for each type of primary taste sensation.
Recognize different abnormalities of taste perception and their causes.
Key Topics:
Significance of Taste Sensation:
Differentiation between pleasant and harmful food
Influence on behavior
Selection of food based on metabolic needs
Receptors of Taste:
Taste buds on the tongue
Influence of sense of smell, texture of food, and pain stimulation (e.g., by pepper)
Primary and Secondary Taste Sensations:
Primary taste sensations: Sweet, Sour, Salty, Bitter, Umami
Chemical basis and signal transduction mechanisms for each taste
Taste Threshold and Index:
Taste threshold values for Sweet (sucrose), Salty (NaCl), Sour (HCl), and Bitter (Quinine)
Taste index relationship: Inversely proportional to taste threshold
Taste Blindness:
Inability to taste certain substances, particularly thiourea compounds
Example: Phenylthiocarbamide
Structure and Function of Taste Buds:
Composition: Epithelial cells, Sustentacular/Supporting cells, Taste cells, Basal cells
Features: Taste pores, Taste hairs/microvilli, and Taste nerve fibers
Location of Taste Buds:
Found in papillae of the tongue (Fungiform, Circumvallate, Foliate)
Also present on the palate, tonsillar pillars, epiglottis, and proximal esophagus
Mechanism of Taste Stimulation:
Interaction of taste substances with receptors on microvilli
Signal transduction pathways for Umami, Sweet, Bitter, Sour, and Salty tastes
Taste Sensitivity and Adaptation:
Decrease in sensitivity with age
Rapid adaptation of taste sensation
Role of Saliva in Taste:
Dissolution of tastants to reach receptors
Washing away the stimulus
Taste Preferences and Aversions:
Mechanisms behind taste preference and aversion
Influence of receptors and neural pathways
Impact of Sensory Nerve Damage:
Degeneration of taste buds if the sensory nerve fiber is cut
Abnormalities of Taste Detection:
Conditions: Ageusia, Hypogeusia, Dysgeusia (parageusia)
Causes: Nerve damage, neurological disorders, infections, poor oral hygiene, adverse drug effects, deficiencies, aging, tobacco use, altered neurotransmitter levels
Neurotransmitters and Taste Threshold:
Effects of serotonin (5-HT) and norepinephrine (NE) on taste sensitivity
Supertasters:
25% of the population with heightened sensitivity to taste, especially bitterness
Increased number of fungiform papillae
The prostate is an exocrine gland of the male mammalian reproductive system
It is a walnut-sized gland that forms part of the male reproductive system and is located in front of the rectum and just below the urinary bladder
Function is to store and secrete a clear, slightly alkaline fluid that constitutes 10-30% of the volume of the seminal fluid that along with the spermatozoa, constitutes semen
A healthy human prostate measures (4cm-vertical, by 3cm-horizontal, 2cm ant-post ).
It surrounds the urethra just below the urinary bladder. It has anterior, median, posterior and two lateral lobes
It’s work is regulated by androgens which are responsible for male sex characteristics
Generalised disease of the prostate due to hormonal derangement which leads to non malignant enlargement of the gland (increase in the number of epithelial cells and stromal tissue)to cause compression of the urethra leading to symptoms (LUTS
These lecture slides, by Dr Sidra Arshad, offer a quick overview of physiological basis of a normal electrocardiogram.
Learning objectives:
1. Define an electrocardiogram (ECG) and electrocardiography
2. Describe how dipoles generated by the heart produce the waveforms of the ECG
3. Describe the components of a normal electrocardiogram of a typical bipolar leads (limb II)
4. Differentiate between intervals and segments
5. Enlist some common indications for obtaining an ECG
Study Resources:
1. Chapter 11, Guyton and Hall Textbook of Medical Physiology, 14th edition
2. Chapter 9, Human Physiology - From Cells to Systems, Lauralee Sherwood, 9th edition
3. Chapter 29, Ganong’s Review of Medical Physiology, 26th edition
4. Electrocardiogram, StatPearls - https://www.ncbi.nlm.nih.gov/books/NBK549803/
5. ECG in Medical Practice by ABM Abdullah, 4th edition
6. ECG Basics, http://www.nataliescasebook.com/tag/e-c-g-basics
Ethanol (CH3CH2OH), or beverage alcohol, is a two-carbon alcohol
that is rapidly distributed in the body and brain. Ethanol alters many
neurochemical systems and has rewarding and addictive properties. It
is the oldest recreational drug and likely contributes to more morbidity,
mortality, and public health costs than all illicit drugs combined. The
5th edition of the Diagnostic and Statistical Manual of Mental Disorders
(DSM-5) integrates alcohol abuse and alcohol dependence into a single
disorder called alcohol use disorder (AUD), with mild, moderate,
and severe subclassifications (American Psychiatric Association, 2013).
In the DSM-5, all types of substance abuse and dependence have been
combined into a single substance use disorder (SUD) on a continuum
from mild to severe. A diagnosis of AUD requires that at least two of
the 11 DSM-5 behaviors be present within a 12-month period (mild
AUD: 2–3 criteria; moderate AUD: 4–5 criteria; severe AUD: 6–11 criteria).
The four main behavioral effects of AUD are impaired control over
drinking, negative social consequences, risky use, and altered physiological
effects (tolerance, withdrawal). This chapter presents an overview
of the prevalence and harmful consequences of AUD in the U.S.,
the systemic nature of the disease, neurocircuitry and stages of AUD,
comorbidities, fetal alcohol spectrum disorders, genetic risk factors, and
pharmacotherapies for AUD.
micro teaching on communication m.sc nursing.pdfAnurag Sharma
Microteaching is a unique model of practice teaching. It is a viable instrument for the. desired change in the teaching behavior or the behavior potential which, in specified types of real. classroom situations, tends to facilitate the achievement of specified types of objectives.
Report Back from SGO 2024: What’s the Latest in Cervical Cancer?bkling
Are you curious about what’s new in cervical cancer research or unsure what the findings mean? Join Dr. Emily Ko, a gynecologic oncologist at Penn Medicine, to learn about the latest updates from the Society of Gynecologic Oncology (SGO) 2024 Annual Meeting on Women’s Cancer. Dr. Ko will discuss what the research presented at the conference means for you and answer your questions about the new developments.
Factory Supply Best Quality Pmk Oil CAS 28578–16–7 PMK Powder in Stockrebeccabio
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Hot Selling Organic intermediates
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Title: Sense of Smell
Presenter: Dr. Faiza, Assistant Professor of Physiology
Qualifications:
MBBS (Best Graduate, AIMC Lahore)
FCPS Physiology
ICMT, CHPE, DHPE (STMU)
MPH (GC University, Faisalabad)
MBA (Virtual University of Pakistan)
Learning Objectives:
Describe the primary categories of smells and the concept of odor blindness.
Explain the structure and location of the olfactory membrane and mucosa, including the types and roles of cells involved in olfaction.
Describe the pathway and mechanisms of olfactory signal transmission from the olfactory receptors to the brain.
Illustrate the biochemical cascade triggered by odorant binding to olfactory receptors, including the role of G-proteins and second messengers in generating an action potential.
Identify different types of olfactory disorders such as anosmia, hyposmia, hyperosmia, and dysosmia, including their potential causes.
Key Topics:
Olfactory Genes:
3% of the human genome accounts for olfactory genes.
400 genes for odorant receptors.
Olfactory Membrane:
Located in the superior part of the nasal cavity.
Medially: Folds downward along the superior septum.
Laterally: Folds over the superior turbinate and upper surface of the middle turbinate.
Total surface area: 5-10 square centimeters.
Olfactory Mucosa:
Olfactory Cells: Bipolar nerve cells derived from the CNS (100 million), with 4-25 olfactory cilia per cell.
Sustentacular Cells: Produce mucus and maintain ionic and molecular environment.
Basal Cells: Replace worn-out olfactory cells with an average lifespan of 1-2 months.
Bowman’s Gland: Secretes mucus.
Stimulation of Olfactory Cells:
Odorant dissolves in mucus and attaches to receptors on olfactory cilia.
Involves a cascade effect through G-proteins and second messengers, leading to depolarization and action potential generation in the olfactory nerve.
Quality of a Good Odorant:
Small (3-20 Carbon atoms), volatile, water-soluble, and lipid-soluble.
Facilitated by odorant-binding proteins in mucus.
Membrane Potential and Action Potential:
Resting membrane potential: -55mV.
Action potential frequency in the olfactory nerve increases with odorant strength.
Adaptation Towards the Sense of Smell:
Rapid adaptation within the first second, with further slow adaptation.
Psychological adaptation greater than receptor adaptation, involving feedback inhibition from the central nervous system.
Primary Sensations of Smell:
Camphoraceous, Musky, Floral, Pepperminty, Ethereal, Pungent, Putrid.
Odor Detection Threshold:
Examples: Hydrogen sulfide (0.0005 ppm), Methyl-mercaptan (0.002 ppm).
Some toxic substances are odorless at lethal concentrations.
Characteristics of Smell:
Odor blindness for single substances due to lack of appropriate receptor protein.
Behavioral and emotional influences of smell.
Transmission of Olfactory Signals:
From olfactory cells to glomeruli in the olfactory bulb, involving lateral inhibition.
Primitive, less old, and new olfactory systems with different path
Explore natural remedies for syphilis treatment in Singapore. Discover alternative therapies, herbal remedies, and lifestyle changes that may complement conventional treatments. Learn about holistic approaches to managing syphilis symptoms and supporting overall health.
New Directions in Targeted Therapeutic Approaches for Older Adults With Mantl...i3 Health
i3 Health is pleased to make the speaker slides from this activity available for use as a non-accredited self-study or teaching resource.
This slide deck presented by Dr. Kami Maddocks, Professor-Clinical in the Division of Hematology and
Associate Division Director for Ambulatory Operations
The Ohio State University Comprehensive Cancer Center, will provide insight into new directions in targeted therapeutic approaches for older adults with mantle cell lymphoma.
STATEMENT OF NEED
Mantle cell lymphoma (MCL) is a rare, aggressive B-cell non-Hodgkin lymphoma (NHL) accounting for 5% to 7% of all lymphomas. Its prognosis ranges from indolent disease that does not require treatment for years to very aggressive disease, which is associated with poor survival (Silkenstedt et al, 2021). Typically, MCL is diagnosed at advanced stage and in older patients who cannot tolerate intensive therapy (NCCN, 2022). Although recent advances have slightly increased remission rates, recurrence and relapse remain very common, leading to a median overall survival between 3 and 6 years (LLS, 2021). Though there are several effective options, progress is still needed towards establishing an accepted frontline approach for MCL (Castellino et al, 2022). Treatment selection and management of MCL are complicated by the heterogeneity of prognosis, advanced age and comorbidities of patients, and lack of an established standard approach for treatment, making it vital that clinicians be familiar with the latest research and advances in this area. In this activity chaired by Michael Wang, MD, Professor in the Department of Lymphoma & Myeloma at MD Anderson Cancer Center, expert faculty will discuss prognostic factors informing treatment, the promising results of recent trials in new therapeutic approaches, and the implications of treatment resistance in therapeutic selection for MCL.
Target Audience
Hematology/oncology fellows, attending faculty, and other health care professionals involved in the treatment of patients with mantle cell lymphoma (MCL).
Learning Objectives
1.) Identify clinical and biological prognostic factors that can guide treatment decision making for older adults with MCL
2.) Evaluate emerging data on targeted therapeutic approaches for treatment-naive and relapsed/refractory MCL and their applicability to older adults
3.) Assess mechanisms of resistance to targeted therapies for MCL and their implications for treatment selection
Prix Galien International 2024 Forum ProgramLevi Shapiro
June 20, 2024, Prix Galien International and Jerusalem Ethics Forum in ROME. Detailed agenda including panels:
- ADVANCES IN CARDIOLOGY: A NEW PARADIGM IS COMING
- WOMEN’S HEALTH: FERTILITY PRESERVATION
- WHAT’S NEW IN THE TREATMENT OF INFECTIOUS,
ONCOLOGICAL AND INFLAMMATORY SKIN DISEASES?
- ARTIFICIAL INTELLIGENCE AND ETHICS
- GENE THERAPY
- BEYOND BORDERS: GLOBAL INITIATIVES FOR DEMOCRATIZING LIFE SCIENCE TECHNOLOGIES AND PROMOTING ACCESS TO HEALTHCARE
- ETHICAL CHALLENGES IN LIFE SCIENCES
- Prix Galien International Awards Ceremony
TEST BANK for Operations Management, 14th Edition by William J. Stevenson, Ve...kevinkariuki227
TEST BANK for Operations Management, 14th Edition by William J. Stevenson, Verified Chapters 1 - 19, Complete Newest Version.pdf
TEST BANK for Operations Management, 14th Edition by William J. Stevenson, Verified Chapters 1 - 19, Complete Newest Version.pdf
2. Introduction
The infant mortality rate and neonatal mortality rate is
very high in India. The organization of a good quality
special care unit and paediatric ward is essential for reducing
the high mortality and improving the quality of care being
given to children.
During the past three decades, improvements in
diagnostic and therapeutic approaches in the care of high
risk infants have influenced their prognosis favourably.
Unfortunately, many neonatal care centres in developing
countries are unplanned and merely improvised.
3. Planning the paediatric ward
During planning of paediatric wards,
The paediatrician, and the nurse – in – charge of paediatric services
should be taken into confidence, so that the special care neonatal units
and paediatric wards are based on their opinions for meeting the
needs of infants during hospitalization
Emphasis should be laid on the following factors :
Asepsis
Warmth or thermo neutral environment
Adequate nutrition with human milk
Non – stimulating, noise free ward
Safety from all biological, physical and chemical hazards
The establishment of an ideal paediatric ward requires professional
expertise and sound infrastructure.
The philosophy of specialized conservative management of high
risk new born babies should be fully exploiting to bring down the
mortality rate in children
4. An ideal paediatric ward
should have facilities like :
Adequate space
Centralized oxygen and
suction facilities
Maintenance of thermo neutral
environment
Running water round the clock
Linens and disposables like
gloves, mask etc.,
Equipment's and articles of
general and special use like IV
stands, various procedure
trays, stethoscopes, torch,
syringes, bowels, kidney tray,
feeding cups, jugs, basin etc.,
Machines like incubator,
phototherapy unit, ventilator,
monitors, etc.,
Stationary as per need.
Toilets and bathrooms.
6. Physical
Facilities :
The neonatologist and nurse in-charge
must be involved while planning the unit
Location :
Neonatal unit should be located as close
as possible to the labour room and
obstetrics theatre
Adequate sunlight for illumination
Fair degree of ventilation of fresh air
7. Space:
۞500 to 600 gross square feet per bed
۞Space includes patient care area, storage
area, space for doctors, nurses, other
staff, office room area, seminar room
area, laboratory area, and space for
families
۞6 feet gap between two incubators for
adequate circulation and keeping the life
saving equipment
Ventilation:
& effective air ventilation
& central air conditioning
8. Floor plan :
Open encumbered space
The walls should be made of
washable glazed tiles and
windows should have two layers
of glass panes
Wash basin with elbow or floor
operated taps facility having
constant round the clock water
supply should be provided
The doors should be provided
with automatic door closers
Isolation room should be present
Lighting :
The whole unit must be well
illuminated and painted white
The lighting arrangements
should be provided uniform
shadow free, illumination of 100
foot candles at the baby’s level
9. Environmental
temperature &
humidity :
• The temperature inside the unit
should be maintained at 28’c +/-
2’c, while the humidity must be
above 50 %
• Portable radiant heater, infra red
lamps can be used
Communication system :
• The unit should have an
intercom facility & a direct
outside telephone facility
10. Acoustic
characteristics :
The ventilation system, incubators, air
compressors, suction apparatus and
many other devices used in the nursery
produce noise
Sound intensity in the unit should be
not exceed 75 decibels
Telephone rings and equipment alarms
should be replaced by blinking lights
Electrical outlets :
Each patient station should have 12 to
16 central voltage – stabilized
electrical outlets sufficient to handle
all pieces of equipment
An additional power plug point should
be preserved
There should be round the clock power
back up including provision of ups
11. Staff
pattern :
A direct who is a full time neonatologist
One neonatal physician is required for every 6 – 10 patients
One resident doctor should be present in the unit round the
clock
Anaesthetist – paediatric surgeon and paediatric pathologist are
essential persons in establishment of a good quality NICU
Other staff :
Respiratory therapist
Laboratory technician
Public health nurse
Social worker
Biomedical engineer
Clark
12. Nurses staffing
pattern :
A nurse : patient ratio of 1:1 maintained through out the
day time and night time is absolutely essential for babies
on multi system support including ventilator support.
For special care neonatal unit and intermediate care nurse
to patient ratio of 1:3 is ideal but 1:5 per shift is
manageable
Head nurse is the over all in-charge
In addition to basic nursing training for level-II care,
tertiary care requires, staff nurse need to be trained in
handling equipment, use of ventilators and initiation of
life support like use of bag and mask resuscitation,
endotracheal intubations, arterial sampling and so – on.
The staff must have a minimum 3 years work experience
in special care neonatal unit in addition to having 3
months hand on training in an intensive care neonatal
unit
13. Equipment :
Equipment and supplies should including all that is
necessary for resuscitation and intermediate care
areas.
Supplies should be kept close to the patient station
so that nurses do not have to go away from the
neonate unnecessarily and nurses time & skill are
used efficiently
There should be servo – controlled incubators and
open care systems for providing adequate warmth
Equipment's required as per the census of the unit
and the level of care providing facility
18. Laboratory facilities :
Micro chemistry laboratory
Well equipped to provide quick and reliable
Facilities for creative protein, total leukocyte counts
and microscopic examination of peripheral blood
Indications for the administration to NICU :
Babies less than 30 weeks
Very low birth weight baby of less than 1500 grams
Cardiopulmonary monitoring
Surfactant therapy
19. Contnd.,
• Convulsions
• Severe birth asphyxia
• Assisted ventilation
• Total parenteral nutrition
• Major surgery
• Babies need to be on special
vigilance care
• Opthalmia neonatrum babies
• Congenital syphilis babies
• Congenital malformation
babies
• Jaundice affected babies
20. BABY CARE AREA:
• BABY CARE AREA:
• • Areas and rooms for inborn or intramural
babies Examination area
• • Mother’s area for breast feeding and
expression of breast milk
• • Nurses’ station and charting area
• HAND-WASHING AND GOWNING ROOM:
• • Should be located at the entrance
• • Self-closing doors.
21. TRANSPORT OF
SICK INFANTS
• TRANSPORT OF SICK
INFANTS:
• • The goal of every
transport is to bring a
sick neonate to
specialized neonatal
center in a stable
condition.
• • To avoid
complications during
transport, the infant
should be as stable as
possible before
leaving the referring
hospital and warm
chain should be
maintained.
22. NURSES’ ROLE AND
REPONSIBILITY:
• NURSES’ ROLE AND REPONSIBILITY:
• To provide-
• • continuing, comprehensive
physical care and supportive
treatment
• • emotionally supportive care to
acutely ill children
• • empathetic support to parents and
families of children in the NICU
23. PHYSICAL
CARE OF
THE CHILD:
• PHYSICAL CARE OF THE CHILD:
• • Apply understanding of the
pathogenesis of the disease.
Perform complex technical skills to
monitor and support the child.
• • Perform nursing activities
related to life support of child.
• • Apply general nursing measures
for patient comfort and
prevention of complications.
• • Provide careful, continuous
clinical observations of the child.
24. MANAGEMENT OF NURSING CARE
• 1. Assessment
• 2. Monitoring physiological data
• 3. Safety
• 4. Respiratory support
• 5. Thermoregulation
• 6. Protection from infection
• 7. Hydration
• 8. Nutrition
• 9. Feeding resistance
• 10. Skin care
• 11. Administration of medication
• 12. Developmental outcome
• 13. Facilitating parent-infant relationship
• 14. Discharge planning and home care
• 15. Neonatal loss
25. Level – I (or)
primary care of
new born
Primary care is simple care of new
born who is normal (or) mild sick
This can be provided by mother, care
taker (or) I level health workers,
Trained Birth Attendant, Multi
Purpose Health Workers, Auxiliary
Nurse Midwives
Such care can be provided at home,
Primary Health Centre, Sub Centre,
Community Health Centre, Nursing
Homes, Taluk Hospitals
The aim is to provided optimal care
based on physiological needs of new
born
26. Component of primary care of new born
Preparation during Antenatal Period
Preparation of delivery & intra natal care
Resuscitation at birth
Physical examination & categorization of risk neonates
Maintenance of warmth to neonates
Breast feeding
Prevention of infection
Routine monitoring and management of minor ailments
Identification of danger signal indications of referral case during
transport
Follow up, growth monitoring, immunization
27. 1.Basic neonatal care
Good nutrition includes iron & folic acid for pregnant mother in
order to prevent malnutrition and to improve the growth of fetus
Immunization and adequate rest
2.Care of newborn at birth :
All deliveries should be at institution (or) attended by Trained Birth
Attendant
Sterile disposable kit can be used
Trained Birth Attendant can assess the new born at birth: cry,
breathing, color
Mouth to mouth resuscitation can be done when required
O2 cylinder must be available at centre
Weighing the baby to be done
If any emergency immediate referral service
28. 3.Warmth to neonates
• The hospital worker must be taught to dry the baby
immediately after birth
• Remove wet cloth wrap the baby in pre warmed cloth
• Head should be covered with cap
• Mother and hospital should be taught to keep the babies warm
by touching the trunk and extremities with the back of their
palm
• No bath should be given soon after birth
• At home room can be warmed by vacuum method
• At Centre over head lamp electrical bulbs can be very effective
in keeping the baby warm
• The best method of warmth is skin to skin, kangaroo method
29. 4.Promotion of breast
feeding
• Mother must be educated about the importance
of the breast feeding
• The baby must be put on to breast feeding after ½
hour of delivery if normal & there is no
complication in LSCS :4-6 hours
• Mother are encouraged to drink extra fluids and
addition 50% in order to maintain health
• 5. prevention of Infection
• Inj.TT 2 doses during AN period
• Using aseptic precaution during delivery to
prevent infection
• Keep delivery room clean, periodically cleaning
and fumigation of room is necessary
30. 6.Home care of LBW neonates
• Neonates below 1800 grams (or) more than 34 weeks of
gestation should be taken care at home
• If there is no sucking reflex feed with spoon
• Strict asepsis should be followed at home itself
• No self medication is encouraged at home
• 7.Identification and referral of high risk neonates:
• Hospital worker to be taught to identify high risk babies so that
timely referral can save life of the neonate
• Neonate at high risk are less than 1800 grams, less than 34
weeks of gestation, pale, cyanosed, rapid breathing more than
60/minute, persistent vomiting/diarrhoea, seizures, who fails to
pass urine / meconium with in 24 hours
31. level II care (or) Secondary of
new born
• The concept of participating mother in the case of new born under
the supervision of doctor, nurse are relevant the case they learnt at
hospital can be practiced at home confidentially
• The main care taken in level – II care needs physical space, trained
manpower
• Location :
• The level – II care should be close to the labor and delivery room
• There should be facility for new born unit so that sick babies can be
transferred quickly
• Nursery should not be located in first floor
• There should be adequate sunlight and illumination at nursery
32. Facilities for neonatal
resuscitation in labor
room
• A wall clock with seconds
• Warmer with radiant heat source
• Mucus extractor, suction apparatus
• Infant laryngoscope with neonatal size blade
• Proper neonatal size E.T. tubes
• Facility for bag and mask ventilation
• Mechanical ventilators
• O2 supply with flow meter
• Umbilical vein canulation set
• Thermometer
• Essential drugs needed for resuscitation such : adrenaline. I.V.Fluids, epinephrine,
Hco3
33. Function at level – II nursery :
• Pre term babies less than 33 to
36 weeks of gestation
• Babies with 1500 to 2000
grams and less than 4000
grams
• Babies with birth asphyxia
• Meconium aspirated
Respiratory Distress Syndrome
• Infant with abnormal behavior
(or) weight pattern
• Infant with metabolic,
hematologic problems
• Neonatal hyperbilirubinemia
needs phototherapy (or)
exchange transfusion
• High risk babies
34. Administrative aspects
• Well developed written protocol
• Admission discharge advice
• Orientation to new health
personnel
• Patient care routine and
proceeds
• In service training and education
• Written instruction about
handling of vacuum equipment
in the unit
• Instruction about the filling of
preformats discharge summary
and follow up
• Ongoing collection of monthly
and annual statistical data
35. Level – III (or)
Tertiary care of
the new born
• New born less than 1500 grams less than 32 weeks, critically ill
babies
• Level III care requires neonatal care experts, maternal – fetal
medicine experts
• Any children who needs intensive care such : hydrofetalis,
congenital heart disease, diaphragmatic hernia, abdominal wall
defects, neural tube defects, should be delivered level – III care
• Approximately 3-5% requires this type of care
36. Functions of level – III
nursing care :
• Resuscitation facilities ( all equipment's )
• Diagnosis and interventional therapy, fetal imaging and prenatal diagnosis of fetal
distress
• Development of fetal medicine to diagnose fetal disorders
• Continuous medical education for doctors, nurses in the form of lecture, seminar,
group discussion
• Documentation, records of all babies should be maintained
• Well equipped lab facilities for 24 hours
• Equipment facilities: open care system, infusion pumps, ventilators, monitors, ECG,
invasive monitors, pulse oxymeter
• Pediatrics under graduate and post graduate education
• Transport facilities – ambulance
• Follow up care