This document discusses the organization and management of neonatal intensive care units (NICUs). It outlines three levels of neonatal care from normal to intensive care and describes the personnel, physical facilities, equipment, and neonatal transfer services needed for properly functioning NICUs. The goal is to provide specialized care to sick newborns to reduce infant mortality rates in India.
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.
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, 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.
With having many challenges surrounding the nurse midwives in India, she still delivers good obstetrician care and can bringing good health of mother and child. can decrease ratio of LSCS. looking for many established centers/clinics/hospitals/birthing centers which runs by midwives independently in India
Role of Child Health Nurse in caring of Hospital ChildAlka Singh
Subject : Child Health Nursing. Topic : Role Of Child Health Nurse In Child care at Hospital, Nursing Diagnosis, Various Measures to make hospital Child Friendly, Nurses Role in Care Of Toddlers, Infants, School Children, Adolescent.
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...
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.
With having many challenges surrounding the nurse midwives in India, she still delivers good obstetrician care and can bringing good health of mother and child. can decrease ratio of LSCS. looking for many established centers/clinics/hospitals/birthing centers which runs by midwives independently in India
Role of Child Health Nurse in caring of Hospital ChildAlka Singh
Subject : Child Health Nursing. Topic : Role Of Child Health Nurse In Child care at Hospital, Nursing Diagnosis, Various Measures to make hospital Child Friendly, Nurses Role in Care Of Toddlers, Infants, School Children, Adolescent.
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.
Seminar on NICU (organization of neonatal intensive care unit)ABHIJIT BHOYAR
This PPT belongs to organization and setup of neonatal intensive care unit services, levels, transport and management. it includes the role of the nurse. and images used in intensive care services.
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
Similar to Organization of neonatal care, services,transport,nicu,organization and management (20)
DEFINITION OR MEANING OF MENSTRUAL (REPRODUCTIVE) CYCLE:-
Menstruation (Greek word, men-month) is monthly uterine bleeding out flowing through vagina into vulva for 4-5 days every 28 days (24-35 days)during reproductive life of a woman from menarche to menopause.
The Menstrual cycle of 28 days starts on day of onset of menstruation and ends at day 28 on start of next mens.
The cycle consists of a series of changes taking place concurrently in the ovaries and uterine lining, stimulated by changes in blood concentration of hormones.
General Physiological changes during puerperiumPRANATI PATRA
introduction
Estrogen and progesterone levels decrease markedly after expulsion of the placenta, reaching their lowest levels 1 week into the postpartum period.
The estrogen levels in non lactating women begin to increase by 2 weeks after birth, and higher by postpartum day 17.
If trauma to the urethra and bladder occur during the birth process, the bladder wall becomes edematous, often with small areas of hemorrhage.
Birth-induced trauma increased bladder capacity and the effects of anesthesia combine to cause a decrease in the urge to void.
introduction
anatomy and physiologic changes-UTERUS: At the end of third stage of labour, the uterus is in the midline , about 2cm below the level of umbilicus and weight 1000g
INTRODUCTION
DEFINITION
TYPES
CAUSES
MANAGEMENT-Management of 3rd stage bleeding
Actual management
MANAGEMENT OF 3RD STAGE BLEEDING
Steps of management
1. Placental site bleeding-
To palpate the fundus and massage the uterus to make it hard. The massage is to be done by placing four fingers behind the uterus and thumb in front.
To start crystalloid solution (NS or RL) with oxytocin (1L with 20 units) at 60 drops per minute and to arrange for blood transfusion if necessary.
Oxytocin 10 unit IM or methergine 0.2 mg is given intravenously.
To catheterize the bladder.
To give antibiotics (Ampicillin 2gm and Metronidazole 500mg IV)
2. Management of traumatic bleed
The uterovaginal canal is to be explored under general anesthesia after the placenta is expelled and haemostatic sutures are placed on the offending sites.
STEPS OF MANUAL REMOVAL OF PLACENTA
The patient is placed in lithotomy position. With all aseptic measures, the bladder is catheterized.
One hand is introduced into the uterus in cone shaped manner following the cord. While introducing the hand, the labia are separated by the fingers at the other hand.
Counter pressure on the uterine fundus is applied by the hand placed over the abdomens. The abdominal hand should steady the fundus and guide the movement of the fingers inside the uterine cavity till the placenta is completely separated.
Taking-In Phase
It takes 2-3 days, during which time the mother’s first concern is with her own needs (sleep and food).
The woman reacts passively, mostly dependent on others to meet her needs.
She is quite talkative during this phase about every detail of her labor and delivery experience
Taking-Hold Phase (Taking Responsibility as a Mother)
It starts the 3rd day postpartum
She progresses from the passive individual to the one who is in command of the situation.
This phase lasts about 10 days.
Once the mother has taken control of her physical being and accepted her role as a mother, she is able to extend her energies to her mate and other children.
Letting-go Phase
This generally occurs when the mother returns home.
In this phase there are two separations that the mother must accomplish.
One is to realize and accept physical separation from the infant. The other is to relinquish her former role as a childless person and accept the enormous implications and responsibilities of her new situation.
Letting-go Phase
This generally occurs when the mother returns home.
In this phase there are two separations that the mother must accomplish.
One is to realize and accept physical separation from the infant. The other is to relinquish her former role as a childless person and accept the enormous implications and responsibilities of her new situation.
Physical Assessment is necessary to identify individual needs or potential problems
Explain to pt purposes of the examination.
Obtain her consent.
Record your findings and report results to the mother.
Ensure privacy and environment where the mother can lie on her back with her head supported.
Ensure bladder is empty & lay patient supine with legs flexed.
The midwives hands should be clean and warm
Definition-
The destructive operations are designed to diminish the bulk of the fetus so as to facilitate easy delivery through the birth canal
types
Craniotomy
Eviceration
Decapitation
Cleidotomy
CRANIOTOMY
Definition
It is an operation to make a perforation on the fetal head to evacuate the contents followed by extraction of the fetus
DECAPITATION
Definition
It is a destructive operation whereby the fetal head is severed from the trunk and the delivery is completed with the extraction of the trunk and that of the decapitated head per vaginam
CLEIDOTOMY
Definition
The operation consist of reduction in the bulk of the shoulder girdle by division of one or both the clavicles
Indications
Dead fetus with shoulder dystocia
Procedure
The clavicles are divided by the embryotomy scissors or long straight scissors introduced under the guidance of left two fingers placed inside the vagina
AMNIOINFUSION--
definition-An amnioinfusion is a technique of instilling an isotonic fluid {such as a normal saline or lactated ringer’s solution} into the amniotic cavity during labor to relieve umbilical cord compression and alleviate fetal distress from severe prolonged variable decelerations in the presence of oligohydramnios.
INDICATIONS
Fetal heart rate abnormalities
APGAR scores for those with low scores
Asphyxia during time of birth
Decreasing the rates of cesarean birth related with FHR problem
PROCEDURE
The amnio infusion procedure involves the use of an intrauterine pressure catheter (IUPC), or a single or double lumen type of IUPC.
The IUPC has been designed to attain an accurate monitoring of uterine contractions among women in the intrapartum period.
It has a special port from which the saline fluid or lactated ringer’s solution is being injected, passing through the tubing and going its way into the uterus.
An IUPC is inserted through standard technique once the membranes ruptures, and then it is attached to intravenous extension tubing. If IUPC is not available, a pediatric nasogastric tube can be used instead.
Lactated ringer’s solution without dextrose is infused into the amniotic cavity; normal saline can be an acceptable fluid alternative
Assisting Physician with Amnioinfusion
Explain the procedure to the patient.
Assist in dorsal recumbent position. Assist with draping and exposing vaginal area.
Connect IUPC tubing to IV fluid, flush
Connect the catheter to the monitor cable
Assist physician with insertion of double lumen IUPC and connect IV tubing to the amnioport to begin amnioinfusion.
The placenta is said to be retained when it is not expelled from the uterus even 30 minutes after the delivery of the baby
Manual placenta removal is a procedure to remove a retained placenta from the uterus after childbirth.
Mannual removal of placenta is done under GA.
Patient placed in lithotomy position
Bladder is catheterized
newborn assessment-
intriduction-Definition of neonatal period:
A period from birth 4 weeks postnatal.
The exam will cover the following:
Record date and time of exam
General assessment and measurements
Skull bones
Face
Mouth & palate
Nose
Ears
Eyes
Chest
Abdomen
Arms
Hands
Legs
Feet
Genitals
Anus
Spine
Skin
reflxes-
Obsterics and Gynaecology-
introduction-Preventive obstetrics is the concept of prevention or early detection of particular health deviations through routine periodic examinations and screening .
The concept of preventive obstetrics concerns with the concepts of the health & wellbeing of the mother her baby during the antenatal,intranatal & postnatal period.
The goal of the preventive obstetrics is the delivery of a healthy infant by a healthy mother at the end of a healthy pregnancy.
Pregnancy & child birth normal physiological
process that change from conception to
delivery.
Objectives
To promote , protect and maintain the health of the mother during pregnancy.
To detect “high risk” cases and give them special attention
To foresee complications and prevent them.
To remove anxiety and dread associated with delivery
physiology and management of third stage of labourPRANATI PATRA
OBSTETRICS & GYNAECOLOGICAL NURSING
physiology and management of third stage of labour-introduction
labour
stages of labor
physiology
management of third stage of labour.
OBSTETRICS & GYNAECOLOGICAL NURSING-
MINOR AILMENT DURING PREGNANCY-
INTRODUCTION-Many women experience some minor
disorder during pregnancy.
These disorder should be treated adequately as they may escalate and become life-threatening.
DEFINITION-“The minor complaints of pregnant women that occur due to physiological alterations of hormones and other causative factors which can be managed without medical interventions.”
- Every system of body may affected by pregnancy.
OBSTETRICS & GYNAECOLOGICAL NURSING
GENETIC COUNSELLING DURING PREGNANC
INTRODUCTION-
COUNSELLING-Counselling is consultation, mutual interchange of opinions, deliberating together.A process in which the counsellor assist the counselee .
Provides concrete, accurate information about inherited disorders.
Provides information about prognosis and follow up.
Discuss ways in which disease can be prevented.
Telehealth Psychology Building Trust with Clients.pptxThe Harvest Clinic
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Medical Technology Tackles New Health Care Demand - Research Report - March 2...pchutichetpong
M Capital Group (“MCG”) predicts that with, against, despite, and even without the global pandemic, the medical technology (MedTech) industry shows signs of continuous healthy growth, driven by smaller, faster, and cheaper devices, growing demand for home-based applications, technological innovation, strategic acquisitions, investments, and SPAC listings. MCG predicts that this should reflects itself in annual growth of over 6%, well beyond 2028.
According to Chris Mouchabhani, Managing Partner at M Capital Group, “Despite all economic scenarios that one may consider, beyond overall economic shocks, medical technology should remain one of the most promising and robust sectors over the short to medium term and well beyond 2028.”
There is a movement towards home-based care for the elderly, next generation scanning and MRI devices, wearable technology, artificial intelligence incorporation, and online connectivity. Experts also see a focus on predictive, preventive, personalized, participatory, and precision medicine, with rising levels of integration of home care and technological innovation.
The average cost of treatment has been rising across the board, creating additional financial burdens to governments, healthcare providers and insurance companies. According to MCG, cost-per-inpatient-stay in the United States alone rose on average annually by over 13% between 2014 to 2021, leading MedTech to focus research efforts on optimized medical equipment at lower price points, whilst emphasizing portability and ease of use. Namely, 46% of the 1,008 medical technology companies in the 2021 MedTech Innovator (“MTI”) database are focusing on prevention, wellness, detection, or diagnosis, signaling a clear push for preventive care to also tackle costs.
In addition, there has also been a lasting impact on consumer and medical demand for home care, supported by the pandemic. Lockdowns, closure of care facilities, and healthcare systems subjected to capacity pressure, accelerated demand away from traditional inpatient care. Now, outpatient care solutions are driving industry production, with nearly 70% of recent diagnostics start-up companies producing products in areas such as ambulatory clinics, at-home care, and self-administered diagnostics.
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This content provides an overview of preventive pediatrics. It defines preventive pediatrics as preventing disease and promoting children's physical, mental, and social well-being to achieve positive health. It discusses antenatal, postnatal, and social preventive pediatrics. It also covers various child health programs like immunization, breastfeeding, ICDS, and the roles of organizations like WHO, UNICEF, and nurses in preventive pediatrics.
How many patients does case series should have In comparison to case reports.pdfpubrica101
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https://pubrica.com/academy/case-study-or-series/how-many-patients-does-case-series-should-have-in-comparison-to-case-reports/
Navigating Challenges: Mental Health, Legislation, and the Prison System in B...Guillermo Rivera
This conference will delve into the intricate intersections between mental health, legal frameworks, and the prison system in Bolivia. It aims to provide a comprehensive overview of the current challenges faced by mental health professionals working within the legislative and correctional landscapes. Topics of discussion will include the prevalence and impact of mental health issues among the incarcerated population, the effectiveness of existing mental health policies and legislation, and potential reforms to enhance the mental health support system within prisons.
CRISPR-Cas9, a revolutionary gene-editing tool, holds immense potential to reshape medicine, agriculture, and our understanding of life. But like any powerful tool, it comes with ethical considerations.
Unveiling CRISPR: This naturally occurring bacterial defense system (crRNA & Cas9 protein) fights viruses. Scientists repurposed it for precise gene editing (correction, deletion, insertion) by targeting specific DNA sequences.
The Promise: CRISPR offers exciting possibilities:
Gene Therapy: Correcting genetic diseases like cystic fibrosis.
Agriculture: Engineering crops resistant to pests and harsh environments.
Research: Studying gene function to unlock new knowledge.
The Peril: Ethical concerns demand attention:
Off-target Effects: Unintended DNA edits can have unforeseen consequences.
Eugenics: Misusing CRISPR for designer babies raises social and ethical questions.
Equity: High costs could limit access to this potentially life-saving technology.
The Path Forward: Responsible development is crucial:
International Collaboration: Clear guidelines are needed for research and human trials.
Public Education: Open discussions ensure informed decisions about CRISPR.
Prioritize Safety and Ethics: Safety and ethical principles must be paramount.
CRISPR offers a powerful tool for a better future, but responsible development and addressing ethical concerns are essential. By prioritizing safety, fostering open dialogue, and ensuring equitable access, we can harness CRISPR's power for the benefit of all. (2998 characters)
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India Clinical Trials Market: Industry Size and Growth Trends [2030] Analyzed...Kumar Satyam
According to TechSci Research report, "India Clinical Trials Market- By Region, Competition, Forecast & Opportunities, 2030F," the India Clinical Trials Market was valued at USD 2.05 billion in 2024 and is projected to grow at a compound annual growth rate (CAGR) of 8.64% through 2030. The market is driven by a variety of factors, making India an attractive destination for pharmaceutical companies and researchers. India's vast and diverse patient population, cost-effective operational environment, and a large pool of skilled medical professionals contribute significantly to the market's growth. Additionally, increasing government support in streamlining regulations and the growing prevalence of lifestyle diseases further propel the clinical trials market.
Growing Prevalence of Lifestyle Diseases
The rising incidence of lifestyle diseases such as diabetes, cardiovascular diseases, and cancer is a major trend driving the clinical trials market in India. These conditions necessitate the development and testing of new treatment methods, creating a robust demand for clinical trials. The increasing burden of these diseases highlights the need for innovative therapies and underscores the importance of India as a key player in global clinical research.
Defecation
Normal defecation begins with movement in the left colon, moving stool toward the anus. When stool reaches the rectum, the distention causes relaxation of the internal sphincter and an awareness of the need to defecate. At the time of defecation, the external sphincter relaxes, and abdominal muscles contract, increasing intrarectal pressure and forcing the stool out
The Valsalva maneuver exerts pressure to expel faeces through a voluntary contraction of the abdominal muscles while maintaining forced expiration against a closed airway. Patients with cardiovascular disease, glaucoma, increased intracranial pressure, or a new surgical wound are at greater risk for cardiac dysrhythmias and elevated blood pressure with the Valsalva maneuver and need to avoid straining to pass the stool.
Normal defecation is painless, resulting in passage of soft, formed stool
CONSTIPATION
Constipation is a symptom, not a disease. Improper diet, reduced fluid intake, lack of exercise, and certain medications can cause constipation. For example, patients receiving opiates for pain after surgery often require a stool softener or laxative to prevent constipation. The signs of constipation include infrequent bowel movements (less than every 3 days), difficulty passing stools, excessive straining, inability to defecate at will, and hard feaces
IMPACTION
Fecal impaction results from unrelieved constipation. It is a collection of hardened feces wedged in the rectum that a person cannot expel. In cases of severe impaction the mass extends up into the sigmoid colon.
DIARRHEA
Diarrhea is an increase in the number of stools and the passage of liquid, unformed feces. It is associated with disorders affecting digestion, absorption, and secretion in the GI tract. Intestinal contents pass through the small and large intestine too quickly to allow for the usual absorption of fluid and nutrients. Irritation within the colon results in increased mucus secretion. As a result, feces become watery, and the patient is unable to control the urge to defecate. Normally an anal bag is safe and effective in long-term treatment of patients with fecal incontinence at home, in hospice, or in the hospital. Fecal incontinence is expensive and a potentially dangerous condition in terms of contamination and risk of skin ulceration
HEMORRHOIDS
Hemorrhoids are dilated, engorged veins in the lining of the rectum. They are either external or internal.
FLATULENCE
As gas accumulates in the lumen of the intestines, the bowel wall stretches and distends (flatulence). It is a common cause of abdominal fullness, pain, and cramping. Normally intestinal gas escapes through the mouth (belching) or the anus (passing of flatus)
FECAL INCONTINENCE
Fecal incontinence is the inability to control passage of feces and gas from the anus. Incontinence harms a patient’s body image
PREPARATION AND GIVING OF LAXATIVESACCORDING TO POTTER AND PERRY,
An enema is the instillation of a solution into the rectum and sig
Antibiotic Stewardship by Anushri Srivastava.pptxAnushriSrivastav
Stewardship is the act of taking good care of something.
Antimicrobial stewardship is a coordinated program that promotes the appropriate use of antimicrobials (including antibiotics), improves patient outcomes, reduces microbial resistance, and decreases the spread of infections caused by multidrug-resistant organisms.
WHO launched the Global Antimicrobial Resistance and Use Surveillance System (GLASS) in 2015 to fill knowledge gaps and inform strategies at all levels.
ACCORDING TO apic.org,
Antimicrobial stewardship is a coordinated program that promotes the appropriate use of antimicrobials (including antibiotics), improves patient outcomes, reduces microbial resistance, and decreases the spread of infections caused by multidrug-resistant organisms.
ACCORDING TO pewtrusts.org,
Antibiotic stewardship refers to efforts in doctors’ offices, hospitals, long term care facilities, and other health care settings to ensure that antibiotics are used only when necessary and appropriate
According to WHO,
Antimicrobial stewardship is a systematic approach to educate and support health care professionals to follow evidence-based guidelines for prescribing and administering antimicrobials
In 1996, John McGowan and Dale Gerding first applied the term antimicrobial stewardship, where they suggested a causal association between antimicrobial agent use and resistance. They also focused on the urgency of large-scale controlled trials of antimicrobial-use regulation employing sophisticated epidemiologic methods, molecular typing, and precise resistance mechanism analysis.
Antimicrobial Stewardship(AMS) refers to the optimal selection, dosing, and duration of antimicrobial treatment resulting in the best clinical outcome with minimal side effects to the patients and minimal impact on subsequent resistance.
According to the 2019 report, in the US, more than 2.8 million antibiotic-resistant infections occur each year, and more than 35000 people die. In addition to this, it also mentioned that 223,900 cases of Clostridoides difficile occurred in 2017, of which 12800 people died. The report did not include viruses or parasites
VISION
Being proactive
Supporting optimal animal and human health
Exploring ways to reduce overall use of antimicrobials
Using the drugs that prevent and treat disease by killing microscopic organisms in a responsible way
GOAL
to prevent the generation and spread of antimicrobial resistance (AMR). Doing so will preserve the effectiveness of these drugs in animals and humans for years to come.
being to preserve human and animal health and the effectiveness of antimicrobial medications.
to implement a multidisciplinary approach in assembling a stewardship team to include an infectious disease physician, a clinical pharmacist with infectious diseases training, infection preventionist, and a close collaboration with the staff in the clinical microbiology laboratory
to prevent antimicrobial overuse, misuse and abuse.
to minimize the developme
One of the most developed cities of India, the city of Chennai is the capital of Tamilnadu and many people from different parts of India come here to earn their bread and butter. Being a metropolitan, the city is filled with towering building and beaches but the sad part as with almost every Indian city
Organization of neonatal care, services,transport,nicu,organization and management
1. ORGANIZATION OF NEONATAL CARE,
SERVICES,TRANSPORT,NICU,ORGANIZATION AND
MANAGEMENT OF NURSING SERVICES IN NICU
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.
• Neonatal intensive care units(NICU) are highly
specialized areas in a hospital that cater to the
needs of all types of sick newborn babies.
3. PURPOSES
• To document the need for such unit in a given set-
up
• Assessment of need based on the existing patient
load and type of illness cared for in the set-up
• To determine the availability of committed and
appropriately trained staff, adequate financial
resources and other important considerations.
4. • I-NORMAL NEONATAL CARE(LEVEL-1)-
This is care given, usually by the mother in a
postnatal ward, supervised by the nurse and doctor
but requiring minimal medical or nursing advice.
• II-SPECIAL CARE NURSERY(LEVEL-2)-
Care given in a special care nursery which provides
observation, treatment and monitoring falling short
of intensive care but exceeding normal routine care.
5. • III-INTENSIVE NEONATAL (LEVEL-3)-
Care given in an intensive care nursery for seriously
ill neonates who require intensive skilled
management by nursing and medical staff.
6. EXAMPLES OF LEVELS OF NEONATAL CARE
1.NORMAL NEONATAL CARE(LEVEL-1)
Babies with mild medical conditions who can be
observed in level-1 neonatal care include babies
with G6PD deficiency, babies of hepatitis B carrier
mothers, babies with mild congenital
malformations(eg-polydactyly ,pre-auricular tags,
hydrocele etc) and babies receiving phototherapy,
at the discretion of the specialist in charge.
7. • Babies born to mothers with maternal
complications like DM, pyrexia, prolonged rupture
of membrane, mild meconium staining, but who are
free from all clinical manifestations of illness are
also included.
• The emphasis is to provide mother craft and the
encouragement of breastfeeding.
8. 2.SPECIAL CARE NURSERY(LEVEL-2)
• All low birth weight infants 2000gm and below.
• All preterm deliveries 35wks and below
• Neonates with Apgar score of 4-6 at five
minutes,and/or requiring any form of resuscitation
at birth
• Babies who require continous monitoring of
respiration or heart rates by apnoea monitor, pulse
oximetry
• Babies who are receiving additional oxygen
9. • Babies who are receiving intravenous glucose,
electrolyte solutions, antibiotics.
• Babies who are being tube feed
• Babies receiving phototherapy
• Babies with persistent hypothermia of 36c and
below
• Babies with congenital malformations that require
special care
10. 3. NEONATAL INTENSIVE CARE UNIT(LEVEL-3)
• Critically ill babies receiving assisted ventilation
• Recurrent apnea
• Who have had major surgeries like PDA
• Perinatal asphyxia(Apgar score of 3 or less at 5
minute)
• Severe meconium aspiration syndrome
11. • Infant weighing less than 1250gms or preterm
deliveries below 30wks
• Babies with convulsions
• Partial or total parenteral nutrition
12. EQUIPMENT RECOMMENDED FOR DIFFERENT
LEVELS OF NEONATAL INTENSIVE CARE
1. Special care nursery level-2
• Incubator or cot adequate for temperature control
• Oxygen analyzer
• Apnoea alarm
• Infusion pump
• Phototherapy unit
• Facilities for frequent ABG monitoring
• Access to equipment for radiological examination
13.
14. NICU
• NICU stands for neonatal intensive care unit also
called a special care nursery. These nurseries care
for babies who born early, who have problems
during delivery, or who develop problems while still
in the hospital.
15. 1.PERSONNEL-
• Doctor incharge of NICU-
• The neonatal intensive care unit shall be under the
charge of an accredited paediatrician who has the
necessary training and experience in neonatal
intensive care or its equivalent.
• Nurses in NICU-
16. • At least 60% of the total nursing complement
• Level-3- the minimum ratio of nurse to baby shall
be 1:1.at least 50% of registered nurses on duty
each shift shall have the relevant training in
neonatal care.
• Level-2- the minimum nurse to baby ration shall be
1:2. There shall be at least one registered nurse
with the relevant training on duty.
17. • Patients- an admitting paediatrician is designated to
be responsible for each neonate admitted to the
NICU
Others-
• At least 1 sweeper and one helper should be
available
• A medico-social worker who can talk parents,
ensure bills are paid, fix appointment for varies
check-up
18. • A biomedical engineer should be available on call
for uninterrupted functioning of all equipment
• A ward clerk will be helpful in maintaining store and
patient records, corresponding with referring
doctors and help in other administrative work.
19. 2. PHYSICAL FACILITY-
• Space-
Each infant should be provided with a minimum
area of 100sq ft or 10metersq. However additional
space would be needed to provide for special
facilities.
20. • Location-
The neonatal unit should be located as close as
possible to the labour room and obstetric operation
theatre, to facilitate prompt transfer of sick and
high risk infants. The nursery should not be located
on the top floor of the hospital, there should be
adequate sunlight to enhance brightness and
provide UV rays to augment asepsis.
21. • Floor-
The unit facility should preferably be in a square
space so that abundant open berred space is
available. The walls should be made of washable
tiles and windows should have two layers of glass
pares to ensure some measure of heat and sound
insulation. Adequate wash basins having constant
water supply should be provided.
22. • Ventilation-
Effective air ventilation is essential to reduce
nosocomial infection. The most satisfactory
ventilation is achieved with laminar air flow system
• Lighting-
Nursery must be well-illuminated and painted white
or off-white to permit prompt detection of jaundice
or cyanosis. It can be best achieved by cool,
fluorescent tubes. Spot lights should be present for
performing various procedures.
23. • Environmental temperature and humidity-
The temperature in the nursery must be maintained
around 26c in order to minimize the effects of
thermal stress on the babies. The air movements
should be so designed that drought is minimized.
24. • Communication system-
The nursery should be provided with an intercom
system so that additional can be called for helping
case of an emergency without leaving the sick
infant.
• Electrical outlets-
There should be adequate number of electrical
sockets at a height of 4-5ft attached to a common
ground. Each infant must be provided with at least
8 electrical outlets.
25. 3. GENERAL SUPPORT SPACE-
Clean utility/ soiled utility area-
• It should be designed for storage of supplies
frequently used in care of newborn such as diapers,
linen, charts and gowns.
• Soiled utility space is essential for storing used and
contaminated material before its removal from the
care area.
26. Nursing station-
• Charting space at each bedside should be provided
• An additional separate area or desk for tasks. Such
as compiling detailed records, completing
requisitions and telephone communication should
be provided.
28. NEONATAL TRANSFER SERVICES
• A transfer service is concerned with organizing and
implementing the transfer of babies and or mothers
from within a defined geographical area.
TYPES OF TRANSFER SERVICES-
• Inutero transfer
• Exutero transfer
29. 1.INUTERO TRANSFER-(based on clinical and
operational patient priority)
• Unplanned(time-critical) transfer-
Transfer of babies from units in the network inorder
to access intensive care or specialist services.
• Unplanned (emergency/urgent) transfer-
Transfer of babies from units in the network in
order to access intensive care or specialist services
30. • Planned (next few days) transfer-
Transfer of babies from units in the network for
investigation and treatment or continuing intensive
care, either to other units in the network or to units
outside the network.
31. 2. EX UTERO TRANSFER(based on clinical priority)-
• Unplanned acute transfers of mothers for specialist
maternal or anticipated neonatal care which cannot
be provided locally, either to other units in the
network or to units outside the network(e.g. other
designated tertiary center)
