this is dealt about the pacemaker temporary and permanent its aim and basic indication for pacemaker breif history of pacemaker development its design and detailed indication of both temporary and permanent pacemaker then method of pacing which should be based on the patient ECG its parts and procedure and complication
this is dealt about the pacemaker temporary and permanent its aim and basic indication for pacemaker breif history of pacemaker development its design and detailed indication of both temporary and permanent pacemaker then method of pacing which should be based on the patient ECG its parts and procedure and complication
CHAPTER 1 SEMESTER V PREVENTIVE-PEDIATRICS.pdfSachin Sharma
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.
CHAPTER 1 SEMESTER V - ROLE OF PEADIATRIC NURSE.pdfSachin Sharma
Pediatric nurses play a vital role in the health and well-being of children. Their responsibilities are wide-ranging, and their objectives can be categorized into several key areas:
1. Direct Patient Care:
Objective: Provide comprehensive and compassionate care to infants, children, and adolescents in various healthcare settings (hospitals, clinics, etc.).
This includes tasks like:
Monitoring vital signs and physical condition.
Administering medications and treatments.
Performing procedures as directed by doctors.
Assisting with daily living activities (bathing, feeding).
Providing emotional support and pain management.
2. Health Promotion and Education:
Objective: Promote healthy behaviors and educate children, families, and communities about preventive healthcare.
This includes tasks like:
Administering vaccinations.
Providing education on nutrition, hygiene, and development.
Offering breastfeeding and childbirth support.
Counseling families on safety and injury prevention.
3. Collaboration and Advocacy:
Objective: Collaborate effectively with doctors, social workers, therapists, and other healthcare professionals to ensure coordinated care for children.
Objective: Advocate for the rights and best interests of their patients, especially when children cannot speak for themselves.
This includes tasks like:
Communicating effectively with healthcare teams.
Identifying and addressing potential risks to child welfare.
Educating families about their child's condition and treatment options.
4. Professional Development and Research:
Objective: Stay up-to-date on the latest advancements in pediatric healthcare through continuing education and research.
Objective: Contribute to improving the quality of care for children by participating in research initiatives.
This includes tasks like:
Attending workshops and conferences on pediatric nursing.
Participating in clinical trials related to child health.
Implementing evidence-based practices into their daily routines.
By fulfilling these objectives, pediatric nurses play a crucial role in ensuring the optimal health and well-being of children throughout all stages of their development.
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
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
The Importance of Community Nursing Care.pdfAD Healthcare
NDIS and Community 24/7 Nursing Care is a specific type of support that may be provided under the NDIS for individuals with complex medical needs who require ongoing nursing care in a community setting, such as their home or a supported accommodation facility.
ICH Guidelines for Pharmacovigilance.pdfNEHA GUPTA
The "ICH Guidelines for Pharmacovigilance" PDF provides a comprehensive overview of the International Council for Harmonisation of Technical Requirements for Pharmaceuticals for Human Use (ICH) guidelines related to pharmacovigilance. These guidelines aim to ensure that drugs are safe and effective for patients by monitoring and assessing adverse effects, ensuring proper reporting systems, and improving risk management practices. The document is essential for professionals in the pharmaceutical industry, regulatory authorities, and healthcare providers, offering detailed procedures and standards for pharmacovigilance activities to enhance drug safety and protect public health.
Explore our infographic on 'Essential Metrics for Palliative Care Management' which highlights key performance indicators crucial for enhancing the quality and efficiency of palliative care services.
This visual guide breaks down important metrics across four categories: Patient-Centered Metrics, Care Efficiency Metrics, Quality of Life Metrics, and Staff Metrics. Each section is designed to help healthcare professionals monitor and improve care delivery for patients facing serious illnesses. Understand how to implement these metrics in your palliative care practices for better outcomes and higher satisfaction levels.
Health Education on prevention of hypertensionRadhika kulvi
Hypertension is a chronic condition of concern due to its role in the causation of coronary heart diseases. Hypertension is a worldwide epidemic and important risk factor for coronary artery disease, stroke and renal diseases. Blood pressure is the force exerted by the blood against the walls of the blood vessels and is sufficient to maintain tissue perfusion during activity and rest. Hypertension is sustained elevation of BP. In adults, HTN exists when systolic blood pressure is equal to or greater than 140mmHg or diastolic BP is equal to or greater than 90mmHg. The
Telehealth Psychology Building Trust with Clients.pptxThe Harvest Clinic
Telehealth psychology is a digital approach that offers psychological services and mental health care to clients remotely, using technologies like video conferencing, phone calls, text messaging, and mobile apps for communication.
R3 Stem Cells and Kidney Repair A New Horizon in Nephrology.pptxR3 Stem Cell
R3 Stem Cells and Kidney Repair: A New Horizon in Nephrology" explores groundbreaking advancements in the use of R3 stem cells for kidney disease treatment. This insightful piece delves into the potential of these cells to regenerate damaged kidney tissue, offering new hope for patients and reshaping the future of nephrology.
2. TMT( Treadmill Test)
• It is a non-invasive method for evaluate ISCHEMIC
HEART DISEASE
• The patient usually exercise on a treadmill and is
continuously monitored
2
3. PROCEDURE
The test consist of walking in
monitor device
ECG will be recorded
through out the monitor
BP is also monitored
speed & grade changes
according to the protocol
3
4. INDICATIONS OF TMT
• Elicit abnormalities not present at rest
• Estimate functional capacity
• Estimate prognosis of CAD
• Likelyhood of coronary artery disease
• Extent of CAD
• Effect of CAD
• Evaluation&management of patients with wide variety of
cardiovascular conditions including valvular heart
disease,CHD,arrhythimias&peripheral arterial disease
4
5. CONTRAINDICATIONS OF TMT
ABSOLUTE
Acute MI within2-3 days
High risk unstable angina
Uncontrolled arrythmia
Symptomatic Severe AS
Acute Endocarditis,Myocarditis or Pericarditis
Decompensated Heart Failure
Acute Pulmonary Embolism or Pulmonary Infarction
Aortic dissection
RELATIVE
LMCA stenosis
High degree AV block
Electrolyte abnormalities
Tachy/Brady arrythmia
Mental /Physical in capability
Hypertrophic Cardiomyopathy
5
6. MASON- LIKER MODIFICATION
• Placement of electrode in
TMT is called MASON-
LIKER MODIFICATION
• RA&LA:Just below the clavicle on
corresponding sides
• V1-V6:Chest electrodes are place
same as in standard ecg
placement
• LL&RL: Just below the rib cage on
corresponding sides
6
7. METs (Metabolic equivalent term)
• It is most significant in TMT
• METs is a term commonly used clinically to express the
oxygen requirment of the work rate during an excercise
test on a treadmill
• One METs is equated with the resting metabolic
rate(~3.5ml of O2/kg body weight x min)
• METs=[speed×[0.1+(Grade×1.8)]+3.5]/3.5
7
8. Clinical Significance of METs For Maximum Excercise
METs ACTIVITY
1METs On Sitting
2-4 METs Light work around the house
Walking at 3-4 mph
>4-<10 METs Short running
Scrabbing floor
moving furnitures
>10 METs
Running>6-7mph
Heavy labour
Swimming
Foot ball
8
9. MYOCARDIAL OXYGEN DEMAND
• It is the amount of oxygen that the heart require to
maintain optimal function
• Factors influence myocardial oxygen demand
• 1.Heart rate
• 2.Blood pressue
• 3.LV contractility
• 4.LV wall stress(IV pressure/Wall thikness/Cavity size)
9
10. DUKE SCORE IN TMT
• Duke score is one of the tool for predicting the risk of
ischemia or infraction in myocardium
• The calculation is done based on the informations
obtained from an excercise test
• Duke score=Excercise time-(5×ST depression)-(4×angina score)
• (where 0= no angina,1=non-limiting angina, 2=excercise limiting
angina)
• A duke score >5 indicates low risk for cardiovascular events
10
12. BRUCE PROTOCOL
• It is the most commenly used protocol
• There are 7stages, most individuals are unable to
complete all of the stages
• Each stage has 3 min duration ,the treadmill speed
&incline is increased every 3 min
12
13. MODIFIED BRUCE PROTOCOL
• This protocol is most often used in older individuals or
those whose excercise capacity is limited by cardiac
disease
• It has 2 warm up stages,each lasting 3min
• The first stage is at 1.7mph and 0%&the second is at
1.7mph and5%
13
14. ACIP(Asymptomatic cardiac ischemia pilot)
PROTOCOL
• Developed to test patients with established CAD
• The ACIP Trial use 2 min stages with 1.5MET increment
between stages after 1-2 warm up stages with 1MET
increment
• Result in a linear increase in heart rate&distributing the
time to occurrence of ST segment depression over a
wider range of heart failure&exercise time than protocols
with more abrupt increment in work load between stages
14
15. MODIFIED ACIP PROTOCOL
• The modified ACIP protocol produce a similar aerobic
demand as the standard ACIP protocol for each minute of
excercise
• Well suited for short or older individuals who can’t keep
up with a walking speed of 3mph
15
16. CORNELS PROTOCOL
• The protocol is good for a wider range of fitness level
depending on starting grade
• Allow for gradual increase in grade &speed
• Started at 0%,5%,10% grade depending on fitness level
16
17. NAUGHTON &WEBER PROTOCOL
• This protocol is use 1-3 minute stages with 1METs
increment
• These protocol may be more suitable for patients with
limited excercise tolerance.Such as patients with
compensated congestive heart failure
17
18. NORMAL RESPONSE TO TMT
• HR increases
• BP increases
• Cardiac output increases
• Oxygen consumption increases
• Total peripheral resistance decreases
18
19. ABNORMAL RESPONSE TO TMT
• HR fails to rise above 120 or unstable to attain the HR of
85% of max
• Physicaly unstable to complete test
• Marked hypertention >260/115mmHg
• Chest pain and unusual shortness of breath
19
20. NORMAL ECG CHANGES DURING TMT
• QRS complex decreases in size
• PR,QRS,QT shortnes
• J point decreases resulting in upsloping of ST segment
• ST segment returns to baseline by 80 milliseconds
• PR segment may down slope
• R amplitude may decrease at rates >130
• P amplitude increases
• T wave decreases
20
21. ABNORMAL ECG CHANGES DURING TMT
• Horizontal or down sloping ST
segment
• ST segment depression or
elevation
• ST segment does not return to
baseline by 80milliseconds
• U or T wave inversion
• Dysrhythamias- rate
dependent blocks above first
degree,atrial flutter/fibrilation
21
22. Emergeny Medicines Used In TMT
❑Atropine: It increase heart rate,which improve hemodynamic stability
❑Adrenalin:To treat cardiac arrest and superficial bleeding
❑Metalar: To treat high BP and to prevent symptoms of angina, to reduce
risk of death rate after a heart attack
❑Lasix: To treate acute and chronic heart failure
❑Emset: To prevent nausea and vomitting
❑Dobutamine: Used to treat acute &potentially reversible heart failure
22
23. INDICATIONS TO STOP TMT
ABSOLUTE RELATIVE
Drop in systole BP>30mmHg Drop in systolic BP>10 mmHg
Moderate-severe angina ST depression>3mm
Increasing nervous system disorder Persisting SVT
Patient desire to stop Increasing chest pain
Pre -signs to poor perfusion ST elevation >1mm
Sustained VT Fatigue, shortness of breath 23
24. NEGATIVE TMT
⮚A negative TMT is declared when the patient can reach
target heart rate without showing any ECG changes
⮚But it would not mean that the blockage is zero
⮚It is meant only by the person performing the test
probably has a blockage of less than 70%
24
25. POSITIVE TMT
• ST segment depression or elevation of 1mm or
more is present in stress test ECG we can declare
it as a positive TMT
1.Mildly positive
2.Moderately positive
3.Strongly positive
25
26. TYPES OF POSITIVE TMT
1)mildly positive
• horizontal ST depression of 1-1.5 mm
• Slowly rising junctional depression,which remain depressed 1.5mm or more
than 80ms after the J point
2)moderately positive
• horizontal ST depression of 1.5-2.5mm
3)strongly positive
• flat ST depression of 2.5mm or more
• horizontal or down sloping ST depression appearing in first stage of
excercise &remaining for more than 8minutes into recovery
26
27. INCONCLUSIVE TMT
• An inconclusive test result is usually due to non-
diagnostic ECG changes
• When the test is terminated early due to exhaustion
• Before maximum HR or workload is reached
27
