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Reported any abnormalities Measuring blood pressure: by two steps before measured: 1 buy cheap advair diskus 250 mcg online asthma symptoms rib pain. Set up manometer properly Measured blood pressure in two steps: 1) Palpatory method 1)Identified approximate systolic pressure by palpating brachial pulse 172 Fundamental of Nursing Procedure Manual Step Satisfied Unsatisfied Not Performed 9 order generic advair diskus asthmatic bronchitis webmd. Reported any abnormal findings 173 Fundamental of Nursing Procedure Manual General Comments: Well performance ( ) Just performed ( ) Poor performance ( ) Students given poor performance need to receive the back evaluation cheap advair diskus 250 mcg with amex asthma bronchitis emphysema. Feedback from instructor 174 Fundamental of Nursing Procedure Manual Appendix 2 Checklist for Bedmaking: un-occupied bed Student: ( ) Instructor: ( ) Evaluated on : ( ) Step Satisfied Unsatisfied: Not (by one nurse) ( Put comments ) Performed 1. Started bedmaking from right side of bed: 1) Apply a bottom sheet and smoothed out it 2) Made a mitered corner in top corner of bottom sheet and secondly in end corner of bottom sheet 3) Tucked bottom sheet under mattress 4) Applied mackintosh and draw sheet to bed correctly and tucked the edge under mattress tightly 7. Move to left side of bed: 1) Spread bottom sheet smoothly over the bed 2) Mitered corner in top corner and in end corner of bottom sheet 3) Tucked bottom sheet under mattress 4) Pulled mackintosh and draw sheet from the center of bed and tucked tightly under mattress 8. Returned to right side again: 1) Applied top sheet to the end of bed in right side of bed 2) Place blanket at the level of 1 feet below from the top edge of bed. Spread the blanket to the end of bed in right side of bed 3) Made cuff out of top edge of sheet over blanket 11. Mitered corner in end of bed and tucked in remained portion of top sheet with blanket tightly under mattress. Moved to left side: 1) Pull the top sheet and smoothed it over to bed 2) Smoothed blanket over to bed 3) Made cuff out of top edge of sheet over blanket 4) Mitered corner in end of bed and tucked the remained tightly under mattress 10. Applied a clean pillowcace over pillow and placed it at the center of bed neatly 11. Perform hand hygiene General Comments: Well performance ( ) Just performed ( ) Poor performance ( ) Students given poor performance need to receive the back evaluation. Feedback from instructor 176 Fundamental of Nursing Procedure Manual Appendix 3 Checklist for Changing occupied bed Student: ( ) Instructor: ( ) Evaluated on : ( ) Step Satisfied Unsatisfied: Not (by one nurse) ( Put comments ) Performed 1. Removed personal belongings from bed-side and put them into bedside locker or safe place. Started bedmeaking from right side: 1) Fanfolded (or rolled) soiled lines from the side of bed and wedged them close to the client 2) Clean the surface of mattress by wet and dry sponge cloth 3) Placed bottom sheet evenly on the bed folded lengthwise with the center fold 4) Adjusted bottom sheet and Mitered a corner in top corner of bottom sheet 5) Tighten bottom sheet and mitered a corner in end corner of bottom sheet. Returned to right side: 1) Placed clean top sheet at the top side of the soiled top sheet 2) Asked the client to hold the upper edge of clean top sheet 3) Held both the top of the soiled sheet and the end of the clean sheet with right hand. Made cuff out of top edge of sheet 6) Tucked the lower ends securely under mattress. Feedback from instructor 179 Fundamental of Nursing Procedure Manual Appendix 4 Checklist for making post-operative bed Student’s name: ( ) Instructor: ( ) Evaluated on : ( ) Step Satisfied Not Not Remarks Satisfied done 1. On the other side, did not tuck the top bedding: 1) Brought head and foot corners of them at the center of bed and formed right angles 2) Folded back suspending portion and rolled to opposite 1/3 side of bed. Removed pillow and placed in opposite side from entering client (or in foot side) 9. Transferred client: 1) Helped lifting client into the bed 2) Covered client by top bedding immediately 3) Tucked top bedding and mitered corners in end of bed General Comments: Well performance ( ) Just performed ( ) Poor performance ( ) Students given poor performance need to receive the back evaluation. Feedback from instructor 180 Fundamental of Nursing Procedure Manual References: A. Castaldi: Clinical Nursing Skills & Techniques, 6th edition,2005, Elsevier Mosby, Penelope Ann Hilton: fundamental nursing skills, I. Produced in collaboration with the Ethiopia Public Health Training Initiative, the Carter Center, the Ethiopia Ministry of Health, and the Ethiopia Ministry of Education. Important Guidelines for Printing and Photocopying Limited permission is granted free of charge to print or photocopy all pages of this publication for educational, not-for-profit use by health care workers, students or faculty. All copies must retain all author credits and copyright notices included in the original document. Under no circumstances is it permissible to sell or distribute on a commercial basis, or to claim authorship of, copies of material reproduced from this publication. Except as expressly provided above, no part of this publication may be reproduced or transmitted in any form or by any means, electronic or mechanical, including photocopying, recording, or by any information storage and retrieval system, without written permission of the author or authors. This material is intended for educational use only by practicing health care workers or students and faculty in a health care field. The skill of basic nursing art for the beginning public heath nurse is of paramount important. The purpose of preparing this lecture note is to equip public health nurses with basic nursing skills, which will enable them to dispatch their responsibility as well as to develop uniformity among Ethiopian Public Health Nurse Training Higher Institutions. The lecture note contains basic selected topics, which are relevant to their scope.
Plasma Protein Exogenous agents such as oxygen generic 250 mcg advair diskus fast delivery asthma definition queue, once into the bloodstream order advair diskus toronto asthma symptoms better with exercise, may bind more or less loosely to plasma proteins (F5 advair diskus 500mcg amex asthma treatment emergency room. Plasma protein can have a substantial role in sequestering toxicants and in slowing their release to body tissues, thereby attenuating toxic shocks. Venoms are animal poisons evolved from saliva, that are injected and distributed in the body by the victim’s circulation. Blood contains one million different protein types, with abundances that span the black mamba paralyze victims. Cardiotoxins auto-immunity), while B lymphocytes produce anti-bodies that from jellyfish attack the heart muscle. Monocytes are immune arrow tips by some hunters induce total body system shutdown. Some hormones are homeostatic control compatibility for transfusion, systems that keep constant the concentration of hemoglobin. Formation of Blood Cells the 5 to 6 liters of blood in the human body originate from undifferentiated mesenchymal cells or pluripotent stem cells found primarily in the bone marrow (long bones, ribs, sternum) and, in some species, in the spleen. These stem cells give rise to erythrocytes, a series of "white" blood cells or leukocytes, and thrombocytes or platelets (F5. Stem cell proliferation is under the influence of specific cytokines (poietins) arising from different tissues in response to changes in physiological status. Cytokines have a major role in stabilizing blood cell populations by stimulating the activity of cells, much like hormones do. Hormones circulate in nanomolar (10 M) concentrations that usually vary by less than one order of magnitude. But on the second child, problems start to appear because she has developed antibodies to the Rh factor, and the problems grow with each successive F5. So, 5 % of healthy patients the presence of cobalt ions will result in the release of fall outside of the “norm”. Statistically, if you have 20 or 30 erythropoietin from the kidney to stimulate the production of individual tests run as part of a panel, chances are that 1 or 2 more erythrocytes. In contrast, hyperoxia or polycythemia will will be slightly outside the normal range. We briefly inhibit (or shut down) the release of erythropoietin, decreasing summarize below the meaning of common blood variables for 1 erythrocyte synthesis. The normal range for a fasting glucose is 60 -109 Any reduction in the populations of needed cells will induce an mg/dl. Diabetes is associated with a fasting plasma glucose of attempt by humoral regulators to restore it. Sometimes a glucose tolerance test, which involves giving a sugary drink followed by several blood the stem cells are at the root of the tree (F5. However, more recent evidence suggests Potassium is controlled very carefully by the kidneys, critical that stem cells from the bone marrow can form nerve, muscle to the proper functioning of nerves and muscles, particularly and other types on non-blood cells. Any value outside the expected range, high or low, Implicit in this blood system, and probably in other body requires medical evaluation. Stem cells given rise to two are taking a diuretic or heart medication (Digitalis, Lanoxin, daughters, one of which replaces the mother, while the other etc. Blood Tests are numerous causes of high and low sodium levels, but the Blood tests are extensively used in evaluating the health status most common causes of low sodium are diuretic usage, of animals and humans. Laboratory results may be outside of diabetes drugs like chlorpropamide, and excessive water intake the normal range because of factors such as race, diet in patients with heart or liver disease. Creatine PhosphoKinase is an enzyme useful for diagnosis of Uric Acid is normally excreted in urine. This enzyme is the first to associated with gout, arthritis, kidney problems and the use of be elevated after a heart attack (3 to 4 hours). They are an index of overall health and Alcohol and a number of diseases cause high values. A/G Ratio is the mathematical relationship They may be elevated from liver problems, hepatitis, excess between the above. Total Cholesterol: A high cholesterol level is a risk factor Alkaline phosphatase is an enzyme found primarily in for heart and atherosclerosis.
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The uterine artery brings blood supply to the organ laterally through the broad ligament at about the level of the isthmus order advair diskus 100 mcg amex definition asthma bronchiale im kindesalter. It provides ascending and descending branches passing upward and downward in the thickness of the broad ligament discount 250mcg advair diskus with mastercard definition of asthma uk. The ascending branch of the uterine artery anastomoses with the ovarian artery superiorly buy advair diskus 100mcg online asthma treatment plan student. Observe also on this diagram the important relationship of the uterine artery with the ureter passing in the pelvic cavity toward the bladder. At that level, the ureter is passing less than one inch lateral to the cervix, immediately inferior to the artery coming in at that level. Observe on this mid-sagittal section the presence of two spaces called pouches, the uterosacral pouch and the rectouterine pouch. These 2 pouches are lined by the parietal peritoneum covering the superior aspect of the pelvic cavity. The uterovesical pouch is anterior to the uterus, between the bladder and the uterus with the rectouterine pouch being between the uterus and the rectum posteriorly. Observe the relationship between the posterior vaginal fornix and the Pouch of Douglas. This close relationship allows a technique called culdocentesis (needle aspiration through the vagina). The broad ligament is the name given to the peritoneum layer covering the uterus and associated organs. It is classically described as having an anterior and posterior lamina and 3 named parts: the mesovarium, the mesosalpinx and the mesometrium. This mid-sagittal section from our Grant’s Dissector allows the visualization of the 3 named parts of the broad ligament: the mesovarium is the shelf-like structure horizontally extending posteriorly toward the ovary the mesosalpinx is the portion of the uterus immediately inferior to the uterine (Fallopian tube) the mesometrium is the portion of the broad ligament that extends laterally from the right and left lateral borders of the uterus, under the level of the ovaries. The anterior and posterior lamina of the uterus can best be demonstrated at that level. The broad ligament and the round ligament were already mentioned in this lecture with the round ligament (a derivative or remnant of the gubernaculum passing anterior to/through the inguinal canal). Other ligaments anchor the uterus and vagina in the pelvic floor: the pubocervical ligament, the cardinal (transverse cervical) ligament and the uterosacral (rectouterine) ligament. Observe on this diagram the round ligament passing anteriorly to/through the inguinal canal. Observe on this new Netter plate (existing th only in the 4 edition) the other ligaments anchoring the uterus and vagina in the pelvic floor: the uterosacral (rectouterine) ligament, the cardinal (transverse cervical) ligament and the pubocervical ligament. Note on this plate how the uterine artery uses the cardinal ligaments to enter the lateral aspect of the broad ligament at the level of the isthmus. The ligaments described in the previous slides maintains the orientation and provide some support of the uterus and associated structures with the levator ani muscles providing strong support to the uterus. Observe again on these Netter plates the anterior and posterior as well as lateral fornices. Note on this slide from Moore and Dalley how a vaginal speculum can be used to spread the vaginal walls to examine the cervix of the uterus. The complex drainage of the ovaries, uterus and vagina is summarized on this slide. Take this opportunity to review the main nodes draining organs and structures of the pelvic cavity: the para-aortic nodes, the internal and external nodes, the superficial and deep inguinal nodes. Produced in collaboration with the Ethiopia Public Health Training Initiative, the Carter Center, the Ethiopia Ministry of Health, and the Ethiopia Ministry of Education. Important Guidelines for Printing and Photocopying Limited permission is granted free of charge to print or photocopy all pages of this publication for educational, not-for-profit use by health care workers, students or faculty. All copies must retain all author credits and copyright notices included in the original document. Under no circumstances is it permissible to sell or distribute on a commercial basis, or to claim authorship of, copies of material reproduced from this publication. Except as expressly provided above, no part of this publication may be reproduced or transmitted in any form or by any means, electronic or mechanical, including photocopying, recording, or by any information storage and retrieval system, without written permission of the author or authors. This material is intended for educational use only by practicing health care workers or students and faculty in a health care field. Human Anatomy and Physiology Preface There is a shortage in Ethiopia of teaching / learning material in the area of anatomy and physicalogy for nurses.
Typical kinds of communication in different Phases of Groups Techniques for Decision Making in Small Groups There are three useful procedures for a small group of people that helps them to arrive at a decision for a problem discount advair diskus 100 mcg fast delivery asthma symptoms 3 dpo. Each procedure provides a different but practical approach to group decision-making purchase advair diskus online from canada asthma symptoms burning chest. Brainstorming enhances by allowing them to express their ideas freely without being inhibited by the fear of criticism generic 100mcg advair diskus visa asthma symptoms in adults cough. The assumption that underlies brainstorming is that if group members feel uninhibited about expressing their ideas, more ideas and better ideas will emerge from the group. Build and improve on ideas already expressed For brainstorming to work effectively; group members must not judge or criticize the ideas expressed by others. This nonjudgmental approach is often difficult to master because most people are conditioned to evaluate the pros and cons of a new idea as soon as it 189 Nursing Leadership and Management is introduced in a group. Criticism, is however counterproductive of the overall goal of brainstorming because members who fear criticism will most likely express conventional solutions and withhold wild or innovative ideas. Nominal Group Technique This technique is designed to promote the expression of many high quality ideas from members who initially work independently and then share their ideas with the group. Unlike the free willing expression of ideas in brainstorming, this technique uses a more systematic procedure that ensures that each member will have the opportunity to present an idea to the group for consideration. The overall goal of the nominal group technique is to arrive at a group decision that represents a pooled judgment that is based on the independent ideas of all group members. Group members, without any discussion, independently write down their ideas about a problem or task 2. This process continues 190 Nursing Leadership and Management around the table until all ideas have been expressed. Members discuss each of the recorded ideas for the purpose of clarification and evaluation 4. The final group decision emerges from the pooled outcome of the independent rankings. The format utilizes both the independent thinking of members (example, writing down ideas) and group interaction, (example, discussing the ideas) in order to arrive at a joint decision. The nominal group technique is used when individuals can be brought together at one location and when the problem requires a relatively quick solution. In health care, this method can be used for determining program priorities or for identifying needed program content in areas such as staff development. As a decision-making procedure, the nominal group technique has several advantages. First, when members are given opportunity to write down their own ideas independently, their ideas tend to be more 191 Nursing Leadership and Management problem centered and of higher quality. Second, the technique allows all members an equal opportunity to express their views and also an equal opportunity to vote on the group decision. This technique prevents a group discussion from being dominated by a few influential members. On the negative side this technique can be time consuming and somewhat difficult to implement in all situations. Delphi Method the Delphi method of decision-making was initially developed by Dalkey and his associates (1963, 1969) who used this method to gather data from groups of experts for the purpose of making forecasts about future events. More recently, in health care, the Delphi method has been employed to determine priorities in such areas as nursing research and cancer nursing. In this method, participants are usually in different geographical locations and they do not meet for face-to-face interaction as they typically do in the brainstorming and nominal group technique procedures. The Delphi method structures the group communication process so that a large group of individuals can work together as a whole and solve a complex problem. Group members are sent a questionnaire which asks them to identify important questions or issues on a specific topic 2. Members responses are compiled and a second questionnaire is administered which asks members to assess and prioritize the list of responses derived from the first round 3. Each time the priorities of members are summarized and narrowed down to those, which are the most important.