By Q. Kelvin. Bluefield State College. 2018.

    Slide 35 Optic tract syndromes and lesions downstream along the visual pathway cause homonymous hemianopia order 5mg prednisone fast delivery, visual field loss through each eye restricted to the same side of the visual world buy prednisone 10mg visa. For example, complete congenital absence of an optic tract causes 150 completely congruous homonymous hemianopia. Acquired homonymous hemianopic field loss due to optic tract disease is usually grossly incongruous. For example, a left optic tract syndrome typically can cause nearly complete right-sided homonymous visual field loss through the right eye with incomplete right-sided homonymous field loss through the left eye. This pattern of field loss is termed incongruous and results because axons forming the optic tract are still relatively spatially segregated according to right and left eyes, hence a small lesion can affect axons from one eye more than axons from the other eye. Because of this spatial segregation of visual information, optic tract lesions can be associated with mild asymmetry in pupillary responses to light. Etiologies are usually structural or vascular, most commonly neoplasia in children and vascular compromise in adults. Slide 36 We can now appreciate that the completely congruous homonymous hemianopic visual field loss in figure D has limited localizing value. This pattern can result from large optic tract lesions that encompass all axons from each eye as well as from smaller lesions in the optic radiations where there is homogeneous mixing of axons carrying information from each eye to the level of individual ocular dominance columns. Localization in the presence of such congruity is accomplished by combining the pattern of visual loss with other deficits such as somatosensory or motor loss. Figures F-H are typical of lesions affecting the temporal, parietal, and occipital lobes. The lesion in Figure F involves the right optic radiation beneath the temporal lobe. The lesion in Figure G is due to watershed infarction following cardiac arrest at the right parietal- occipital junction with sparing of the macular representation. The lesion in Figure H is bilateral, asymmetric homonymous hemianopia with central macular preservation following bilateral infarction in the posterior cerebral artery circulations. Copper released from liver associated with Wilson’s disease does not only end up in peripheral Descemet’s membrane as Kayser-Fleischer rings. It becomes deposited throughout the body with early symptoms usually associated with predilection for deposition in basal ganglia. Slide 38 The description “cherry red spot” is not specific for acute retinal infarction immediately following central retinal artery obstruction. Storage material accumulates within retinal ganglion cell bodies in several metabolic lysosomal disorders. Because the ganglion cell layer is normally thickened in the macula, these distended cell bodies create a visible perifoveal opacification of the otherwise transparent retina. The prominence of the normal choroidal vasculature beneath the fovea is also described as a cherry red spot. Slides 39-40 Diseases causing pigmentary retinal degeneration share the disturbance of pigment within retinal pigment epithelium cells as well as migration of pigment from devitalized cells into the retina. Microaneurysms, tiny ectasias in capillary walls that develop after pericyte death, are the earliest clinical sign. Exudation of serum proteins and hemorrhage occur with moderately advanced disease. Ischemic retina produces angiogenic factors that promote growth of fragile neovascular tissue that bleeds, scars, and disturbs ocular anatomy and function. Similar compromise of the optic disc called diabetic papillitis results in swelling of the optic disc. Neovascular glaucoma develops when peripheral iris becomes scarred to peripheral cornea thereby blocking access of aqueous humor to the trabecular meshwork. Fluctuating serum glucose levels cause similar fluctuations in aqueous humor with correspond swelling and shrinkage of the crystalline lens leading to cataract formation. The earliest sign in the retinal vasculature is arteriolar narrowing because of auto-regulation and arteriolar spasm. Hemorrhage, exudation of large serum proteins, choroidal infarction, and swelling with eventual infarction of the optic disc can occur when the normal mechanisms of auto- regulation are overwhelmed.

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    Local side effects are more common with whole virus vaccines than subunit or split vaccines buy prednisone 40mg visa, and also more common with intradermal vaccination than intramuscular vaccination effective 20mg prednisone. Since the inactivated vaccines do not contain live virus, they cannot cause influenza infection – often respiratory illness is incorrectly attributed to influenza vaccination. Live attenuated virus vaccines do contain live virus; however, side effects are rare, with a runny nose, congestion, sore throat, and headache being the most commonly reported symptoms, with occasional abdominal pain, vomiting, and myalgia (Musana 2004). They are not recommended for use in children below the age of 5 years, although a study by Piedra et al. Controversies have arisen around the possibility of exacerbated asthma in children between 18-34 months of age (Bergen 2004, Black 2004, Glezen 2004). L – likelihood of transmission to high risk persons – healthcare workers and care providers can transmit influenza to patients, as can other employees in institutions serving the high risk population groups, as well as people living with individuals at high risk. U – underlying medical conditions such as diabetes mellitus, chronic heart or lung disease, pregnancy, cancer, immunodeficiency, renal disease, organ transplant re- cipients, and others. A – age > 65 years, or between 6-23 months of age Since the risk of influenza rises linearly from the age of 50 years, some promote the vaccination of those aged between 50 and 64 in addition to those above 65 years of age. In a study of health professional attitudes to such a policy in England, both sides were equally divided (Joseph 2005). In the era of a potentially pending pandemic, other groups also have importance for targeting – poultry workers in the Far East are being vaccinated to prevent infection with circulating human influenza strains. This vaccine will not protect against avian influenza strains, but will help prevent dual infection, if infection with avian influ- enza does occur, thereby reducing opportunities for reassortment of two strains in one human host. For the same reason, travelers to areas where avian influenza is present are advised to be vaccinated against human influenza (Beigel 2005). Elderly, non-institutionalized individuals with chronic heart or lung dis- eases, metabolic or renal disease, or immunodeficiencies. Other groups defined on the basis of national data and capacities, such as contacts of high-risk people, pregnant women, healthcare workers and others with key func- tions in society, as well as children aged 6–23 months. Out-of-home caregivers and household contacts of children aged 0-23 months South Africa has the following guidelines (summarised from Schoub 2005), divid- ing the population into 4 groups who may receive the vaccine –! Recommendation for Use 135 o Children with chronic pulmonary or cardiac diseases as well as immunosuppressed children. Category 2 – Contacts of high-risk persons - healthcare workers, caregiv- ers of the elderly and high-risk patients, and persons living with high risk persons. People six months of age and older with chronic illnesses requiring regular medical follow-up or hospitalisation in the previous year! People six months of age and older with chronic illnesses of the pulmonary or circulatory systems (except asthma)! Children and teenagers aged six months to 18 years on long-term aspirin therapy (because aspirin treatment puts them at risk of Reye’s syndrome if they develop a fever)! Canada, al- though having similar recommendations for priority groups, actively encourages vaccination of everyone above the age of 6 months (Orr 2004). However, frontline workers such as healthcare personnel, as well as police forces and military personnel, might be high priority targets. Minor illnesses such as mild upper respiratory tract infections or allergic rhinitis are not con- traindications. Caution should be used when giving the vaccine to those who may come into con- tact with immunocompromised patients, as this caused controversy in 2004 when vaccine supplies were limited (Manion 2005). Both studies conclude that inadvertent vaccination or exposure to the at- tenuated virus is unlikely to result in significant adverse effects. However, it should be noted that small numbers of patients were involved, and until sufficient data are obtained, extreme caution should be exercised. In addition, o safety in asthma sufferers and patients with underlying medical conditions that put them at risk for wild type influenza infections has not been established. Strategies for Use of a Limited Influenza Vaccine Supply Antigen sparing methods Several methods of reducing the amount of antigen in vaccine preparations have been investigated. Most importantly are the use of adjuvants and the exploitation of a part of the immune system designed to elicit an immune response – dendritic cells.

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    Clean the upper outer quadrant with alcohol swab: • Stretch the skin and inject the medicine • Draw back the piston (plunger) to check whether or not you are in the blood vessel ( if blood returns buy 40mg prednisone overnight delivery, withdraw and get a new needle & reinject in a different spot) • Push the drug slowly into the muscle • When completed order prednisone 5 mg mastercard, withdraw the needle and massage the area with swab gently to and absorption. M Injection is the deltoid muscle and the outer part of the thigh (quadriceps muscle) 3. Purpose • When the given drug is irritating to the body tissue if given through other routes. Basic Nursing Art 118 • When it is particularly desirable to eliminate the variability of absorption. Give very slowly unless there is an order to give it fast (Normally 40-60 drops is given in 1 minute). Intravenous Therapy Definition: It is the administration of a large amount of fluid into the system through a vein. Purpose • To maintain fluid & electrolyte balance • To introduce medication particularly antibiotics. V pole • Adhesive tape • Medication chart Preparation of the Patient Since an infusion therapy takes several hours to complete, the patient should first be made conformable. Basic Nursing Art 121 • Support needle with sterile gauss or sterile cotton balls • If necessary to keep it in proper position in the vein • Anchor the I. Infusion bottle should be labeled with the date, time infusion is started, drops per minute, and any added medications. If more than one bottle as used in 24 hrs, it should be labeled as bag 1,2,3, and so on. Usual areas used for intravenous infusion are: a) The median basilica vein on the inner surface of the arm. Blood Transfusion Basic Nursing Art 122 Definition: It is the giving of blood to a patient through a vein Propose • To counteract severe hemorrhage and replace the blood loss. Factor and the nd expiration date with a 2 number, blood group, Rh-factor and the nd expiration date with a 2 nurse or a doctor. Always member to have anti- histamine injection ready in case a patient has reaction from the blood. Be familiar with the most usual symptoms of blood reactions which are:- Immediate Reaction: a) Headache b) Backache c) Chills d) Pyrexia e) Rash of the skin (urticaria ) Late Reaction a) Dyspnea b) Renal shut down in severe cases c) Heamaturia d) Chest pain e) Rigor (rigidity) G. Purpose ƒ When vein puncture is difficult ƒ When pro longed, continuos infusion is needed ƒ When a secure infusion is essential ƒ When rapid infusion is important ƒ When emergency situation combine these indications. Equipment Sterile Basic Nursing Art 125 • Dressing forceps (1) • Cotton balls in a gallpot • Solution for cleansing • Gloves • Hole sheet (Fenestrated towel) • Syringe and needle • Scalpel (surgical knife) • Mosquito forceps (3) • Aneurysm needle (1) • Silk • Intravenous cannula or vein flow (2) • Small, straight scissors (1) • Small, curved scissors (1) • Needle holder (1) • Round needle (1) • Cutting needle (2) • Tissue forceps (1) • Gauze (slit at one end) • Probe • Fine dissecting forceps (1) • Local anesthesia Clean • Receiver of dirty swab • Stand light, if available • Adhesive tape (plaster) • Dressing scissors Procedure • Bring equipment to the bedside of the patient • Explain procedure to the patient • Shave the area, if needed • Position the patient properly Basic Nursing Art 126 • The nurse will then open the set and pour the cleaning lotion in to the galipot for the doctor • The doctor then scrub his hands, put on gloves, clean and drape the area, he will insert the I. V • The channel is securely tied with silk and skin is closed • The nurse dresses the site and secure it with adhesive plaster • Remove all equipment, wash and send for sterilization H. Inhalation Definition: Inhalation is the act of drawing in of gas vapor or steam into the lungs for therapeutic purposes It could be in dry, moist or vapour form. Oxygen Administration: Purpose To provide and maintain a normal supply of o2 for blood, and tissues o2 may be administered in three ways. Giving O2 by mask There are many kinds of masks used for O2 administration the common ones are: 1. B mask provides an oxygen concentration of 90% with the flow meter set at 7 liters/minute. This kind of mask allows the patient to eat, Basic Nursing Art 127 drink and to expectorate. Equipment - A cylinder of O2 with a reducing value and pressure tubing to be connected with the O2 cylinder. If the patient is unconscious, a tray containing a galipot of saline or water, wooden applicator and receiver for soiled applicator is necessary in order to clean the nostrils Procedure 1. Connect the mask to tubing and open the fine adjustment to the required rate of flow. Stay with the patient till he is reassured if it is his first time to be on oxygen therapy.

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    Development depends on the appropriate and sustainable use of the environment and the management of natural resources buy generic prednisone 10mg line. Given the high environmental degradation in drought-prone and pastoral areas cheap 10mg prednisone fast delivery, environmental rehabilitation (soil and water conservation) is an essential element. They are important approaches which aim to tackle the causes of food insecurity and the serious problems created by these for social wellbeing and economic growth in Ethiopia. The interventions are aimed at reducing excess mortality that might result during the first few weeks to months of the emergency situation. A programme to control diarrhoeal diseases and follow up (surveillance) of epidemic occurrence. Coordination of operational partners, including the sector offices and non- governmental organisations working in your community. Responses include those that are curative, such as therapeutic care and those that are preventative of further problems such as improving the water supply and sanitation to prevent epidemics of disease. Ideally a standard general ration of food is provided in order to satisfy the full nutritional needs of the affected population. In a population affected by an emergency, the general ration should be calculated in such a manner as to meet the population’s minimum energy, protein, fat and micronutrient requirements for light physical activity. Within these two approaches there are two kinds of programmes: supplementary feeding programmes (which may be ‘targeted’ or ‘blanket’)and therapeutic feeding programmes. Targeted supplementary feeding programmes In this approach supplementary food is restricted to those individuals identified as the most malnourished, or most nutritionally vulnerable or at risk during nutritional emergencies. This includes pregnant women, lactating mothers and young children under five years of age (see Figure 8. The main objective of a targeted supplementary feeding programme is to prevent the moderately malnourished from becoming severely malnourished and consequently, to reduce the prevalence of severe acute malnutrition and associated mortality. The milk is rich in micronutrients and is the first phase of a feeding regimen—eight times daily— that helps the body recover from the shock of malnutrition and conditions it to digest food. In conclusion, food insecurity obliges households to use coping strategies that can, over time, lead to poor health consequences especially for vulnerable segments of the population. These include: blanket supplementary feeding, targeted supplementary feeding and general ration distribution. Write your answers on your study diary and discuss them with your Tutor at the next Study Support meeting. You can check your answers with the Notes on the Self Assessment Questions at the end of the Module. You need to know how to identify acute malnutrition and how to differentiate between severe acute malnutrition, and moderate acute malnutrition. In this session, you will apply your knowledge of nutritional assessment to decide whether children are acutely malnourished or not. Finally, you will learn the principles of management of people with moderate acute malnutrition. You will look at the management of people with severe acute malnutrition in Study Session 10. Learning Outcomes for Study Session 9 When you have studied this session, you should be able to: 9. When the nutritional status of a child deteriorates in a relatively short period of time, the child can be said to have acute malnutrition. Oedema in children almost always signifies the presence of severe acute malnutrition. Indicator Severe acute Moderate acute No acute malnutrition malnutrition malnutrition Children(6monthsupto18years) W/H (weight for Less than 70% of 70-79. The presence of one criterion is sufficient to categorise a patient as malnourished. If there is any one indicator from the severe acute malnutrition column, then the child or adult is classified as severely malnourished. If there is no indicator in the severe column, and there is at least one indicator in the moderate acute malnutrition column, then the child or adult is classified as moderately malnourished.

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