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These chemicals are intentionally inhaled to blood pressure normal child discount inderal 80 mg overnight delivery produce a state that resembles alcohol intoxication with initial excitation arrhythmia medications buy generic inderal 80 mg, drowsiness hypertension guidelines jnc 7 purchase inderal 40mg without a prescription, lightheadedness arteria elastica 40x inderal 80mg for sale, and agitation c. The abusers of these inhaled agents are often called huffers, sniffers, baggers, or snorters these individuals often present after inhaling an aerosol or gas with a loss of consciousness and the presence of the aerosol can or residue/paint around or in the mouth, nose, and oral pharynx d. A prototype agent is identified with each region of the effected airway respiratory track for mild to moderate exposures, as severe concentrated exposures of many of these agents overlap in signs and symptoms the deeper the symptoms are in the respiratory track and the slower the rate of symptom onset the less water soluble the airway respiratory irritant a. Inhalants of abuse (volatile solvents, cosmetics/paints, propellants/asphyxiants/nitrous oxide) g. High concentrations and or protracted exposure may develop non-cardiac pulmonary edema q. Often have none of the above symptoms for first half hour to several hours then are much milder until more severe lower respiratory tract symptoms develop i. Hydrogen sulfide A direct neurotoxin and is rapidly absorbed through lung generating systemic effects a. Distinctive rotten egg smell which rapidly causes olfactory fatigue/loss of sense of smell b. Hydrogen sulfide is known as the ?knock down gas because of near immediate and sudden loss of consciousness with high concentrations h. Heavier than air displacing oxygen from low lying areas and closed spaces causing direct asphyxia b. Make sure the scene is safe as many gases are heavier than air and will build up in low lying areas. Pertinent cardiovascular history or other prescribed medications for underlying disease 13. Administer (humidified if available) oxygen and if hypoventilation, toxic inhalation or desaturation noted, support breathing a. Maintain the airway and assess for airway burns, stridor, or airway edema and if indicated, perform intubation early (recommendation to avoid supraglottic airways cricothryoidotomy may be required in rarer severe cases b. This medication should be repeated at this dose with unlimited frequency for ongoing distress 4. Treat topical chemical burns [see appropriate Toxins and Environmental section guideline(s)] 10. In severe respiratory irritation, in particular hydrogen sulfide, with altered mental status and no improvement with removal from the toxic environment, administer oxygen (humidified if available) as appropriate with a target of achieving 94-98% saturation consider consultation for transfer to a hyperbaric oxygen therapy Medication Administration 1. Generally, speaking to patients with exposure to highly soluble airway/respiratory irritants you will find that they have self-extricated due to the warning properties such as the smell, rapidity of onset of irritation, and other symptoms 2. Airway respiratory irritants can exacerbate underlying reactive airway diseases. As patients may be off gassing (particularly hydrogen sulfide and hydrogen cyanide) in the back of the transport vehicle, it is recommended to have adequate ventilation of the patient compartment 3. Removal from the toxic environment, oxygen (humidified if available), general supportive therapy, bronchodilators, respiratory support, and time are core elements of care as there are no specific antidotes for any of these inhaled agents with the exception of heavy metals that may be chelated by physicians after agent identification 4. Hydrogen sulfide causes the cells responsible for the sense of smell to be stunned into inaction and therefore with a very short exposure will shut down and the exposed victim will not perceive the smell yet the victim continues to absorb the gas as it is still present 5. Household bathroom, kitchen, and oven cleaners when mixed can generate a varied of these airway respiratory irritants (ammonia, chloramine, and chlorine gas releases are particularly common). A very common exposure is to chloramine, a gas liberated when bleach (hypochlorite) and ammonia are combined. Chloramine then hydrolyzes in the distal airways and alveoli to ammonia and hypochlorous acid 7. Some inhalants can cause the heart to beat rapidly and erratically and cause cardiac arrest b. This syndrome most often is associated with abuse of butane, propane and effects of the chemicals in the aerosols Pertinent Assessment Findings 1. Patient may describe a specific odor (chlorine swimming pool smell, ammonia smell, fresh mowed hay smell [phosgene]) which may be helpful but should not be relied upon as the human nose is a poor discriminator of scent 2. Baydala L, Canadian Paediatric Society, First Nations, Inuit and Metis Health Committee. Effects of infusion of human methemoglobin solution following hydrogen sulfide poisoning. Exaggerated responses to chlorine inhalation among persons with nonspecific airway hyperreactivity. Occupationally related hydrogen sulfide deaths in the United States from 1984 to 1994. Acute accidental exposure to chlorine gas in the Southeast of Turkey: a study of 106 cases. High-dose hydroxocobalamin administered after H2S exposure counteracts sulfide poisoning induced cardiac depression in sheep. Exposure to identifiable agents that are not intended to cause significant injury or fatality Exclusion Criteria 1. Exposure to chlorine, phosgene, ammonia or other agents that are intended to cause significant injury or fatality 2. Move affected individuals from contaminated environment into fresh air if possible 2. Irrigation with water or saline may facilitate resolution of symptoms and is recommended for decontamination of dermal and ocular exposure 5. Exposed individuals who are persistently symptomatic warrant further evaluation and treatment per local standards Patient Safety Considerations 1. Toxicity is related to duration of exposure and concentration of agent used (exposure in non-ventilated space) 2. Traumatic injury may result when exposed individuals are in proximity to the device used to disperse the riot control agent. Toxicity is related to time of exposure and concentration of agent used (exposure in non ventilated space). Symptoms begin within seconds of exposure, are self-limited and are best treated by removing patient from ongoing exposure. A randomized controlled trial comparing treatment regimens for acute pain for topical oleoresin capsaicin (pepper spray) exposure in adult volunteers. Revision Date September 8, 2017 292 Hyperthermia/Heat Exposure Aliases Hyperthermia, heat cramps, heat exhaustion, heat syncope, heat edema, heat stroke Definitions 1. As it progresses tachycardia, hypotension, elevated temperature, and very painful cramps occur. Heat Stroke: occurs when the cooling mechanism of the body (sweating) ceases due to temperature overload and/or electrolyte imbalances. When no thermometer is available, it is distinguished from heat exhaustion by altered level of consciousness 4. Heat Syncope: is a transient loss of consciousness with spontaneous return to normal mentation attributable to heat exposure 5. Heat Edema: is dependent extremity swelling caused by interstitial fluid pooling Patient Care Goals 1. Mitigate high risk for agitation and uncooperative behavior Patient Presentation Inclusion Criteria 1. Excited delirium [see Agitated or Violent Patient/Behavioral Emergency guideline] Exclusion Criteria 1. Confined space Pediatric Considerations: Children left in cars who show signs of altered mental status and elevated body temperature should be presumed to have hyperthermia 3. Place on cardiac monitor and record ongoing vital signs and level of consciousness 7. If temperature is greater than 104?F (40?C) or if altered mental status is present, begin active cooling by: a. Continually misting the exposed skin with tepid water while fanning the victim (most effective) c. Monitor for arrhythmia and cardiovascular collapse (see Cardiovascular section guidelines) 11. All patients suffering from life threatening heat illness (including heat stroke) should be transported to the hospital Patient Safety Considerations Consider use of physical securing devices (see Agitated or Violent Patient/Behavioral Emergency guideline) to protect vascular access sites. Patients at risk for heat emergencies include neonates, infants, geriatric patients, and patients with mental illness 2.

It can come on at any time blood pressure medication for elderly inderal 80 mg online, and is often related to heart attack party tribute to trey songz generic 40 mg inderal with mastercard exercise but it has occurred at rest on some occasions heart attack pulse 40mg inderal with amex, particularly in the evenings blood pressure unsafe levels effective 40mg inderal. It makes her stop whatever she is doing and she often feels faint or dizzy with the pain. Detailed questioning about the palpitations indicates that they are a sensation of a strong but steady heart beat. In her previous medical history she had her appendix removed at the age of 15 years. At the age of 30 years she was investigated for an irregular bowel habit and abdominal pain but no specific diagnosis was arrived at. Two years ago she visited a chemist and had her cholesterol level measured; the result was 4. In her family history her grandfather died of a myocardial infarction, a year previously, aged 77 years. Examination On examination, she has a blood pressure of 102/65 mmHg and pulse of 78/min which is reg ular. There is some tenderness on the left side of the chest, to the left of the sternum and in the left submammary area. On the basis of the information given here it would be reasonable to explore her anxieties and to reassure the patient that this is very unlikely to represent coronary artery disease and to assess subsequently the effects of that reassurance. It may well be that she is anxious about the death of her grandfather from ischaemic heart disease. She has expressed anxiety already by having the cholesterol measured (and found to be normal). She has a history which is suspicious of irritable bowel syndrome with persistent pain, irregular bowel habit and normal investigations. Ischaemic chest pain is usually central and generally reproducible with the same stimuli. The associated shortness of breath may reflect overventilation coming on with the pain and giving her dizziness and palpitations. The characteristics of the pain and associated shortness of breath should be explored fur ther. Asthma can sometimes be described as tightness or pain in the chest, and she has sea sonal rhinitis and a family history of asthma. Gastrointestinal causes of pain such as reflux oesophagitis are unlikely in view of the site and relationship on occasions to exercise. The length of the history excludes other causes of acute chest pain such as pericarditis. The problem of embarking on tests is that there is no simple screening test which can definitively rule out significant coronary artery disease. Too many investigations may reinforce her belief in her illness and false-positive findings do occur and may exacerbate her anxieties. However, if the patient could not be simply reassured it might be appropri ate to proceed with an exercise stress test or a thallium scan to look for areas of reversible ischaemia on exercise or other stress. A coronary arteriogram would not be appropriate without other information to indicate a higher degree of risk of coronary artery disease. History A 30-year-old woman is brought up to the emergency department at 2 pm by her hus band. She has a history suggestive of depression since the birth of her son 3 months earlier. She has been having some counselling since that time but has not been on any medication. The previ ous evening about 10 pm she told her husband that she was going to take some pills and locked herself in the bathroom. Two hours later he persuaded her to come out and she said that she had not taken anything. They went to bed but he has brought her up now because she has complained of a little nausea and he is worried that she might have taken something when she was in the bathroom. The only tablets in the house were aspirin, paracetamol and temazepam which he takes occasionally for insomnia. Her pulse is 76/min, blood pressure is 124/78 mmHg and respiratory rate is 16/min. There is some mild abdom inal tenderness in the upper abdomen but nothing else abnormal to find. Aspirin and temazepam would be likely to produce more symptoms in less than 14 h if they have been taken in significant quantity. However, the salicylate level should certainly be measured; in this case it was not raised. In the absence of drowsiness at this time, it is not necessary to consider temazepam any further. Paracetamol overdose causes hepatic and renal damage, and can lead to death from acute liver failure. The severity of paracetamol poisoning is dose related with a dose of 15 g being serious in most patients. Patients with pre-existing liver disease and those with a high alcohol intake may be susceptible to smaller overdoses. It is often the first test to become abnormal when there is liver damage from paracetamol overdose. There are few symptoms in the first 24 h except perhaps nausea, vomiting and abdominal dis comfort. Acute liver failure may develop between days 3 and 5, and renal failure occurs in about 25 per cent of patients with severe hepatic damage. The earlier this is used the better but it is certainly still worth while 16 h after the ingestion. In this case a level of paracetamol of 64 mg/L confirmed that treatment was appropriate and that the risk of severe liver damage was high. Further advice can always be obtained by ringing one of the national poisons information ser vices. The electrolyte, renal and liver function tests and the clotting studies should be monitored carefully over the first few days, and referral to a liver unit considered if there is marked liver dysfunction. Patients with fulminant hepatic failure are considered for urgent liver transplantation. The other areas that need to be addressed in this case are the mental state and the safety and care of the son and any other children. She should be seen by a psychiatrist or other appropriately trained health worker. The question of any possible risk to the baby should be evaluated before she returns home. On direct questioning she states that she has lost 8 kg in weight over the past year although she says her appetite is good. This is a disorder usually of teenagers or young adults char acterized by severe weight loss, a disorder of body image (the patient perceiving themself as being fat despite being objectively thin) and amenorrhoea (or, in men loss of libido or potency). Often sufferers from this condition work in a profession where personal image is very important. Some patients exhibit the bulimic behaviour of recurrent bouts of overeating and self-induced vomiting. The skin is dry with growth of lanugo hair over the neck, cheeks and limbs as in this woman. Severe physical complications include proximal myopathy, cardiomyopathy and peripheral neuropathy. A number of interrelated mechanisms cause the metabolic alkalosis in this patient. The vom iting causes a net loss of hydrogen and chloride ions, causing alkalosis and hypochloraemia. The loss of fluid by vomiting leads to a contracted plasma volume with consequent second ary hyperaldosteronism to conserve sodium and water, but with renal loss of potassium, due to its secretion in preference to sodium and the fact that fewer hydrogen ions are available for secretion by the renal tubules. These events combine to give the typical picture of an alkalosis with low chloride and raised bicarbonate in the blood, and urine which contains excess potassium and very little chloride.

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Communications with women in early labour need to hypertension yeast infection purchase inderal 40mg with mastercard be friendly blood pressure chart over 60 cheap 40mg inderal with amex, clear and sympathetic and any advice (including to pulse pressure hypovolemia inderal 40mg with amex remain at home) should be accompanied by a rationale3 arrhythmia on ultrasound generic inderal 40mg line. Women access a range of sources of information including web-based materials, textbooks, and antenatal classes, but these may be less useful if their labour does not follow the ?normal pattern3. Birth companions may help to support women to stay at home, but for some their anxiety about seeing the woman in pain may also encourage her to go to hospital sooner,1,3. Women can be offered assessment either at home or in the maternity unit in early labour, unless their clinical needs require immediate admission. Midwives communications with women in early labour should be clear, friendly and compassionate. Advice, including remaining at home, should be accompanied by the rationale 10 the Royal College of Midwives Advice should be individualised for each woman and the circumstances of her pregnancy and labour. Women who have insecure or unsuitable housing (for example women in asylum seekers accommodation or homeless women in hostels) should have personalised plans for the location of early labour made with them. Women and their birth companions should be provided with education in pregnancy about the latent phase of labour the evidence and recommendations presented in this section were derived from existing high quality systematic reviews as referenced below: 1. Experiences of early labour management from perspectives of women, labour companions and health professionals: A systematic review of qualitative evidence. Kobayashi S, Hanada N, Matsuzaki M, Takehara K, Ota E, Sasaki H, Nagata C, Mori R. A balancing act in an unknown territory: A metasynthesis of frst-time mothers experiences in early labour. Birthing pools and other aids (such as birth chairs, foor mats and bean bags) are highly valued by women to support different birthing positions. However, many women may not have access to these, particularly in obstetric settings or if they are restricted by monitoring equipment. Space to mobilise is supported by providing storage for both personal possessions and equipment, so preventing rooms becoming too cluttered. Comfortable furniture (such as double beds or armchairs) can also help support women and their companions through long labours, and enable different birthing positions to be adopted. Women prefer a private space where they can control who enters the room and be out of sight of other people. Alcoves, such as window seats, can provide fexible space and make the room feel homelier. Adaptable lighting can help a space feel more relaxing whilst also facilitating the lighting needs for clinical assessments and procedures. Women also like to have control over the temperature and ventilation, however the temperature needs of new-born babies may need to be considered. Large openable exterior windows are preferred by women to help provide natural light and ventilation, but full length windows may make women feel exposed. Women prefer rooms to be insulated from noise and particularly do not want to be overheard or hear other women giving birth. Women may feel more relaxed if they are able to stay in the same room for their whole stay in the unit and are able to personalise their space. In birth environments there are different, and sometimes conficting, priorities for women, their companions, midwives and doctors. Spaces need to be supportive for women to mobilise and adopt comfortable positions, but also need to work well for emergencies. This is particularly highlighted in terms of lack of storage, space, layout, and clutter posing a risk in emergency situations. Poor design of the room or ward may affect the care given by midwives, particularly if they need to spend time adapting the room before welcoming the woman or leaving the room to write notes. Workplace conditions can be challenging for midwives, with a lack of control over environmental factors, including noise. Midwives also may need to get into positions to assist births both in and out of the birth pool which are uncomfortable or not well supported by the physical environment. Midwives need a dedicated space to write during birth so that they do not need to leave the room to complete documentation. Helen Spiby, Phoebe Pallotti, Catrin Evans, Gina Sands, Jeanette Eldridge, Kerry Evans, Mandy Forrester, Lia Brigante. The risk of acid aspiration syndrome is an extremely rare but very serious complication of anaesthesia. There is currently no evidence on which to base recommendations for women at increased likelihood of needing an anaesthetic during labour or birth ; more research is urgently needed. There is some low-quality evidence to suggest that for the few women who are not able to drink freely during labour, additional intravenous fuids may reduce the duration of labour. Women with increased likelihood of needing anaesthesia should discuss eating and drinking with the midwife and medical team and should be informed about the extremely rare but serious risk of acid aspiration syndrome Good Practice Points. Explain to women and birth companions what food and drink are available locally (especially ?out of hours), taking into account that some families may be on a very low income. Discuss with women, in the context of local policies, what facilities are available for families provisions. Intravenous fuids for reducing the duration of labour in low risk nulliparous women. There is low quality evidence to suggest there is no clear difference in the rates of caesarean section between upright and supine positions. However, upright positions are associated1 with a signifcant reduction in instrumental deliveries1. There is low quality evidence that upright positions are associated with a reduction in episiotomies1,2 but an increase in second degree perineal tears in some positions such as standing. There is low quality1 evidence that there is no clear difference in the number of third or fourth tears between upright and supine positions during labour1. Upright positions during labour may be associated with a very small increase in the risk of postpartum haemorrhage1,2. There is low quality evidence that upright positions are associated with fewer recorded abnormal fetal heart rate patterns when compared to supine positions but there is no clear difference in the number of babies admitted to neonatal intensive care. Cardiotocography versus intermittent auscultation of fetal heart on admission to labour ward for assessment of fetal wellbeing. Results indicate that it can reduce the likelihood of requiring an epidural and qualitative studies have illustrated that women who choose to labour in water feel a high sense of control and satisfaction. There is some evidence that, for women receiving midwifery led care, water immersion during the frst or second stage of labour does not affect rates of spontaneous birth, instrumental birth, or caesarean section. There is no evidence of the effect of water immersion on blood loss or1 genital trauma. There is no evidence to suggest that using water in labour affects adverse outcomes for women and babies. Some women have made birth plans, considering epidural analgesia depending on their experience when in labour. There is some evidence that overall birth satisfaction is lower for women who used epidural analgesia compared with no pain relief or other analgesia methods. However, most women who had an epidural were satisfed with the effectiveness of their labour analgesia. Continuity of carer and the support and presence of a midwife are key factors associated with positive experiences of epidural analgesia. After an epidural takes effect many women will want and value the presence of the midwife and to discuss the plans for the remaining part of labour. Studies have reported that women are fearful of adverse side effects and fnd it diffcult to access good quality information about epidural analgesia. Intrapartum informed consent is often undertaken by the anaesthetist who the woman has not met before. Women would prefer to be informed about epidurals by their midwife or obstetrician during the antenatal period, ideally during the second or third trimester of pregnancy. Key information for epidural analgesia should include benefts and potential side-effects. Midwives should be mindful that women can feel pressured to have or not to have an epidural. The midwife should remain with a woman after an epidural is sited as the woman may wish to discuss plans for the remaining part of labour Good Practice points. Midwives discuss coping strategies or pain relief with women and their birth companions during antenatal visits 20 the Royal College of Midwives

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Environmental factors affecting development may include both diet and disease exposure pulse pressure of 100 order inderal 80mg with mastercard, as the principles well as social arteria angularis purchase 40mg inderal, emotional and cognitive experiences blood pressure is highest in the 80 mg inderal with amex. There are critical periods for the various aspects of development arteria technologies best 40mg inderal, when events can lead to Becoming a parent today enhanced (or indeed reduced) functioning. These critical or sensitive periods peak at between How adults learn 12 and 36 months. Groups and activities Useful resources 1 3 2 4 Section 2 / 18 / 29 the Preparation for Birth and Beyond approach Introduction 2 the theories and concepts [3 of 7] the evidence for antenatal education Attachment. Attachment theory describes the dynamics of long-term relationships between humans, the Preparation especially in families. The pattern of these attachment relationships infuences development and subsequent relationships in childhood and adult life. Mothers, fathers and other carers develop affectional bonds with babies during pregnancy, the principles from birth and in the subsequent weeks known as ?bonding. Bonding helps parents and others to offer their baby the love, care and nurture they need for Becoming a parent today protection, development and survival. From the age of about six months to two years, infants develop attachment relationships with Groups and activities familiar carers, and these help them feel safe, secure and protected. Useful resources 1 3 2 4 Section 2 / 19 / 29 the Preparation for Birth and Beyond approach Introduction 2 the theories and concepts [4 of 7] the evidence for antenatal education Self-effcacy. Success with small steps builds self-effcacy and creates a context for bigger changes. The belief that ?I have the personal capabilities to succeed in specifc situations can play a major role in how a father or mother approaches the goals, tasks and challenges Key points of parenting. The self-effcacy of a mother and a father can affect the extent to which they feel able to take the theories and concepts on and succeed in the tasks of early parenting. Practitioners can help build self-effcacy by focusing on strengths and on what is working, by Useful resources helping parents to look for solutions, by celebrating small achievements, by creating a safe, supportive learning environment and by respecting parents as experts in their own lives. Behaviour change theories and approaches look at reasons that the Preparation may infuence the way in which people alter their behaviour, as well as why some people fnd for Birth and it diffcult to change. People are more likely to make changes when they feel that it is possible for them to do so and when they feel committed to the change (see ?Self-effcacy). Change is also more likely when the person fnds the changes rewarding and better for them. Change also often involves a sense of loss of the comfort of old patterns of behaviour, or the the principles learned responses to particular situations. For example, Becoming a parent today mothers who are thinking about breastfeeding may be more likely to hold their baby skin-to How adults learn skin, or to have a try to see what breastfeeding feels like. Being open to trying new things Groups and activities and readiness for change is not a fxed state and can be infuenced by a number of factors. Non-judgemental, non-confrontational and non-adversarial approaches (such as motivational interviewing)* may be more effective than more prescriptive and confrontational approaches. Such non-threatening approaches encourage adults to think for themselves about their current situation, the changes they could make and the risks and advantages involved. It includes both the support that is available if people need it and the support they for Birth and actually receive when they are in diffculties. Social support includes, for example, the availability of practical assistance, tangible resources such as money, knowledge, experience and information, and emotional help. Social support can protect against stress and can directly inhibit the development of the theories and concepts psychological and physical diffculties. Social capital refers to the links and resources that exist for individuals and families within their Useful resources local communities and other social networks, such as online communities. Previous life experience infuences what parents may want and need to learn, as well as how they do this most effectively. Most adults like to know the reasons behind what they are learning, rather than just to accept the principles what is being taught. Adults often learn most effectively through ?learning by doing rather than passive listening. Most adults are problem solvers and learn best when the topics are of immediate relevance How adults learn and when they are not simply provided with the answers and opinions of others. Learning may move through a cycle, in which parents frst build on their practical, concrete Useful resources experience, then engage in refection and discussion, before fnally formulating underlying ideas and testing them in new situations. These groups the Preparation and activities need to recognise and support the myriad ways in which mothers and fathers learn, for Birth and prepare and are supported during this time and, in doing so, to refect the concerns of the wider Beyond approach family and specifc communities, as well as service outcomes and priorities. New parents are most likely to turn to their family and friends for information and support, the principles and to supplement this with magazines, books, web-based information and interaction with the theories and concepts other parents through online social networks (see fgure on next page). Community groups or antenatal courses help expectant parents to build social support networks and to learn from each other, as well as from the group leader or expert. For those families that are most vulnerable, there are specialist, intensive programmes, such as 3 the Family Nurse Partnership programme, which is available in some areas. The Preparation Family and friends offer emotional and practical Universal maternity and for Birth and support, knowledge and ideas. Key points the principles the theories and concepts the wider community: virtual and real friends and family Becoming a parent today Universal services How adults learn Groups and activities Community groups Intensive Useful resources Building social support and learning through Intensive programmes for the most local groups of ?parents like me/us?: having vulnerable: the experiences and life 1 time and space to think/learn about becoming circumstances of some parents mean 3 a mother or father, while developing new that they will need more intensive friendships, especially in the case of a frst child. Section 2 / 25 / 29 the Preparation for Birth and Beyond approach Introduction 2 Becoming a parent today [3 of 3] the evidence for antenatal education Online resources and sites. There is a wide range of social networks and forums that allow parent-to-parent support. Blogs, journals and real-life stories can help parents to refect on and share their experiences. Mobile phone applications allow parents-to-be to receive information related to their stage of pregnancy. Although parents from minority groups are likely to be searching for topics similar to those the theories and concepts searched by other parents, there is very limited content specifcally designed for them. Content specifcally for fathers is usually to be found in dedicated sections of more general How adults learn parenting sites. Groups and activities Useful resources 1 3 2 4 Section 2 / 26 / 29 the Preparation for Birth and Beyond approach Introduction 2 How adults learn the evidence for antenatal education Models of adult learning, self-effcacy and behaviour change emphasise that most adults tend to acquire new skills and knowledge through practical and active learning, and that their learning the Preparation will be affected by their existing knowledge and experience, their commitment and motivation, for Birth and and by the attitudes of friends, family and people who are important to them. Beyond approach Few mothers and fathers prefer to be passive learners, merely receiving information through talks Introduction or printed material. Active and participative learning methods give adults the chance to share Key points and to refect on what they know, think and feel, building on the skills and knowledge that they already have. The principles the theories and concepts the role of a Preparation for Birth and Beyond group leader is to facilitate and help adults to learn, Becoming a parent today rather than to shoulder the responsibility of teaching them. This is most easily achieved by using How adults learn a variety of activities for small and large groups, where parents can think, share and learn, and Groups and activities where there are opportunities for practical ?learning by doing, as well as by asking parents to read about, prepare and try out skills in their own time. Useful resources There is some evidence that younger parents may feel more comfortable learning alongside people of their own age. Fathers may prefer at least some time in a group with fathers who already have some experience of parenthood themselves. Section 4 offers more detailed ideas, advice and examples of how to develop groups and activities based on these principles. These themes have been developed using advice from experts and feedback from the Preparation different groups of mothers and fathers at various stages of pregnancy and parenthood. They also for Birth and incorporate learning from the Family Nurse Partnership programme. The themes cover the core Beyond approach aspects of pregnancy, birth, early child development and parenthood, and each contains a menu of topics. These themes are covered in detail in Section 4, but each is briefy outlined here: Introduction Key points. Our developing baby is concerned with the physical, cognitive, social and emotional development of babies during pregnancy and in the frst days and weeks after birth, as well as the principles with the factors affecting this development. Changes for me and us covers topics concerned with the practical and emotional changes Becoming a parent today that mothers and fathers face as individual parents, as a couple and as a family. Giving birth and meeting our baby focuses on the psychological, social and physical aspects Groups and activities of labour and birth, as well as on the experiences of the frst few hours after birth.

Sometimes chemotherapy can slow or destroy cells in the bone marrow that make blood cells hypertension epidemiology generic inderal 40mg visa. Special precautions you may need to blood pressure reduction cheap 40mg inderal with mastercard take ?John is getting a type of chemotherapy that made it very important to arrhythmia stress 80mg inderal with mastercard take certain safety precautions at home blood pressure normal value inderal 80 mg mastercard. You may need to take precautions if you are giving your child chemotherapy at home. You may need to put them into special waste bags or containers marked ?hazardous and bring them back to the hospital for disposal. External beam radiation therapy is the most common type of radiation therapy used to treat cancer in children. Young children may be given medicine that helps them relax, stay still, or sleep during treatment. Your child will most likely receive radiation for only 1 to 5 minutes during each visit. The radiation source is placed inside the body near the cancer cells and may be left in place for minutes, hours, or days, depending upon the type of brachytherapy. Sometimes, the radiation source is left inside the body permanently, even after it is no longer giving off any radiation. Before receiving external beam radiation therapy, your Damage to healthy cells causes side child will have a treatment planning session (called a effects. Side effects depend on the simulation) in which: part of the body receiving radiation as well as the dose of radiation. Allogeneic transplants use stem cells from a biological your child is given healthy blood sister, brother, parent, or other family member or from forming stem cells. About the transplant Your child will receive stem cells through a catheter, just like a blood transfusion. She will get frequent blood tests to make sure that new blood cells are being made and that the cancer has not come back. After an allogeneic or syngeneic transplant, it may take 1 to 2 years for the immune system to return to normal. Be the Match, operated by the National Marrow Donor Program 41 Surgery Types of surgery How surgery is used to? Resection: this is surgery to remove tissue treat cancer or part or all of an organ. As much lymph nodes may also be removed during of the tumor as possible is removed. Limb-sparing surgery (also called limb type of cancer your child has and where the salvage surgery): An operation to remove tumor is located. Some of the bone and tissue around the tumor may also be removed, after surgery and the part of the limb that is removed After surgery, it is common to feel pain. This Medicine is given to treat pain and to help your type of surgery helps to save the use and child be more comfortable. It is used to treat on the type of surgery and the size and location some cancers of the bone and soft tissue. This response is triggered when the immune system comes across a substance on the foreign invader (called an antigen) that it recognizes as ?foreign. How immunotherapy is given Some types of immunotherapy are given as shots or pills. Side efects of immunotherapy Side effects depend on the type of immunotherapy and vary from person to person. Many targeted cancer therapies have been approved for the treatment of specifc types of cancer. Side efects of targeted therapy the side effects of targeted therapy, for the most part, differ from those of standard chemotherapy and some can be substantial. The nurse said this was the most important step he and our family could take to prevent infection. This is especially important before level of white blood cells is from eating, after using the bathroom, after being in a public bacteria in his or her own body. Learn what types of foods and drinks are best for your diffcult for children to eat well child Most children need to eat a variety of foods, while during treatment. For example, some vitamins interfere with with, nag, or punish your child absorption of certain chemotherapy drugs. Take special care with food to lower the risk of or a movie can distract your infection You may need to take special care as you handle child and make it easier for him and prepare food. Physical activities, such need to be cooked or peeled, and meats may need to be as walking or playing, may well cooked. Very young children: Babies and young children show discomfort by crying when touched. Other signs of pain include not being able to be comforted or being withdrawn or tense. A change in sleeping or eating patterns, or tugging at a part of the body, may also be signs of pain in young children. Specialists in music or art therapy or those who practice acupuncture, biofeedback, massage therapy, or hypnosis may also help to reduce pain. Each child needs a personalized plan to control pain?based on their age, treatment, and side effects. Over-the-counter pain medicines, such as ibuprofen (also known as Advil) or acetaminophen (also known as Tylenol), may reduce pain and are a good frst approach. Not giving your child enough pain medicine can lead to pain that could have been prevented. This is because some pain medicines can reduce fevers, which may mask, or hide, this sign of infection. This helped me to understand that I should not try to hold off or limit his pain medicine. I also met with a counselor who gave me insights and listened in ways that friends could not. This section has practical advice to guide you to the help you may need during this diffcult time. Other sites, such as Lotsa Helping Hands, make it easier to organize help from people in your community. Your doctor can give you the names of health care professionals who can help you, such as a psychiatrist, psychologist, family therapist, or social worker. Talking with other families who are going through similar events may also be benefcial. Learn what to expect Ask how the type of treatment your child is receiving has affected other children, so you can prepare your child. Try to pick out a wig before the hair falls out, so you can match it to their hair color. Get advice from a dietician so you know what to expect and how you can help your child prepare for and cope with physical changes. Unfortunately, some children speak before they think or before they have the facts. For example, they can role-play conversations with your child that may be helpful. Help your child stay in touch with friends You can encourage and help your child to connect with friends through texts, e-mails, online video chats, phone calls, and/or social media sites. Sometimes a social worker or child life specialist can help your child think through what they would like to share with friends. They continued to call, but it got harder to have things in common the longer Meg was out of school. You and your child can also meet with a social worker, child life specialist, or psychologist about feelings that don?t have easy solutions or seem to be getting worse over time. Some children prefer to express their feelings through drawing, painting, writing, or playing music. See the Practices That Help Children: Integrative Medicine Approaches section on page 76 to learn more. Signs of clinical depression include If your child has any of these signs, talk with the doctor. Here are some ways to help your child cope with long stays at the hospital and time away from school. Hospital stays Being in the hospital can be diffcult for anyone, especially children.

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