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Contingency plans and emergency procedures Every laboratory that works with infectious microorganisms should institute safety precautions appropriate to the hazard of the organisms and the animals being han- dled purchase hytrin 5 mg amex. A written contingency plan for dealing with laboratory and animal facility acci- dents is a requirement in any facility that works with or stores Risk Group 3 or 4 microorganisms (containment laboratory – Biosafety Level 3 and maximum con- tainment laboratory – Biosafety Level 4) order 2mg hytrin with mastercard. National and/or local health authorities should be involved in the development of the emergency contingency plan cheap hytrin express. Biosafety in the laboratory 393 Contingency plan The contingency plan should provide operational procedures for: • Precautions against natural disasters, e. The cause of the wound and the organisms involved should be re- ported, and appropriate and complete medical records kept. Ingestion of potentially infectious material Protective clothing should be removed and medical attention sought. Identification of the material ingested and circumstances of the incident should be reported, and appropriate and complete medical records kept. Potentially infectious aerosol release (outside a biological safety cabinet) All persons should immediately leave the affected area and any exposed persons should be referred to the appropriate center for medical advice. Broken containers and spilled infectious substances Broken containers contaminated with infectious substances and spilled infectious substances should be treated in the same way as biological residue leaks. The cloth or paper towel and the broken material can then be cleared away; glass fragments should be handled with forceps. If dustpans are used to clear away the broken material, they should be autoclaved or placed in an effective disinfec- tant. Cloths, paper towels and swabs used for cleaning up should be placed in a contaminated-waste container. If laboratory forms or other printed or written matter are contaminated, the informa- tion should be copied onto another form and the original discarded into the con- taminated-waste container. Biosafety in the laboratory 395 Breakage of tubes containing potentially infectious material in centrifuges without sealable buckets If a breakage occurs or is suspected while the machine is running, the motor should be switched off and the machine left closed (e. If a breakage is discovered after the machine has stopped, the lid should be replaced immediately and left closed (e. All broken tubes, glass fragments, buckets, trunnions, and the rotor should be placed in a non- corrosive disinfectant known to be active against the organisms concerned. The centrifuge bowl should be swabbed with the same disinfectant, at the appropriate dilution, and then swabbed again, washed with water and dried. Breakage of tubes inside sealable buckets (safety cups) All sealed centrifuge buckets should be loaded and unloaded in a biological safety cabinet. If breakage is suspected within the safety cup, the safety cap should be loosened and the bucket autoclaved. Fire and natural disasters Fire departments and other services should be involved in the development of emergency contingency plans. It is useful to arrange visits from these services to the laboratory to acquaint them with its layout and contents. After a natural disaster, local or national emergency services should be warned of the potential hazards within and/or near laboratory buildings. Occupational transmission of Myco- bacterium tuberculosis to health care workers in a university hospital in Lima, Peru. Laboratory management of agents associ- ated with hantavirus pulmonary syndrome: interim biosafety guidelines. Method for inactivating and fixing unstained smear preparations of Mycobacterium tuberculosis for improved laboratory safety. Increased risk of tuberculosis in health care workers: a retrospective survey at a teaching hospital in Istanbul, Turkey. Survey of mycobacte- riology laboratory practices in an urban area with hyperendemic pulmonary tuberculosis. Increased risk of Mycobacterium tuber- culosis infection related to the occupational exposures of health care workers in Chiang Rai, Thailand. Frequency of nonparenteral occupa- tional exposures to blood and body fluids before and after universal precautions training. Delays in diagnosis and treatment of smear positive tuberculosis and the incidence of tuberculosis in hospital nurses in Blantyre, Malawi. Incidence of tuberculosis, hepatitis, brucellosis, and shig- ellosis in British medical laboratory workers. Factors influencing the transmission and infectivity of Mycobacterium tuberculosis: implications for clinical and public health management. A twenty-five year review of laboratory-acquired human infections at the National Animal Disease Center. The cost-effectiveness of preventing tuberculosis in physicians using tuberculin skin testing or a hypothetical vaccine Arch Intern Med 1997; 157: 1121-7. Transmission of tuberculosis among patients with human immunodeficiency virus at a university hospital in Brazil. A multi-center evaluation of tuberculin skin test positivity and conversion among healthcare workers in Brazilian Hospitals. Sterilization of Mycobacterium tuberculo- sis Erdman samples by antimicrobial fixation in a biosafety level 3 laboratory. Tuberculin skin test conversion among medical students at a teaching hospital in Rio de Janeiro, Brazil. Tuberculin skin testing among healthcare workers in the University of Malaya Medical Centre, Kuala Lumpur, Malaysia. Are univer- sal precautions effective in reducing the number of occupational exposures among health care workers? Its usefulness depends largely on the quality of the sputum specimen and the performance quality of the laboratory. Considerable efforts have been made to improve the sensitivity of sputum smear microscopy (Steingart 2006) and special emphasis will be given in this chapter to these efforts. As most laboratories in 402 Conventional Diagnostic Methods low-resource countries have no access to culturing mycobacteria, alternative simple culturing methods will be discussed, as well as the value of alternative culture media such as blood agar, which is more readily available in most laboratory set- tings than the traditional egg-based media used for mycobacterial isolation. Al- though no multicenter studies have been published to show their efficiency for cultivating mycobacteria, we think that these alternatives should be presented in this chapter, because they may be particularly useful in settings where standard procedures simply cannot be performed due to the absence of laboratory equipment or reagents.
Te Gram stain is the preferred chlamydia is strongly recommended because of the increased rapid diagnostic test for evaluating urethritis and is highly utility and availability of highly sensitive and specifc testing sensitive and specifc for documenting both urethritis methods (e purchase hytrin online pills. However effective hytrin 5mg, because men Treatment should be initiated as soon as possible after diag- with documented chlamydial or gonococcal infections have nosis order hytrin 2mg online. Azithromycin and doxycycline are highly efective for a high rate of reinfection within 6 months after treatment chlamydial urethritis; however, infections with M. Single-dose regi- or gonorrhea is recommended 3–6 months after treatment, mens have the advantage of improved compliance and directly regardless of whether patients believe that their sex partners observed treatment. Expedited partner treatment and patient Erythromycin ethylsuccinate 800 mg orally four times a day for 7 days referral are alternative approaches to treating partners (71). Persons who have persistent or be instructed to abstain from sexual intercourse for 7 days after recurrent urethritis can be retreated with the initial regimen single-dose therapy or until completion of a 7-day regimen, if they did not comply with the treatment regimen or if they provided their symptoms have resolved. Persistent urethritis for reinfection, men should be instructed to abstain from sexual after doxycycline treatment might be caused by doxycycline- intercourse until all of their sex partners are treated. If compliant with the initial regimen and re-exposure can be excluded, the fol- Follow-Up lowing regimen is recommended while awaiting the results of Patients should be instructed to return for evaluation if symp- the diagnostic tests. Symptoms Recommended Regimens alone, without documentation of signs or laboratory evidence of urethral infammation, are not a sufcient basis for retreatment. A four-glass Meares-Stamey lower-urinary- diagnosis of gonococcal cervical infection, it is not a sensitive tract localization procedure (or four-glass test) might be helpful indicator, because it is observed in only 50% of women with in localizing pathogens to the prostate (255). Estimates vary When an etiologic organism is isolated in the presence considerably depending on the source and sensitivity of the of cervicitis, it is typically C. For reasons that are unclear, cervicitis the suspected cause, all partners in the past 60 days before the can persist despite repeated courses of antimicrobial therapy. Because the sensitivity of microscopy (commonly referred to as mucopurulent cervicitis or cervicitis) to detect T. Several factors should affect the decision to provide presumptive therapy for cervicitis or to await the results of Management of Sex Partners diagnostic tests. Expedited partner treatment and patient referral (see For women in whom any component of (or all) presumptive Partner Management) are alternative approaches to treating therapy is deferred, the results of sensitive tests for C. Women who receive such therapy should return infectious disease in the United States, and prevalence is high- after treatment so that a determination can be made regard- est in persons aged ≤25 years (93). Some women who have uncomplicated cervical infection are clearly attributable to cervicitis, referral to a gynecologic already have subclinical upper-reproductive–tract infection specialist can be considered. To detect chlamydial infections, health-care provid- Follow-up should be conducted as recommended for the ers frequently rely on screening tests. If symptoms persist, sexually active women aged ≤25 years is recommended, as is women should be instructed to return for re-evaluation because screening of older women with risk factors (e. Recent evidence to recommend annual chlamydia screening of sexually active suggests that the liquid-based cytology specimens collected for women aged ≤25 years. Among Treating infected patients prevents sexual transmission of women, the primary focus of chlamydia screening eforts the disease, and treating all sex partners of those testing positive should be to detect chlamydia and prevent complications, for chlamydia can prevent reinfection of the index patient and whereas targeted chlamydia screening in men should only be infection of other partners. Treating pregnant women usually considered when resources permit and do not hinder chlamydia prevents transmission of C. An appropriate sexual Chlamydia treatment should be provided promptly for all per- risk assessment should be conducted for all persons and might sons testing positive for infection; delays in receiving chlamydia indicate more frequent screening for some women or certain treatment have been associated with complications (e. Te following recommended treat- urethral infection in men can be made by testing a urethral ment regimens and alternative regimens cure infection and swab or urine specimen. Unlike the test-of-cure, which is not recommended, to treat patients for whom compliance with multiday dosing repeat C. If retesting at 3 months In patients who have erratic health-care–seeking behav- is not possible, clinicians should retest whenever persons next ior, poor treatment compliance, or unpredictable follow-up, present for medical care in the 12 months following initial azithromycin might be more cost-efective in treating chla- treatment. Erythromycin might be less efcacious than either azithromycin or doxycycline, mainly Patients should be instructed to refer their sex partners for because of the frequent occurrence of gastrointestinal side evaluation, testing, and treatment if they had sexual contact efects that can lead to noncompliance. Levofoxacin and with the patient during the 60 days preceding onset of the ofoxacin are efective treatment alternatives but are more patient’s symptoms or chlamydia diagnosis. To minimize Among heterosexual patients, if concerns exist that sex disease transmission to sex partners, persons treated for chla- partners who are referred to evaluation and treatment will mydia should be instructed to abstain from sexual intercourse not seek these services (or if other management strategies are for 7 days after single-dose therapy or until completion of a impractical or unsuccessful), patient delivery of antibiotic 7-day regimen. To minimize the risk for reinfection, patients therapy to their partners can be considered (see Partner also should be instructed to abstain from sexual intercourse Management). Patients must also inform their partners of their 3–4 weeks after completing therapy) is not advised for persons infection and provide them with written materials about the treated with the recommended or alterative regimens, unless importance of seeking evaluation for any symptoms suggestive therapeutic compliance is in question, symptoms persist, or of complications (e. Abstinence should be continued until 7 days after successfully could yield false-positive results because of the a single-dose regimen or after completion of a multiple-dose continued presence of nonviable organisms (197). Pregnant Doxycycline, ofoxacin, and levofoxacin are contrain- women aged <25 years are at high risk for infection. Pregnant women is most frequently recognized by conjunctivitis that develops diagnosed with a chlamydial infection during the frst trimester 5–12 days after birth. Specimens for culture isolation and noncul- during pregnancy because of drug-related hepatotoxicity, the ture tests should be obtained from the everted eyelid using a lower dose 14-day erythromycin regimens can be considered dacron-tipped swab or the swab specifed by the manufacturer’s if gastrointestinal tolerance is a concern. The results of one study involving a limited number of patients suggest that a short Recommended Regimen course of azithromycin, 20 mg/kg/day orally, 1 dose daily for 3 days, might be efective (292). Erythromycin base or ethylsuccinate 50 mg/kg/day orally divided into 4 doses daily for 14 days Topical antibiotic therapy alone is inadequate for treatment of chlamydial infection and is unnecessary when systemic Follow-Up treatment is administered. Follow-up of infants is recom- approximately 80%, a second course of therapy might be mended to determine whether the pneumonia has resolved, required. Terefore, follow-up of infants is recommended although some infants with chlamydial pneumonia continue to to determine whether initial treatment was efective. Mothers of infants who have chlamydia pneumonia and Management of Mothers and Their Sex Partners the sex partners of these women should be evaluated and Te mothers of infants who have chlamydial infection and treated according to the recommended treatment of adults for the sex partners of these women should be evaluated and treated chlamydial infections (see Chlamydial Infection in Adolescents (see Chlamydial Infection in Adolescents and Adults). In addition, peripheral eosinophilia (≥400 cells/ treatment is not indicated, and the efcacy of such treatment is mm3) occurs frequently. Sexual abuse must be considered a cause of chlamydial Diagnostic Considerations infection in preadolescent children, although perinatally trans- Specimens for chlamydial testing should be collected from mitted C. Tissue culture is the defnitive standard for tract, and rectum might persist for >1 year (see Sexual Assault chlamydial pneumonia. However, because of lower sensitivity, a negative Gram stain should not be considered sufcient for ruling out infection in asymptom- other Management Considerations atic men. Te majority specimen types including endocervical swabs, vaginal swabs, of urethral infections caused by N.
Cardiac arrest follows quickly after respiratory arrest as soon as the heart muscle is affected by the anoxia buy 2mg hytrin mastercard, which occurs trusted hytrin 2 mg. The outcome for the child will depend to great extent on the speed with which resuscitation is began order discount hytrin. The steps for resuscitation can be remembered as “A, B, C, D” where A is for airway, B for breathing and C is for circulation and D is for drug administration. Oxygen administration: Oxygen administration elevates the arterial saturation level by supplying more available oxygen to the respiratory tract. Nursing care must be planned carefully when children are in tents: • The tent should be open as little as possible so that as high an oxygen concentration as possible can be maintained. Most children do not like nasal catheter because it is irritant; assess the nostrils of the infant carefully when using nasal catheter. The pressure of catheter can cause areas of necrosis, particularly on the nasal septum. Administering Enemas: Enemas are rarely used with children unless a part of preoperative preparation or are required for radiological study. The usual amount of enema solution used are as follows: • Infant: less than 250 ml • Preschooler: 250-350 ml • School age child: 300-500 ml • Adolescent: 500 ml 30 Pediatric Nursing and child health care For an infant: • Use a small soft catheter (no 10 to 12 French) in place of an enema tip. This may be true, but such a diagnosis is difficult to prove and should never be made without taking a careful history and performing a proper examination in any child with fever. Young children appear to tolerate fever better than adults but some develop convulsions. If you still do not have a definite cause for the fever, rule out (Malaria, Early measles, Pneumonia, meningitis) A) Features of Febrile convulsions: • Begin between 6 month and 5 years of age • Incidence is 3 % by 5 years of age • Epilepsy develop in 3 % of cases • % are neurologically abnormal • 30 % of cases develop further seizure with fever • Febrile seizures lasting over 30 minutes are more serious • Repeated convulsions may damage the brain. The best treatment is controlling and preventing high fever rather than giving continuous anticonvulsants. If the fever is high (over 39 degree centigrade) • Tepid sponging with ordinary water will help to reduce but ice cold water is harmful because it causes constriction of blood vessel in the skin and prevents heat loss. Children must be able to get rid of the heat, otherwise febrile convulsions can be precipitated c. Take care the airway does not become blocked by the tongue or secretions by placing the patient in the coma position with the mouth downwards and using suction p. A malaria blood film, a lumbar puncture, dextrostix in blood or clinistix in urine, measuring blood pressure, and a thorough history and examination will usually reveal the cause. In case of a feverish, toxic, comatose child, also start treatment with penicillin and chloramphenicol and refer to hospital. This is not only due to congenital malformation or perinatal injury to the central nervous system but also the frequency of “febrile“ convulsions in response to a rapid rise of temperature at the onset of acute infective illnesses 1. Nursing Management during seizure: • Provide privacy • Protect head injury by placing pillow under head and neck • Loosen constrictive clothing’s • Remove any furniture from patient side • Remove denture if any 35 Pediatric Nursing and child health care • Place padded tongue blade between teethes to prevent tongue bit • Do not attempt to restrain the patient during attack • If possible place patient on side 3. Nursing Management after seizure: • Prevent aspiration by placing on side • On awaking re-orient the patient to the environment • Re-assure and calm the patient 3. When an indwelling tube is inserted into the trachea, the term tracheostomy is used. A trachestomy is performed to by pass an upper airway obstruction, to remove tracheoborncheal secretions, to prevent aspiration of oral or gastric secretions in the unconscious or paralyzed patient and to replace an endotracheal tube. There are many disease processes and emergency conditions that make a tracheostomy necessary. After the trachea is (opened) exposed a tracheostomy tube of appropriate size is inserted. The tracheostomy tube is held in place by tapes fastened around the patients neck usually, a square of sterile gauze is placed between the tube and the skin to absorb drainage and prevent infection. Complications: Early complications immediately after the trachestomy is performed include: • bleeding • pneumothorax • air embolism • aspiration • subcutaneous or mediastinal emphysema • recurrent laryngeal nerve damage or • posterior tracheal wall penetration. Immediate Postoperative Nursing care: • The patient requires continuous monitoring and assessment. Nutrition status of the mother 44 Pediatric Nursing and child health care A) Management of low birth weight: Clean air way Initiate breathing Establish circulation Keep Warm Administer Vit. Due to maternal origin • Amniotic fluid infection • Obstructed labor • Congenital syphilis Placenta previa • Causeless • Toxemia of pregnancy • Recurrent and the bleeding is painless Gestational Hepatitis B. Due to fetal and maternal origin Premature separation of placenta Trauma Abruption placenta 48 Pediatric Nursing and child health care Causeless Accidental Painful(rigid) C. Congenital pneumonia It is caused by aspiration of amniotic fluid or ascending infection. Route of infection: • Transplacental • Amniotic fluid infection • Environment • Instrument Other Neonatal problems: • Congenital abnormalities • Prematurity and related problems • Jaundice • Birth Trauma 4. Neonatal resuscitation: During the initial resuscitation efforts, a 100 % oxygen concentration is administered to the neonate. This adjustment is essential, since elevated pao2 levels can cause irreparable damage to retinal vessels. Furthermore, high oxygen concentrations can directly injure lung tissue premature infants with immature lungs and eye vessels are at particular risk for two conditions that are a direct result of oxygen toxicity: retrolental fibroplasia and bronchopulmonary dysplasia. This may be true, but such a diagnosis is difficult to prove and should never be made without taking a careful history and performing a proper examination in any child with fever. Malaria: one negative blood film report does not exclude malaria B Early measles: look for koplik’s spots C Pneumonia: look at the child for flaring of nostrils, rate of breathing, Lower chest in drawing D Otitis media: check eardrums E Meningitis: neck stiffness, irritability F Urinary tract infection: check urine G Tonsillitis: look at the throat H Relapsing fever: take blood film for haemo parasite 4. This is not only due to congenital malformation or perinatal injury to the central nervous system but also the frequency of “febrile “convulsions in response to a rapid rise of temperature at the onset of acute infective illnesses 55 Pediatric Nursing and child health care Causes: 1. In the neonatal period the major causes of convulsions are • Congenital defect of the brain • Cerebral damage occurring during the process of birth from hypoxia or trauma both account for 90 % of the cases. The remaining 10 % includes: • infection of the brain ( meningitis ) • hypoglycaemia • hyperbillirubinaemia with kernicterus etc 2. Feeding Recommendations during sickness and health: Up to 4 months of age • Breast feed as often as the child wants, day and night, at least 8 times in 24 hours. Shiro, kik, merek fitfit, mashed potatoes and carot, gommen,undiluted milk and egg and fruits 57 Pediatric Nursing and child health care • Add some extra butter or oil to child’s food • Give these foods:-3 times per day if breastfed 5 times per day if not breastfed • Expose child to sunshine 12 months up to 2 years: • Breast feed as often as the child wants, Give these foods 5 times per day • Give adequate serving of: porridge made of cereal and legume mixes. Shiro, kik, merek fitifit mashed potatos and carrot, gommen, undiluted milk and fruits • Add some extera butter or oil to child food • Give these foods 5 times per day 2 years and older: Give family food at least 3 times each day. Also twice daily, give nutrious food between meals, such as: egg, milk, fruits, kita, dabo 58 Pediatric Nursing and child health care Study Questions 1. They may be obvious on examination of the newborn or they may be detected by histological structures.