Include one page summary as a handout for other people
Identify and describe this contraceptive method (Depo-Provera)
Describe the risks and benefits of method
Explains the effectiveness of method
Identifies contraindication of method
Explain how the contraception method is used
Address patient education
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PowerPoint Guide
1. A title slide – Name, Title and what the paper is about
2. Never use less than 24 point font. If you use smaller font, people will not be able to see your information and you will have too much information on the slide.
3. Use bullet points. PowerPoint slides do not need full sentences, and should never have a paragraph full of information.
4. Use images effectively. You should have as little text as possible on the slide. One way to accomplish this is to have images on each slide, accompanied by a small amount of text (a max. of 4 bullets).
5. You must include speaker notes (of about 120 -150 words per slide) below
6. Use only one message per slide. If you have more than one message, add a slide.
7. Use only elements that add to the content of the message. Use graphics that clearly support your message. Good graphics can significantly add to learning, bad graphics can confuse and distract your audience.
8. Slide Design. Each slide should address a single concept.
9. Slides should follow a logical progression, each building on the other
10. Use no more than 4 bullet short lines of text on any one slide (The rest of the what you want to say should be in the speaker notes).
11. Use upper and lower case text, NOT all caps
12. Choose a color appropriate to the mood you want to convey
13. Avoid using too many colors (maximum of 3)
14. Use photographs (images) to help the audience relate slide information to real world situations.
15. Cite/reference always to avoid plagiarism.
16. Color, Dark Blue to project a stable, mature message – has a calming effect
Red or Orange to trigger excitement or an emotional response, Green to make audience comfortable, Yellow to get audience attention quickly (more so than any other color), Gray to promote the idea of “quality”, White to project honesty/sincerity. Black is not appealing to most viewers so be balanced!
17. Maintain a consistent design with regard to colors, font styles, and graphics.
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Catheter Associated Urinary Tract Infections
Use evidence-based nursing interventions to research whether early removal of indwelling urinary catheters and shunning non-evidence based interventions does contribute to a significant decline in the risk of catheter-associated urinary tract infections among inpatients with indwelling urinary catheters.
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Catheter Associated Urinary Tract Infections
Statistics indicate that nearly 13,000 deaths occur annually due to urinary tract infections (UTIs). Approximately 75% of UTIs are linked to urinary catheters. Statistics further show that approximately 15-25% of inpatients use catheters. Still, UTIs constitute the fourth most prevalent healthcare related infection in the U.S, with over 93,000 reported inpatient incidences in 2011.
Besides, UTI’s constitute 12% of the total infections reported in acute care, while 12-16% of hospitalized adult patients have higher chances of using indwelling urinary catheters. The study of catheter-associated urinary tract infections (CAUTI) is essential as it highlights evidence-based nursing interventions needed for early removal of indwelling urinary catheters aimed at containing possible risks of CAUTIs among inpatients with indwelling urinary catheters.
Catheter Associated Urinary Tract Infections
Abstract
The research has established that the use of evidence-based nursing interventions for early removal of indwelling urinary catheters and shunning non-evidence based interventions does contribute to a significant decline in the risk of catheter-associated urinary tract infections among inpatients with indwelling urinary catheters.
Catheter Associated Urinary Tract Infections
According to Huang (2016), a urinary tract infection is a type of infection that affects the urinary tract and other parts of the urinary system including the bladder, urethra, kidney, and ureters and is the most prevalent healthcare related infection.
Center for Disease Control (CDC) statistics indicate that 13,000 deaths occur annually due to urinary tract infections (UTIs).Nearly 75% of the UTIs are linked to urinary catheters, while approximately 15-25% of inpatients use catheters (Hartley, 2015). Piechota (2016) defines indwelling urinary catheter as the urinary discharge tube that is inserted into the patient’s urinary bladder via the urethra and left in situ while continuously connected to a closed urinary drainage system. Urinary Tract Infections (UTIs) constitute the fourth most prevalent healthcare related infection with over 93,000 reported incidences in hospitalized patients in 2011 (Hartley, 2015).
Thus UTI’s constitute 12% of the total infections reported in acute care. Statistics further suggests that nearly all-healthcare related urinary tract infections occur as a result of the improper instrumentation of the urinary tract. CDC Statistics also shows that 12-16% of hospitalized adult patients have higher chances of using indwelling urinary catheters.
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Bloom Taxonomy
The present health care system dictates that delivery processes integrate various interfaces and patient handoff amid myriad health care practitioners with different levels of educational and professional background. During the timeframe of a four-day hospital stay, a patient might come into contact with 50 different personnel, including doctors, clinicians, technicians, and others. Dynamic clinical practice thus includes many cases where essential information should be correctly communicated.
Team cooperation is critical. When health care specialists are not communicating productively, the safety of a patient is at risk for various reasons: insufficient essential information, mix-up of information, ambiguous orders over the telephone, and ignored adjustments in status. Poor communication leads up to circumstances where medical errors can take place. These mistakes have the capacity to amount in severe injury or surprise patient demise. Medical flaws, particularly those caused by lack of communication, are widespread challenge in today’s health care organizations.
Conventional medical education stresses the significance of a practice that is free from errors, using severe peer pressure to accomplish perfection at the time of diagnosis and treatment. Mistakes are thereby conceived normatively as a harbinger of failure. This situation generates an atmosphere that prohibits the fair, honest assessment of errors needed if organizational learning is to occur.
It is significant to stress that nurturing a team cooperation environment may have problems to solve: extra time, conceived loss of independence, lack of confidence, conflicting ideas, amid others. However, many health care personnel are aware of the poor communication and teamwork, as a consequence of a culture of truncated outcomes that has bloomed in many health care situations (Helmreich and Schaefer, 2009).
Bloom Taxonomy
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According to Irwin, McClelland and Love (2006)communication is the core factor in medical care. In essence communication between physicians and patients is amassing a growing amount of attention with the health care in the U.S. In the last few years descriptive and investigational research has attempted to focus on the communication activities during medical consultations. Nevertheless, the knowledge obtained from these endeavors is restricted. This is likely because amid inter-personal relationships, the physician-patient collaboration is one of the most sophisticated ones.
While advanced technologies could be utilized for medical diagnosis and treatments, interpersonal communication is the key apparatus by which the doctor and the patient trade information (Stiles & Putman, 2007). Particular factors of doctor-patient communication appear to have considerable effect on patients’ attitudes and safety, for instance, contentment with care, positive response to treatment, recall and having knowledge about medical information, dealing with disease, qualify of life, and even condition of health.
Cooperation and communication are particularly essential in the case of a chronic disease, such as a cancer (Fallowfield, Maguire & Baum, 2002). Today, specialists of communication have progressively been focusing on psychological features of cancer. Creating a proper inter-personal cooperation between physicians and patients can be interpreted as a significant function of communication.
Furthermore, proper inter-personal relationship forms the basis for optimum medical care. On the other hand, the significance of a good physician-patient relationship relies on its therapeutic qualities. Another key function of medical communication is supporting the exchange of information between the physician and the patient.
Bloom Taxonomy
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Information can be regarded as a resource brought into the verbal exchange between the two parties. From a medical standpoint, physicians need information to determine the correct diagnosis and treatment strategy. From the patient’s standpoint, two needs have to be accomplished when meeting with the physician: the need to know and understand and the need to experience a sense of being known and understood. To be capable of achieving doctor’s and patient’s needs, both alternate between information-transmission and information- hunting.
Patients have to provide details about their symptoms, physicians’ needs to considerably look out relevant information. At times patients may be inclined to ask for as much information as possible, doctors appear to know patients needs for information. For instance, where cancer is involved, the desire for information is most great. A great number of cancer patients’ discontentment with transmission of information emanates from concordance between views of patients and physicians.
When relaying information to cancer patients about their disease (good or bad), doctors might explain medical information more empirically while patients explain it as a matter of individual relevance. As a consequence, the doctor might experience a satisfying sense that he has offered right and relevant information. The patient conversely might feel he has discovered nothing satisfying. Recent research indicates that about 45 percent of cancer patients have reported that no information has been provided relating to dealing with their disease (Fallowfield et al., 2002), however most patients wanted such information. Doctors must thereby first motivate their clients to exchange their key worries without interruption (Ben-Sira, 2008).
Bloom Taxonomy
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Psychological privacy involves a patient’s capacity to be in charge of active and cognitive inputs and outputs, to think and formulate behaviors, values to establish with whom to share information. Nevertheless, asking delicate questions and divulging confidential information is inevitable if the physician desires to find an effective diagnosis and treatment. The degree to which doctors communicate in a more dynamic, high-regulation style, could be conceived by patients as abuse of their psychological privacy. Physicians’ attitudes during patient examinations are regulated by societal values. It seems that at the time of medical interactions limited privacy is needed.
Constant eye contact, for instance, could be viewed by the patient as excessively intimate for the relationship. Conversely physical privacy can be regarded as a relevant aspect of non-verbal communication and can lead to improved quality of the inter-personal interactions between physicians and patients (Stiles and Putman, 2007). Other result gauges utilized to examine the quality of the physician-patient interaction are patients’ recall and understanding information. As it stands, most patients fail to recall or comprehend what the physician has told them.
Patient compliance is also a broadly utilized result variable and is regarded a measure of the productivity of provider-patient communication. Doctor-patient interaction might have significant outcomes for patient’s health outcomes, thus this relationship can be viewed as a type of social support. Lack of information appears to play a vital function in psychological challenge that can come up during the diagnosis and treatment (Irwin, McClelland & Love, 2006).
Bloom Taxonomy
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References
Ben-Sira.Z. (2008). “Affective and instrumental components in the physician patient relationship: an additional dimension of interaction theory.” Journal of Health Sociological Behavior, 170-185.
Fallowfield. L. J., Hall A., Maguire. G. P. and Baum. M. (2002).“Psychological outcomes of different treatment policies in women with early breast cancer outside a clinical trial.” British Medical Journal, 301- 575.
Irwin W. G., McClelland R. and Love.A. H. G. (2006). “Communication skills training for medical students: an integrated approach.” Medical Education, 387-390.
Stiles. W. B. and Putnam. S. M. (2007).Analysis of verbal and non-verbal behavior in doctor-patient encounters: In Communicating with Medical Patients. Newbury Park, CA: Sage Publications.
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Appendix: Interview
I chose to interview a personal acquaintance of mine who happens to be a screenplay enthusiast. I think it is a fantastic occupation path since it balances creativity and professional writing.
1. What are you pursing as an undergraduate student?
I am studying Journalism.
2. How will your undergraduate studies influence your future career?
I am on track to work in the corporate world, probably as an editor
3. When did you first develop interest in screenplay writing?
I like to think when you first write a screen-play and gets positive comments from people who have been in the production scene for some time, you get interest in that moment. It had never occurred to me that this was something I’d be doing as pastime thing.
4. How much experience with screenplay writing do you have?
None as a matter of fact, but I have always been involved with creative writing on the side (for instance, poems and flash stories).
5. What are some of your objectives for the future?
Finishing my undergraduate, find a job, get a job, and see what fate throws my way. I have come to discover in life that whatever you make plans, the big guy above somehow has a totally different idea.
6. Would say that screenwriting you will be engaged in as a side project rather than a full time career?
I don’t want to find myself restricting myself at all. My undergraduate will put me up in the corporate world, but this might as well turn into an amazing gig in the future.
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Florida International University Herbert Wertheim College of Medicine Personal Statement
Instructions
The Florida International University Herbert Wertheim College of Medicine strives to ensure that its students become respectful physicians who embrace all dimensions of caring for the whole person. Please describe how your personal characteristics or life experiences will contribute to the Florida International University Herbert Wertheim College of Medicine community and bring educational benefits to our student body. (1000 characters)
Is there any further information that you would like the Committee on Admissions to be aware of when reviewing your file that you were not able to notate in another section of this or the AMCAS Application? (1000 characters)
Why have you chosen to apply to the Florida International University Herbert Wertheim College of Medicine and how do you think your education at Florida International University Herbert Wertheim College of Medicine will prepare you to become a physician for the future? (1 page, formatted at your discretion, upload as PDF)
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The impact that pediatric medical devices have on the world of healthcare
Pediatric medical devices are used in treating or diagnosing conditions and illnesses from birth to the age of twenty-one. There is an extensive range of pediatric devices ranging from imaging machines to tongue blades. While a number of products are designed particularly for children, other products are borrowed from adult applications or are made for more general utilization (Samuels-Reid & Blake, 2014).
This paper provides an exhaustive evaluation of the way in which pediatric medical devices in health care have changed over time. The paper also provides an analysis of the extent to which pediatric medical devices have affected the diagnoses in healthcare. Furthermore, this paper provides an assessment of how target markets have changed with pediatric medical devices.
Medical devices essentially include the items which are utilized in diagnosing, curing, mitigating, treating, or preventing a disease. There is an extensive assortment of medical devices ranging from simple tools such as surgical clamps and bandages to complex ones such as pacemakers. Pediatric patients are amongst those a medical device is designed to treat and include persons aged from birth to not more than 21 years (United States Government Accountability Office, 2016).
Designing medical devices for paediatrics could be difficult. This is because children are by and large smaller and more active compared to adults, their functions and body structures change during childhood, and children might actually be long-term users of medical devices which brings new concerns with regard to longevity of device and lasting exposure to implanted materials (Field & Tilson, 2015).
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Pediatric medical devices in healthcare have changed over time
The history of pediatric medical devices in healthcare is fascinating in terms of how advancements have been made over time to address the unmet needs of paediatrics. As more children continued to suffer from illnesses, medical device manufactures started to make pediatric medical devices that are tailored to youngsters and babies. These devices were vital for improving not just health, but also the quality of life for babies and young people (Zimmerman & Strauss, 2010).
From the 1930s through to the 1940s and 50s, adult respiratory intensive care units (ICUs) were set up for the purpose of battling the blight of the polio outbreak with iron lung ventilators. These respiratory intensive care units, out of necessity, also cared for pediatric patients who had the polio disease (Epstein & Brill, 2012).
In their newly created neonatal ICUs, neonatologists developed procedures for environmental and nutritional support for premature toddlers and sick babies along with ventilation methods and monitoring for the treatment of respiratory distress syndrome, which is also commonly called the hyaline membrane disease. It is worth mentioning that the understanding and utilization of the surfactant and continuous positive airway pressure mechanical ventilation improved to a great extent the survival of babies with hyaline membrane disease (Downes, 2013).
In the 1960s, advancements in pediatric congenital heart surgery resulted in a need of developing intensive care units and devices for providing complex postoperative care. This need was accelerated by the introduction of cardiopulmonary bypass for repairing congenital heart lesions. The first pediatric ICU medical devices were developed by Goran Haglund in the year 1955 and utilized in Europe at Children’s Hospital of Gotenburg in the northern European nation of Sweden (Samuels-Reid & Blake, 2014).
In 1967, John Downes opened a pediatric Intensive Care Unit at Children’s Hospital of Philadelphia, which had a few pediatric ICU devices. Over the next 4 decades, hundreds of pediatric Intensive Care Units were established in many community hospitals, children’s hospitals, and academic institutions across Europe and North America. By 1995 for instance, there were about 306 general pediatric intensive care units in America with pediatric medical devices and that number rose to 349 in the year 2001 (Waugh & Granger, 2011).
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John Gibbon at the Jefferson Medical College Hospital in the state of Philadelphia in the year 1953 carried out the world’s first open heart surgical operation on an infant using the total cardiopulmonary bypass machine that he had designed and developed. Prior to that surgery, adolescents and babies who had congenital heart disease were considered inoperable or they were treated with closed heart surgery (Epstin & Brill, 2012).
In 1938 at Children’s Hospital in Boston, Robert Gross carried out the very first ligation of a patent ductus arteriosus in a young child aged 7 and in 1944, he repaired an aortic coarctation. Still in the year 1944, Swedish professionals Nylin and Craafort carried out a repair of an aortic coarctation (Downes, 2013). In the year 1945 at Johns Hopkins Hospital, Vivien Thomas and Alfred Blalock conducted an extracardiac shunt between the ipsilateral pulmonary artery and the subclavian artery in an infant girl aged fifteen months with tetralogy of Fallot (Epstin & Brill, 2012).
These procedures, in addition to the introduction of cardiopulmonary bypass, served to revolutionize the treatment of heart disease in children and in fact stimulated the development of pediatric cardiac ICUs and medical devices, and helped to improve perioperative care. Noninvasive Mechanical Ventilation was initially introduced during the late 1980s for pediatric patients who had nocturnal hypoventilation (Cheifetz, 2013).
Noninvasive Mechanical Ventilation uses a mask placed over the mouth and/or nose or prongs which are inserted into the nares in order to provide positive pressure ventilator assistance. Either continuous positive airway pressure (CPAP) or bilevel positive airway pressure (BiPAP) which produces differing expiratory and inspiratory positive airway pressures might be utilized (Epstin & Brill, 2012).
Noninvasive Mechanical Ventilation is utilized in augmenting impaired respiratory effort in various illnesses and conditions such as congestive heart failure, asthma, neuromuscular disorders, and cystic fibrosis. In treating adolescents and babies who have hypoxemic respiratory failure with Noninvasive Mechanical Ventilation, professionals have found low incidence of intubation and improvement in dyspnea, ventilation, and oxygenation (Cheifetz, 2013).
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The other respiratory-assist, noninvasive pediatric medical device which has become more and more popular lately is the humidified, high-flow gas that is delivered to the infant through a nasal cannula. In essence, 1 unit of the Vapotherm 2000i delivers about 40 L/min of gas flow with over ninety-five percent humidity (Waugh & Granger, 2011). The high humidity serves to increase comfort at the higher levels of gas and prevent nasal mucosal drying.
In principle, the high-flow system generates continuous positive airway pressure. It is worth mentioning that this device – the high-flow nasal cannula – has been utilized in babies who are premature in order to prevent apnea of prematurity and generates the same distending pressures as nasal continuous positive airway pressure. This pediatric medical device became highly popular owing to its anecdotal success as well as comfort because of subjective improvement of respiratory distress and prevention of intubation of teenagers, children and babies who have respiratory difficulties (Sreenan et al., 2011).
Many children and infants who are severely sick require mechanical ventilation and endotracheal intubation for cardiorespiratory failure or postoperative care. The first mechanical ventilation was designed and developed in the year 1910 by Sievers and Lawen. This ventilator provided negative and positive pressure through a piston cylinder. Iron lungs were the next mechanical ventilators. They were negative-pressure, electrically powered body tanks which were utilized widely for polio pediatric patients in the 1920s, 30s, 40s and even 50s (Downes, 2013).
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Modern mechanical ventilators utilize computers in providing various ventilation modes – volume versus pressure –, to synchronize with the ventilator effort of the patient, and to adjust patterns of inspiratory flow in order to improve gas flow distribution. Initially conceptualized in the year 1972, High-Frequency Oscillatory Ventilation (HFOV) is popular in the treatment of refractory to conventional ventilation in children and babies (Lunkenheimer et al., 2011).
This pediatric device basically delivers a tidal volume not more than the dead space volume at a rate of over a hundred-and-fifty breaths every minute and a higher mean airway pressure (Cheifetz, 2013). High-Frequency Oscillatory Ventilation maintains an open lung but avoids large pressure changes and phasic volume, which minimizes the cyclical stretch of the pediatric patient’s lungs and ventilator-induced lung injury.
Researchers have reported that using High-Frequency Oscillatory Ventilation in the first twenty-four hours of mechanical ventilation decreases the mortality by 47 percent compared with its use after twenty-four hours of mechanical ventilation (Fedora et al., 2010). Moreover, using High-Frequency Oscillatory Ventilation has been shown to improve oxygenation and survival by eighty-nine percent in children without increasing the risk of air leaks and pneumothorax. On the whole, the HFOV pediatric medical device has helped to improve mortality in children and babies, although its efficacy has not been proved in premature babies.
Ventricular Assist Devices (VADs) are utilized in pediatric patients with heart failure. Matsuda and Matsumiya (2012) noted that ventricular assist devices are utilized in patients who have cardiomyopathy with heart failure or severe cardiogenic shock as a bridge to recovery or to heart transplantation. These devices are attached surgically to the failing ventricle with an implantable or extracorporeal pneumatic or electric pump which brings about improved blood flow.
In essence, Ventricular Assist Devices allow for improved quality of life and mobility in adolescents and babies who have failed medical management for their heart failure (Goldman et al., 2013).
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Extracorporeal Life Support (ECLS) pediatric medical device was first employed in the year 1976 in children and babies who had postoperative cardiac failure, persistent fetal circulation, massive meconium aspiration and infant respiratory distress syndrome (Bartlett et al., 2010). This device supports a pediatric patient in circumstances in which the respiratory and/or cardiac disease cannot be medically managed through conventional means and ensures sufficient tissue oxygen delivery for supporting end-organ function.
It is notable that Extracorporeal Life Support involves surgical placement of cannulae into a main artery or vein for veno-arterial Extracorporeal Life Support, or only a main vein for veno-venous Extracorporeal Life Support (Bartlett et al., 2010). In children and older babies, Extracorporeal Life Support has been utilized for support during very serious sepsis, Acute Respiratory Distress Syndrome, or cardiac failure because of cardiomyopathy/myocarditis, hemodynamic instability following congenital heart surgery palliations/repairs, and at times as a bridge to heart transplant (Walker, Liddell & Davis, 2014).
The survival rates for Extracorporeal Life Support pediatric medical device for patients who require cardiopulmonary resuscitation is sixty-four percent in youngsters who have cardiac arrest following open-heart surgery and sixty-one percent in newborns without congenital heart disease (Chen et al., 2011).
Pediatric patients are of many different sizes, ranging from over 100 kilograms to less than 1 kilogram. This creates the need for a wide range of bronchoscopes, endotracheal tubes, catheter sizes, in addition to other pediatric medical devices. Pediatric critical care would today not be possible without the development of size-appropriate pediatric medical devices.
Prior to the 1950s, Shann, Duncan and Brandstater (2013) noted that endotracheal tubes were made with the use of rubber or metal material. Introduced during the ‘50s, plastic polyvinyl chloride endotracheal tubes become less rigid at body temperature and they soften. They are also less probable to bring about subglottic stenosis. When smaller-sized uncuffed and cuffed endotracheal tubes were developed and introduced into the marketplace, prolonged intubation of adolescents and babies was actually made possible (Shann, Duncan & Brandstater, 2013).
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Likewise, intravenous access is of great importance for the administration of medicines and fluids to pediatric patients who are severely sick. During the mid-1940s, plastic catheters replaced metal needles which were rigid thereby making long-term intravenous access possible. In the late 1950s, the current flexible, intravenous catheter-around-the-needle pediatric medical device was developed by George Doherty (Zimmerman & Strauss, 2010).
During the ‘60s and ‘70s, percutaneous central venous access developed. It is notable that the launch of pediatric-sized equipment facilitated monitoring of central venous pressures, placement of catheters for parenteral nutrition, as well as placement of pulmonary artery catheters for measuring hemodynamic variables including pulmonary artery pressure, vascular resistance, and cardiac output (Zimmerman & Strauss, 2010).
When designing the pediatric medical devices which could be implanted into the body of a child, the key factors that have been taken into consideration by medical device manufacturers over the years are as follows: (i) how the pediatric medical device would fit the body of the child as he or she grows; (ii) how the pediatric medical device is absorbed by the child’s body; and (iii) the durability of the medical device (Cheifetz, 2013).
When a medical device manufacturer designs a respiratory medical device for adult patients, the manufacturer could focus on the particular physiologic condition of the patient. However, when the manufacturer designs a respiratory device for the youngest infants, the manufacturer has to think holistically. The manufacturer should think about the baby’s entire body since everything is actually interrelated.
In addition, each aspect of an infant’s growing body has been taken into account over the years in developing effective medical devices for this population. When using surgical tape for instance, the fragile skin of the child is of particular importance. Materials utilized in developing these products are made without detrimental toxins and are gentle on the child’s skin (Shann, Duncan & Brandstater, 2013).
On the whole, in the area of pediatric medical devices, a substantial amount of progress has been made over the years. In making this progress, medical device manufacturers have ensured that they develop products which are tailored to accommodate the lifestyle, activities and growth of a child. Chen et al. (2011) reported that long-term pediatric medical devices are today designed to fit within the lifestyle of children as much as possible and not forcing the children to fit to the medical devices as it used to be the case in the first half of the 20th century when children were forced to fit into medical equipment for adult patients.
Even with chronic diseases, children should be allowed to be children. Over the years, professionals have exploited the opportunity for growth and development in pediatric biomedical engineering as they do their best to create innovative medical devices which improve the quality of pediatric care for children and babies.
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Pediatric medical devices have affected the diagnoses in healthcare
The pediatric medical industry is a very fragmented industry that comprises giant corporations and start-up companies. The Food and Drug Administration regulates many different diagnostic medical devices under specified procedures. It is notable that diagnostic medical devices for pediatric patients range from items such as cardiac monitors, vision evaluation instruments, and blood pressure cuffs to complex imaging equipment.
Basing upon their complicatedness, pediatric diagnostic medical devices are usually assigned to one of 3 classifications – Class I, Class II and Class III – and regulated by the Food and Drug Administration accordingly (Food and Drug Administration, 2016). In addition, diagnostic medical devices for pediatric patients comprise a diverse range of products commonly referred to as in-vitro diagnostic devices: they are essentially systems, instruments, and reagents used in the diagnosis of illness or other conditions.
The Food and Drug Administration regulates pediatric in-vitro diagnostic medical devices in the United States which are manufactured and sold by medical device manufacturers and other tests which are vital in diagnosing a number of uncommon conditions and illnesses (Food and Drug Administration, 2016).
An oxygen machine helps the pediatric patient to breath and a heart pump helps in bringing blood from the heart of the child to the rest of his or her body. These and other pediatric medical devices have helped to save so many children lives. According to the Food and Drug Administration (2016), pediatric medical devices are crucial in treating sick children and infants who are affected by various diseases, including uncommon illnesses.
Pediatric medical devices are helpful in the prevention of premature death and each year, they greatly improve the quality of life for numerous youngsters and infants. Some medical devices are developed particularly for children and infants and some are developed specifically for patients who are above a particular age. Many times however, healthcare providers modify medical devices meant for adult patients for usage in pediatric patients (Samuels-Reid & Blake, 2014).
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Pediatric medical devices are crucial in treating adolescents and infants who have heart disease. Modern examples include ventricular assist medical devices, atrial septal defect occluders, defibrillators, balloon catheters, pacemakers, prosthetic heart valves, endovascular stents.
Epstein and Brill (2012) stated that together with improvements in medical and surgical practice over the last 2 decades, pediatric medical devices have contributed very much to decreasing the overall burden of mortality and morbidity seen in adolescents and babies who have heart disease. Almond (2013) reported that the majority of cardiac medical devices utilized in adolescents and infants nowadays are utilized off-label in which the risk-benefit of those medical devices has not been characterized properly.
In essence, medical devices designed for pediatric patients face a number of challenges to Food and Drug Administration approval linked largely to ethical considerations of device testing in adolescents and babies, heterogeneity of the patient population, and the small target population. Even though comparatively few cardiovascular medical devices have actually been approved by the Food and Drug Administration for use in children, the number of pediatric medical devices that are successfully being approved by the FDA is on the rise (Food and Drug Administration, 2016).
Many FDA approvals of pediatric medical devices are being given via the Humanitarian Device Exemption pathway, which is in fact designed for uncommon conditions which make it appropriate for medical devices that treat pediatric congenital heart disease.
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One major pediatric medical device used by medical professionals and organizations for diagnosis and which has been very helpful in saving the lives of very many babies and children is the Vertical Expandable Prosthetic Titanium Rib (VEPTR). This pediatric medical device has actually been influential in saving the lives of over 320 young children and babies who would have otherwise died due to the lack of breathe considering that they suffered from thoracic insufficiency syndrome (TIS) – a rather rare disease (Shann, Duncan & Brandstater, 2013).
The VEPTR pediatric medical device is basically curved like a ribcage. Moreover, it has holes which allow the surgeon to expand this pediatric medical device in outpatient surgery each 6 months. This device is implanted in adolescents and babies – who could be as young as six months of age – until skeletal maturity, often 16 years in boys and 14 years in girls.
VEPTR was invented by Dr. Robert Campbell and it actually took him thirteen years to obtain approval from the federal drug administration given that it took a very long period of time in accumulating many pediatric patients with rare sicknesses. The VEPTR is intended for a number of purposes which include: treating scoliosis, which refers to a sideways curve within the spine; stabilizing the ribs and spine in adolescents and infants who have serious chest wall deformities to allow these children to breathe better; reconstructing the chest when a number of ribs need to be taken out for some kinds of cancer surgical operation (United States Government Accountability Office, 2011).
On the whole, VEPTR is used in treating adolescents and babies with a group of conditions commonly referred to as thoracic insufficiency syndrome. In this thoracic insufficiency syndrome, the thorax of the pediatric patient – which consists of breastbone, rib cage and spine – are not able to support normal breathing. One of the treatment options entails the placement of a titanium rib. A number of other medical devices have been developed or are currently being developed for use in the diagnosis of pediatric patients in healthcare. Some of these pediatric medical devices are illustrated in the table below (United States Government Accountability Office, 2011):
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Pediatric Medical Device
Condition diagnosed, treated or use
1
Biodegradable valve ring for infants and adolescents
Utilized for repairing cardiac valve
2
PediVAS pediatric circulatory assist device
Utilized in temporary and acute life support for small children and babies
3
Septal cincher
Utilized in reducing the gap of a cardiac valve
4
Pediatric ultrasound imaging for surgical planning and diagnostics
Utilized to perform cardiac imaging
5
Antiseptic and nonthrombogenic catheters for babies
Utilized in treating infection and clotting problems with catheters in infants
6
Bowel lengthening device
Utilized for treating the short bowel syndrome
7
Catheter for peripheral nerve blocks
Utilized for securing catheter placement during pediatric pain management
8
Neurosurgical articulated tools
Utilized during pediatric brain surgical procedure
9
Pyloromyotomy surgical tool
Utilized to make laparoscopic pyloromyotomy easier and safer
10
NICU dashboard
Utilized for monitoring and synthesizing multiple pediatric vital sign inputs
11
Esophageal atresia surgical tool
Used to treat esophageal atresia
12
RoboImplant for scoliosis: a bionic ortho implant that is remotely operated
Used to treat acquired and congenital spine disorders for instance early onset scoliosis
13
Magnetic Mini-Mover for pectus excavatum
Used to treat sunken chest or pectus excavatum.
14
Melody Transcatheter Pulmonary Valve
Utilized in repairing a leaky or blocked pulmonary heart valve which has formerly been replaced to rectify heart defects. This pediatric medical device is inserted without the use of open heart surgical operation and while the child’s heart is beating. It could delay the need for more invasive open heart surgical operation.
15
Debakey VAD Child left ventricular assist system
Used for pediatric heart transplantation. Also used for youngsters aged five to sixteen with BSA 1.5 to 0.7 with class 4 heart failure refractory to medical therapy
16
Shelhigh Pulmonic Valve Conduit Model NR-4000
Used in infants and youngsters aged from 0 to four years who require replacement of an absent or dysfunctional artery
17
Contegra Pulmonary Valve Conduit
Used in youngsters below the age of eighteen years who require reconstruction of RVOT because of pulmonary stenosis, Pulmonary Atresia, and Truncus Arteriosus.
18
Berlin Heart EXCOR pediatric ventricular assist device
Used in youngsters aged sixteen years and below who have class 4 cardiac failure and listed for transplantation
19
CardioSEAL Septal Occlusion System
Used to treat adult and pediatric patients who have complex single ventricle physiology
Target markets have changed with pediatric medical devices
Target markets have changed considerably since medical device manufacturers now have to focus also on pediatric medical devices to satisfy the unmet needs and not focus solely on medical devices for the adult patient population. Even so, the development of pediatric medical devices lags five to ten years behind the development of medical devices for adult patients (Food and Drug Administration, 2016).
As is true for manufacturers of biologics and medicines, medical device manufacturers naturally look for business opportunities in markets of adequate profitability and size in order to merit the investment risk. In particular, if the Food and Drug Administration demands far-reaching clinical data for approval of the medical device, manufacturers might be discouraged from making medical devices for small markets such as pediatric patients by the practical and expense challenges of carrying out satisfactory trials to show efficacy and safety of the device.
Even so, the Safe Medical Devices Act 1990 allowed the Humanitarian Device Exemption (HDE) to promote both the development and introduction of sophisticated medical device technologies to satisfy the unmet needs of small patient populations including adolescents, neonates and infants (Food and Drug Administration, 2016).
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A Humanitarian Device Exemption application contains a sufficient amount of information for the Food and Drug Administration to establish that the medical device does not create a significant or unreasonable risk of injury or sickness, and that the likely benefit to health of the targeted patient population really outweighs the risk of disease or injury from its utilization.
To qualify for a Humanitarian Device Exemption, medical device manufacturers should initially request that the medical device must be designated as a Humanitarian Use Device by the Office of Orphan Products Development. A Humanitarian Use Device refers to a medical device that is designed to benefit patients in diagnosing or treating a condition or illness which is manifested in or affects less than four-thousand people annually in America (Fedora et al., 2010).
If a medical device is to be utilized for diagnosis of diseases, the documentation in a Humanitarian Device Exemption application should show that less than four-thousand patients annually would be subjected to diagnosis by that particular medical device in America.
The Humanitarian Device Exemption provides various incentives for start-ups to manufacture pediatric medical devices which have enabled a number of companies to focus on the pediatric patient target market. For instance, unlike companies that make other products such as drugs and biologics, pediatric device makers are not required to provide clinical evidence that demonstrates the efficacy or effectiveness of their devices (Food and Drug Administration, 2016).
This is a major incentive that has allowed device makers and start-ups to focus on the pediatric patient target market since clinical trials to support efficacy claims often take a number of years to carry out and are costly. Furthermore, the period of time specified for regulatory review of an application is often shorter for Humanitarian Device Exemptions compared to the time period for other premarket approval applications.
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The other incentive for pediatric device manufacturers is certainly the waiver of filing fees often demanded as per the Medical Device User Act, which is more than $200,000 (Food and Drug Administration, 2016). Partly because of these incentives, entrepreneurs at a number of small start-up firms are now developing several ground-breaking and inventive medical devices, focusing on the target market that comprises children aged <21 and these device makers and start-ups seek to address the unmet needs of small patient populations particularly pediatric patients.
Certainly, medical device makers have changed the focus of their target market somehow, from focusing on medical devices for the adult patients to making devices for adolescents, infants and neonates to take advantage of the HDE incentives.
Today, manufacturers of pediatric medical devices are largely entrepreneurs at small, start-up firms. These start-up firms design and produce a number of revolutionary medical devices including medical devices which address the medical needs of small population of patients. Field and Tilson (2015) reported that there are a number of motivations for companies to make pediatric medical devices for small patient populations.
Some start-up firms focus on addressing unmet needs in the society and contribute to the society without the need to navigate the processes of decision-making common with complex, big medical device manufacturers. In other cases, the projected business opportunity is extremely risky or extremely small to be worth attention from current large companies though is still lucrative enough to attract small groups of entrepreneurs or venture capitalists.
It is notable that in exchange for partial ownership of the start-up firm, most venture capitalists and angel investors usually offer the required funding aimed at bringing promising and ground-breaking innovations into the marketplace (Goldman et al., 2013). Besides infusions of capital, venture capitalists and angel investors who have previously worked with other new firms might offer strategic advice and management expertise to guide managers of start-up medical device companies.
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In healthcare, technological innovations could save lives of patients and even increase the quality of life. Artificial hips and knees allow patients to be able to get back to their feet, stents prop open weak arteries, and pacemakers help in restoring rhythm to the patient’s heart. Nonetheless, these medical devices have largely been meant only for adult patients, not children.
For a lot of years, Downes (2013) reported that pediatric patients have been dealing with ill-fitting medical devices which were designed for adults. Healthcare providers were forced to adapt medical devices made for adults to adolescents and babies and the resultant improvisations have usually been far from ideal, not just in terms of safety, but also in terms of efficacy.
However, over the past few years, target markets have changed with more professionals and medical device makers being more willing to produce devices that are particularly customized for infants and children. More and more focus is now being put on the designing and making of appropriate state-of-the-art pediatric medical devices. For instance, the consortium Southern California Centre for Technology and Innovation in Pediatrics (CTIP) was formed in the year 2011 for the purpose of bringing together the best experts to accelerate the development of pediatric medical equipment – a path, which, as Almond (2013) pointed out, has not been lucrative or simple to tread.
In essence, these experts give advice to aspiring developers of medical devices on the process of manufacturing, protection of intellectual property, funding opportunities, regulatory oversight, commercial partnerships, as well as clinical trial design. The CTIP is basically a consortium between Children’s Hospital Los Angeles and the University of Southern California (Children’s Hospital Los Angeles, 2016). It is of major importance to have best advisers given that there are a number of intrinsic challenges in commercializing medical equipment and devices for paediatrics – a field which is typified by usually vulnerable and small patient populations.
There are also a number of contests organized in order to foster innovation which would advance pediatric healthcare and address the unmet medical and surgical device needs for babies and adolescents. For example, there is the yearly contest held by the Sheikh Zayed Institute for Pediatric Surgical Innovation at Children’s National Health System in Washington, DC (Sheikh Zayed Institute for Pediatric Surgical Innovation, 2016).
This contest is part of the institute’s 3rd yearly symposium and from 8 finalists, 2 pediatric medical innovators, Prospiria from Texas and AventaMed from Ireland were selected to get a fifty-thousand dollar award. Acknowledging that pediatric ear tube surgical operation is the main reason that youngsters and babies undergo surgical procedure which necessitates general anesthesia, AventaMed designed and created a hand-held ear tube pediatric medical device which does not necessitate full general anesthesia.
On the other hand, Prospiria presented to the contest a non-invasive pediatric medical device utilizing optoacoustic imaging for monitoring endotracheal tube positioning for pediatric life support patients (Sheikh Zayed Institute for Pediatric Surgical Innovation, 2016).
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Conclusion
To sum up, pediatric medical devices consist of the items which are employed in diagnosing, curing, mitigating, treating, or preventing a disease in adolescents, babies and neonates. In healthcare, the history of pediatric medical devices is quite exciting in terms of how progress has been made over the years aimed at addressing the unmet needs of paediatric populations. As more youngsters and infants continued to suffer from various ailments, medical device makers began developing medical devices specifically designed for pediatric patients.
Today, these pediatric medical devices are crucial for improving both the health as well as the quality of life for youngsters comprising adolescents, infants and neonates/newborns. Pediatric medical devices are critical in diagnosing and treating ailing adolescents and babies who are affected by many ailments, including rare ailments. These devices are useful in the prevention of premature death in children.
References
Almond, C. S. (2013). The FDA review process for cardiac medical devices in children: A review for the clinician. Prog Pediatr Cardiol, 33(2): 105-109
Bartlett, R. H., Gazzaniga, A. B., Jefferies, M. R., Huxtable, R. F., Haiduc, N. J., & Fong, S. W. (2010). Extracorporeal membrane oxygenation (ECMO) cardiopulmonary support in infancy. Trans Am Soc Artif Intern Organs 22:80–93
Cheifetz, I. M. (2013). Invasive and noninvasive pediatric mechanical ventilation. Respir Care48:442–458
Chen, Y. S., Chao, A., Yu, H. Y., Ko, W. J., Wu, I. H., Chen, R. J., Huang, S. C., Lin, F. Y., & Wang, S. S. (2011). Analysis and results of prolonged resuscitation in cardiac arrest patients rescued by extracorporeal membrane oxygenation. J Am Coll Cardiol 41:197–203
Children’s Hospital Los Angeles. (2016). A better fit: State-of-the-art medical devices are finally being customized for pediatric patients. Retrieved from http://www.chla.org/publication/better-fit
Downes, J. J. (2013). The historical evolution, current status, and prospective development of pediatric critical care. Crit Care Clin 8:1–22
Epstein, D., & Brill, J. E. (2012). A history of pediatric critical care medicine. Pediatric Research, 23(58): 987-996
Fedora, M., Klimovic, M., Seda, M., Dominik, P., & Nekvasil, R. (2010). Effect of early intervention of high-frequency oscillatory ventilation on the outcome in pediatric acute respiratory distress syndrome. Bratisl Lek Listy 101:8–13
Field, M., & Tilson, H. (2015). Safe Medical Devices for Children Executive Summary. Institute Of Medicine.
Goldman, A. P., Cassidy, J., de Leval, M., Haynes, S., Brown, K., Whitmore, P., Cohen, G., Tsang, V., Elliott, M., Davison, A., Hamilton, L., Bolton, D., Wray, J., Hasan, A., Radley-Smith, R., Macrae, D., & Smith, J. (2013). The waiting game: bridging to paediatric heart transplantation. Lancet 362:1967–1970
Lunkenheimer, P. P., Rafflenbeul, W., Keller, H., Frank, I., Dickhut, H. H., & Fuhrmann, C. (2011). Application of transtracheal pressure oscillations as a modification of “diffusing respiration”. Br J Anaesth 44:627
Matsuda, H., & Matsumiya, G. (2012). Current status of left ventricular assist devices: the role in bridge to heart transplantation and future perspectives. J Artif Organs 6:157–161.
Samuels-Reid, J. H., & Blake, E. D. (2014). Pediatric medical needs: A look at significant US legislation to address unmet needs. Expert Rev Med Devices, 11(2): 169-174
Shann, F. A., Duncan, A. W., & Brandstater, B. (2013). Prolonged per-laryngeal endotracheal intubation in children: 40 years on. Anaesth Intensive Care 31:663–666
Sheikh Zayed Institute for Pediatric Surgical Innovation. (2016). 2015 Highlights: 2015 Sheikh Zayed Prize for Pediatric Device Innovation. Retrieved from http://www.pediatric-surgery-symposium.org/
Sreenan, C., Lemke, R. P., Hudson-Mason, A., & Osiovich, H. (2011). High-flow nasal cannulae in the management of apnea of prematurity: a comparison with conventional nasal continuous positive airway pressure. Pediatrics 107:1081–1083
United States Government Accountability Office. (2011). Pediatric medical devices: Provisions support development, but better data needed for required reporting. GAO
Walker, G., Liddell, M., & Davis, C. (2014). Extracorporeal life support—state of the art. Paediatr Respir Rev 4:147–152
Waugh, J. B & Granger, W. M. (2011). An evaluation of 2 new devices for nasal high-flow gas therapy. Respir Care 49:902–906
Zimmerman, J. J., & Strauss, R. H. (2010). History and current application of intravenous therapy in children. Pediatr Emerg Care 5:120–127
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Death of the Heart muscle
Question for discussion
Mr. Smith was lifting a heavy piece of furniture when he experienced crushing pain in his chest, began sweating heavily, and was nauseated. His wife drove him to the hospital, where he was diagnosed with a myocardial infarction (MI, also called a heart attack) and given intravenous drugs to dissolve a clot that was obstructing a major coronary artery. After his hospitalization, Mr. Smith?s doctor told him that some of his heart muscle had died. Explain the Pathological processes associated with the death of the heart muscle
Pathological processes associated with the death of the heart muscle
The function of heart relies on a complex network of cells’ ‘the cardiomyocytes for its appropriate function. These cells are the contracting cells in the heart, that exist in a three dimensional network of endothelial cells, vascular smooth muscle, an abundant fibroblasts and transient populations of immune cells. Gap junctions electrochemically coordinate the contraction of the individual cardiomyocytes, and their contraction to the extracellular matrix that transduces force and coordinates the overall contraction of the heart. In the cells, the repeating units of actin, as well as the myosin form the sarcomere structure, the basic functional unit of the cardiomyocyte.
The sarcomere has more than 20 proteins form connections between extracellular matrix and myocytes that regulate muscle contraction. The dysfunction occurs due to the disruption in the interaction in the complex activity that exist between multimeric complexes and many proteins. The heart can tolerate a variety of pathological insults, even then if the adoptive responses that aim to maintain functions eventually fail, they result in a range of functional deficits of cardiomyopathy. (Pamela and Leslie,2011).
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Patho-physiological processes of cell injury
Tissue injury and cell death occur due to ischemic insult, is determined by the magnitude and duration of the blood supply and the changer induced due to reperfusion. Prolonged ischemia, reduces the ATP levels and intracellular PHdue to anaerobic metabolism and accumulation of lactate. This results in the dysfunction of ATPase dependent ion transport mechanisms, that contribute to increasing intracellular mitochondrial calcium levels, swelling of the cell and the rupture of the cell, ultimately resulting in the death of the cell by necrotic, necroptotic. Apoptopic and autophagic mechanisms. (Theodore et.al,2012).
Reversible and irreversible cell injury
Reversible cell injury
Reversible cell injury denotes pathological changes that can be reversed, provided the stimulus is removed and the cellular injury is mild. Cellular injury can be recovered only to a certain point.(Farber et.al,1981)
Irreversible cell injury
Irreversible cell injury is a pathological change that is permanent and can cause cell death and cannot be reversed to normal state.(Farber et.al,1981)
Sustaining heart attack
The cell injury causes loss of phosphorylation in mitochondria, increase in anaerobic glycolysis, slowing down of the pumping of sodium, failure of active transport. The morphological changes that include swelling of the cell, loss of microvilli and blebs. All these abnormalities can be reversible if the oxygenation is restored.
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Cell injury off the Heart Muscle
Question for discussion
Mr. Smith was lifting a heavy piece of furniture when he experienced crushing pain in his chest, began sweating heavily, and was nauseated. His wife drove him to the hospital, where he was diagnosed with a myocardial infarction (MI, also called a heart attack) and given intravenous drugs to dissolve a clot that was obstructing a major coronary artery. After his hospitalization, Mr. Smith?s doctor told him that some of his heart muscle had died.
Pathological processes associated with the death of the heart muscle
The function of heart relies on a complex network of cells’ ‘the cardiomyocytes for its appropriate function. These cells are the contracting cells in the heart, that exist in a three dimensional network of endothelial cells, vascular smooth muscle, an abundant fibroblasts and transient populations of immune cells. Gap junctions electrochemically coordinate the contraction of the individual cardiomyocytes, and their contraction to the extracellular matrix that transduces force and coordinates the overall contraction of the heart. In the cells, the repeating units of actin, as well as the myosin form the sarcomere structure, the basic functional unit of the cardiomyocyte.
The sarcomere has more than 20 proteins form connections between extracellular matrix and myocytes that regulate muscle contraction. The dysfunction occurs due to the disruption in the interaction in the complex activity that exist between multimeric complexes and many proteins. The heart can tolerate a variety of pathological insults, even then if the adoptive responses that aim to maintain functions eventually fail, they result in a range of functional deficits of cardiomyopathy. (Pamela and Leslie,2011).
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Patho-physiological processes of cell injury
Tissue injury and cell death occur due to ischemic insult, is determined by the magnitude and duration of the blood supply and the changer induced due to reperfusion. Prolonged ischemia, reduces the ATP levels and intracellular PHdue to anaerobic metabolism and accumulation of lactate. This results in the dysfunction of ATPase dependent ion transport mechanisms, that contribute to increasing intracellular mitochondrial calcium levels, swelling of the cell and the rupture of the cell, ultimately resulting in the death of the cell by necrotic, necroptotic. Apoptopic and autophagic mechanisms. (Theodore et.al,2012).
Reversible and irreversible cell injury
Reversible cell injury
Reversible cell injury denotes pathological changes that can be reversed, provided the stimulus is removed and the cellular injury is mild. Cellular injury can be recovered only to a certain point.(Farber et.al,1981)
Irreversible cell injury
Irreversible cell injury is a pathological change that is permanent and can cause cell death and cannot be reversed to normal state.(Farber et.al,1981)
Sustaining heart attack
The cell injury causes loss of phosphorylation in mitochondria, increase in anaerobic glycolysis, slowing down of the pumping of sodium, failure of active transport. The morphological changes that include swelling of the cell, loss of microvilli and blebs. All these abnormalities can be reversible if the oxygenation is restored.
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Medical Nursing for Veterinary Technicians
Part 1: Orogastric tube placement
Orogastric tube is normally used to decompress the stomach of the patient, especially if the stomach is distended so much that it makes it difficult for adequate ventilation. Decompression is done by placing the orogastric tube (a flexible tube) into the canine’s mouth into the stomach (Jack & Watson, n.d.).
Procedure of placing and removing orogastric tube
Similar to any other procedure, several steps are needed to conduct this process to ensure safe tube placement and efficient decompression. To begin with, the healthcare provider must prepare in advance all the equipment required, as indicated by the proper sizes of tubes as based with the patient’s age. The healthcare provider must get donned with the appropriate personal protective equipment to protect the canine and himself from infection causative agents (Jack, Watson & Heeren, 2014).
The patient is then properly positioned. For instance, in non-trauma and non-intubated patient, the head should be placed in a flexed position. This helps easier passage of the orogastric tube through the oesophagus. However, most of the patients that demand gastric decompression are often intubated; thus, head movements may jeopardize positioning of the endotracheal tube. In this case, the head position should be neutral.
To estimate the depth of tube, measurements should be done from the mouth, around the patient ears to position just below the xyphoid process. Starting from the procedure, the distal end of the tube must be coated with a lubricant that is water soluble (usually Viscous Lidocaine) to minimize injuries and discomforts (Jack, Watson & Heeren, 2014).
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For the intubated patients, the endotracheal tube should be held by the assistant provider firmly, as the provider inserts the orogastric tube in the mouth, down to the oesophagus. The tube should pass with ease, and if any resistance is felt; then it should be withdrawn and procedures begun again. The tube is then placed on the premeasured depth. The syringe is then inserted at the end of the orogastric tube to withdraw the stomach content. In advanced healthcare facility, the tube is hooked directly to suction that will withdraw gastric contents.
To ensure that the tube is properly place, a syringe filled with air is usually placed on one end of orogastric tube, and the provider listens above epigastrum instil air rapidly at least 20cc. If it was well placed, the injected air is heard. The tube is then secured in place using a tape (Kirk, Othmer, Grayson & Eckroth, 2013).
If the correct placement of orogastric tube is bot confirmed, it should be removed immediately. The tube should be removed immediately if the patient develops shortness of breath or breathing difficulties. During the removal procedure, the patient should be administered with activated charcoal through the tube, by either blowing it into the tube of flushing with water.
The tube should be kinked to prevent the aspiration of lavage fluid. Once the tube has been kinked, it should be removed in one quick sweep. The patient should be extubated upon the return of gag reflex. The patient should remain head elevated in sternal recumbency position to avoid aspiration (Osweiler, 2011).
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Advantages and contraindications
The advantage of this procedure is that it facilitates the decompression of air from the patient distended stomach, thus improving the patient’s ventilation. Additionally, it orogastric tube is also used to empty the stomach content to avoid regurgitation and potential aspiration. This root is preferred as it helps minimize health complications that occur with the nasal routes such as bleeding and nasal trauma.
The contraindications of this method is that it should not be performed in patients identified with intact gag reflex, but it is the most safe methods for patients with major trauma in the head, spinal cord or facial as it minimizes complications (Kirk, Othmer, Grayson & Eckroth, 2013).
Complications of orogastric tube placement
If the tube is well inserted, minimal complications should arise. However, some of the complications noted includes mal-positioning of the tube causing discomfort. Oesophageal variceal haemorrhage and posterior pharyngeal perforations could occur during insertion. The complications that could arise during use include reflux, sinusitis, blockage and kinking of the tube. In some cases, unprecedented dislodgement could occur and mucosal adherence complications could arise during removal processes (Osweiler, 2011).
Part 2: Fluid administration
1. Physical parameters
Fluid therapy is very vital for most of the medical conditions for veterinary patients. To identify the exact need for fluid therapy, the patient history and physical exam findings play a huge role in determining the fluid selection, volume, location needed and composition of the fluid. Therefore, fluid administration is individualised to patient needs (O’Grady, 2011).
The health assessment conducted includes pulse rate, respiratory rates, lung sounds, body weight, skin turgor, mental state, and mucous membrane colour and temperature extremity. These assessments provide clue of dehydration. The clinical signs that correspond to dehydration percentages are shown below (Gajewski and Hillel, 2012).
Percentages
Clinical signs
5% and below dehydration
No clinical signs detectable, mild dehydration
5%-6% dehydration
Subtle skin elasticity is loss
6%-8% dehydration
Moderate dehydration. Reduced skin turgor, slightly sunken eyes into the orbitals, high capillary refill time
10%-12% dehydration
Severe dehydration. Completely dry mucous membranes, sunken eyes, dull eyes, loss of skin turgor, and signs of shock including tachycardia, weak pulses, irregular heart rate and consciousness alteration.
12%-15% dehydration
Most severe dehydration. Signs of shock present, death imminent of uncorrected quickly.
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2. Phases of fluid therapy for feline patient
The patient in this case study is a cat that weighs 8 lbs; dehydration rate is reported at 10%. The patient does not present signs of shock. The cat does not suffer from diarrhoea or vomiting.
a) Calculating the fluid need rates
To identify the fluid replacement volume, the veterinarian needs to know the dehydration percentage, the ongoing fluid losses as well as the fluid maintenance requirement. This is calculated as based using the following formula (Hansen, 2012).;
Fluid deficit (ml) = Body weight in Kg x percentage dehydration (in decimal point)
The ongoing fluid loss includes sensible as well as the insensible fluid losses. The sensible fluid losses include those which can be quantified such as urination. The insensible losses includes those which cannot be quantified e.g. through faeces and cutaneous losses. Maintenance fluid is the volume required by the patient per day to sustain the patient balance.
Most of the providers apply the standard requirements such as 40- 60 ml/kg/day. However, it is important to monitor the maintenance requirements by calculating the hydration deficit. In this case, the patient is has no ongoing losses, thus the fluid maintenance is as calculated below (Davis, 2013).
Fluid deficit (ml) = Body weight (lb) X percentage dehydration (in decimal) X 500
8 x 0.1 x 500 = 40ml/kg/day
Monitoring IV fluid therapy and its importance
The patient IV fluid therapy is monitored by conducting serial measurement of the body weight to monitor excessive or inadequate fluid therapy. The new weights will be compared with the base line weight. The serum chlorides measurements will also be conducted to enable identify electrolytes imbalances. The measurements of urinary output are a good indicator of fluid balance. Therefore, monitoring is important it enables the veterinarian identify of there is over or under provision of fluid; and early identification of electrolyte imbalances that could lead to further complications (O’Grady, 2011).
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Part 3Dental Prophylaxis
a) Difference between horse and dog teeth
Like any living animals that have teeth, horses and dogs have premolars, molars, incisors and canines. The tooth structure is similar to the other animals. The horses have hyposodont tooth and the jaw conformation is anisognathic. The upper jaw and the maxilla are considerably wider in comparison of the mandible and the lower jaw (Kirk, Othmer, Grayson & Eckroth, 2013).
This enables the horse maximize their chewing efficiency, making them fed adequately for long time. On the other hand, dogs are carnivore and thus their teeth reflect the evolutionary history of carnivores. However, pet dogs are omnivores; which requires dental management practices such as prophylaxis. The differences of the two species teeth is as summarized in table 1.2 below (Berkovitz, Moxham, Linden & Sloan, 2010):
Horses’ dental formula
Dog’s dental formula
a) Temporary teeth I – 3/3 C- 0/0 P – 3/3 M – 0/0 = 12 x 2 = 24 b) Adult (permanent teeth) I – 3/3 C – 1/1 P – 3 or 4/3 M – 3/3 = 20 (or 21) x 2 = 40 (or 42)
a) Puppy (temporary teeth). I – 3/3 C – 1/1 P – 3/3 M – 0/0 = 14 x 2 = 28 b) Adult (permanent teeth) I – 3/3 C – 1/1 P – 4/4 M – 2/3 = 21 x 2 = 42
b) Importance of dental prophylaxis in both species
The dental prophylaxis consists of examination of oral dental, coupled with odontoplasty of the enamel points that are extremely sharp. In horses, the sharp enamels should be removed two times year when the permanent dentition; and after as many times as required, depending on the horse management practices. For horses that graze freely in the range may require dental prophylaxis yearly; whereas those confined should be done twice a year. In dogs, they should have dental prophylaxis performed at least once per year (Gajewski and Hillel, 2012).
In both, the aim and importance of this practice is to remove the sharp enamel edges that could cause irritation of the soft tissue. Additionally, it is also done to clean the two species teeth and make the evaluation of the oral cavities or any dental related health complication present (Kirk, Othmer, Grayson & Eckroth, 2013).
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c) Comparison of dental prophylaxis procedures in both species
The procedure is quite similar, where the animals are put under general anaesthetic care, to ensure that the patient is comfortable and to ensure effective cleaning. It also allows insertion of endotracheal tube in the trachea of the patients, in order to protect the bacteria from cleaned teeth from invading the lungs. The dental prophylaxis includes (Berkovitz, Moxham, Linden & Sloan, 2010):
a) supra-gingival cleaning; which involves the cleaning of the regions above the gum line done suing the mechanical scalers.
b) Subgingival cleaning; involves cleaning of the ears below the gum line to remove the plaques as well as the calculus responsible for periodontal infection. This stage mainly causes the roughening of the teeth.
c) Polishing; The roughened surfaces increases retentive ability of plaque and calculus, causing faster build up and progression of periodontal disease progression. Polishing is done to smoothen tooth surface, reducing the adhesive plaque ability.
d) Sulcal and subgingival lavage; the polishing as well as the scaling and polishing makes lots of debris get trapped, the gingiva is flushed with antibacterial solution, where periodontal disease occurs, then it is flushing is done using saline.
e) Fluoride treatment; done to strengthen and harden the dentin, which causes the tooth sensitivity to reduce, and is known to retard the formation lesions.
f) Treatment planning; done using dental graphs and all other modalities responsible in reestablishment of oral health.
g) Dental charting: involves recording if the findings and oral health recommendations. The chart is used to examine the disease progression or regression.
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Part 4
What is CPR? What is its goal?
Cardiopulmonary Resuscitation (CPR) is used to check dog’s heartbeat when the dogs gets accidentally injured and stops breathing with the aim of bringing it back to life. The pet’s owner should report the incidence to the provider so that they can prepare the emergency room adequately. The procedure used to perform CPR includes is described (Sirois, 2013).
Procedure of performing CPR
To begin with, the veterinary should be armed with their crash cart. The basic items in this cart include endotracheal tube, needles/syringes, Dopram, IV catheter supplies, bandaging materials, epinephrine and atropine. To perform CPR, the dog’s mouth is open gently, and the tongue pulled out. The dog’s neck and head is straightened gently to avoid further injuries. The dog’s chest is examined to check sign of respiration (Sirois, 2013); which can be evaluated by holding the dog’s mouth to feel any respirations.
If the dog is not breathing, then one performs mouth to snout by holding the mouth closed, the provider should cup his or her hand around the dog’s nose and blow two breaths into the dog’s snout. The breathing should go in, the procedure should be continued. The recommended breaths are one breath for every 3 seconds or an average or 20 breaths/min (Macintire et al., 2012).
The next step is to check for circulation. The dog’s femoral artery should be checked to check if it has pulse. If no pulses are felt, chest compressions should be done. The dog should be positions on its right side; the dog’s chest is located (normally at the position where elbow joins the ribcage). The compression should be done based on the dog’s size. For dogs below 16 pounds, compression should be done using thumb and forefinger in both chest sides (Jack, Watson & Heeren, 2014).
For larger dogs, palm method compression is the most effective. The compression should be done 1.5 inches for each compression. The compression rate which is recommended should be at least 3 compressions/ 2 seconds. For every 15 compressions, at least two breaths should be done. Where there are no abdominal injuries, the healthcare provider assistant should perform interposed compression of the abdominal simultaneously. This aids in making the blood flow back to the heart. The CPR procedures should be repeated until the sign for breathing or pulse is heard from the dog (Lopate, 2012).
References
Berkovitz, B., Moxham, B., Linden, R., & Sloan, A. (2010). Master Dentistry Volume 3 Oral Biology. London: Elsevier Health Sciences UK.
Gajewski M, Hillel Z. (2012). Anesthesia management of patients with hypertrophic obstructive cardiomyopathy. Prog Cardiovasc Dis 2012;54(6):503–11.
Hansen B.(2012). Technical aspects of fluid therapy. In: DiBartola SP, ed. Fluid, electrolyte, and acid-base disorders in small animal practice. 4th ed. St. Louis (MO): Elsevier Saunders; 2012:373
Jack, C., & Watson, P. Veterinary technician’s daily reference guide.
Jack, C., Watson, P., & Heeren, V. (2014). Veterinary Technician’s Daily Reference Guide: Canine and Feline, 3rd Editi. John Wiley & Sons.
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