Improving Child Health in Nepal: Balvita, Vitamin A, and Deworming Programs -Baal Vita
Table of Contents(toc)
vitamin a capsules in nepal
What are vitamins?
Vitamins are types of micronutrients needed for proper growth and maintainance of health. Vitamins are found in the foods we eat daily.
How much vitamin does a person require?
Vitamins are required in very small quantity for our body. The growing a children require more amount of vitamins and minerals than adults. Adults are also required to eat sufficient amount of vitamins for maintenance of their body. Vitamins are also required to boost the immune system of our body. This helps our body to fight against different kind of communicable and non communicable disease like infection of bacteria, viruses and fungus as well as cancer and heart diseses.
Where do we get nutrients and vitamins from?
Generally if a person is eating healthy and nutritious balanced diet and he or she is not suffering from any disease then there is high chance that the person is already taking sufficient amount of nutrition and nutrients in his or her diet. But in some cases and if the person is suffering from disease or not able to eat properly then there might be nutrition defeciency.
Why do children need nutrients supplement?
Children are special population, nutrition during childhood refers to their health growth and long term health benefit. If a child suffers from nutrition deficiency in childhood the person might suffer is who life due to this. Nutrition supplement during childhood also means that the child will be healthy his whole life. Growth and development failure during his or her childhood means he/she will have problem with his/her whole life.
Does my child need nutrition supplement?
The answer to this question is not all the children may need nutrition supplement. But still there is possibility that your child might be having nutrition deficiency. If the nutrients are supplied in safe doors then there is no side effect of it. So basically there is no harm in supplementing nutrients to your child but this may benefit your child instead. Supplementing nutrition will treat the nutrition deficiency while not harming your baby. For the same reason you should provide supplement nutrition to your baby rather than not doing it. There is more benefit of providing supplement. There is high chance that you are baby might have nutrition deficiency so it should be advised to treat the nutrition deficiency.
What are the nutrition supplement that I can give to my baby?
There are multiple supplementary options available for our baby. There is a famous nutrition supplement which contains 16 types of micro nutrients all in one called Balvita supplied by government of nepal for free. Special nutrients supplement required for children is vitamin A.
What is Balvita?
Balvita is a type of nutritional supplement that is designed to provide essential vitamins and minerals to support the growth and development of children. Balvita is typically recommended for children who may have nutritional deficiencies or who require additional support for healthy growth and development.
It is also called multi micronutrient powder as well.
How to feed balvita to my baby?
Deworming
According to WHO the country in which there is more than 20 % of ppulation suffering from worm infestation then the country should deworm the population twice a year.
Neapal also has hugh prevalence of worm infestation and among children and the pregnant women the prevalence of infestatio nis more than one third.
It has been shown that one tablet of albendazole 400 mg or mebendazole 500 mg can kill almost all of the intestinal worms.
Nepal has decided to distribute albendazole for purpose of deworming. This tablet can kill various types of worms including Ancylostoma canium, Ancylostoma duodenale (Nectar americanus), Ascaris lumbricoids (intestinal worm), Enteribiasis (pinworm), Oesophagostomum bifurcum etc.
Mechanism of action of albendazole:
The active metabolite of albendazole is albendazole sulfoxide. It causes selective degenration if the cytoplasmic degeneration of the microtubules in intestinal and tegmental cells of intestinal helminths and larvae; glycogen is depleted, glucose uptake and cholinesterase secretion is imparired, and desecratory substance is accumulated intracellularly. ATP production decreases. This causes energy depletion and immobilization and subsequent worm death. Thus dead worm is passed down in stool.
Dose of albendazole:
Childres one year to less than 2 years -> 200 mg (1/2 tablet twice yearly
Children 2 years to 5 years -> one tablet of 400 mg twice yearly
Pregnant woman after first trimester -> one tablet of albendazole 400 mg
What is vitamin A?
Vitamin A is a micronutrient found mostly in green leafy vegetables and animal source foods like meat, eggs and dairy products.
What does vitamin a do in our body:
High dose vitamin A supplementation is done to prevent and treat many conditions among children and adults.
The dose of vitamin A in different population is summerized below
Children 6 to under 12 months of age – one oral vitamin A dose of 100,000 IU two times per year
Children 12 to 59 months of age – one oral vitamin A dose of 200,000 IU two times per year
Women immediately following childbirth, or as soon as possible up to six weeks post-partum, can be given one oral dose of vitamin A 200,000 IU
To treat complications related to deficiency- xerophthalmia etc three doses one upon diagnosis, one the following day and third dose one month later (Note: one dose: 100,000 IU for children aged 6-<12 months; 200,000 IU for children more than 12 months)
For measles: one upon diagnosis and another the following day(Note: one dose: 100,000 IU for children aged 6-<12 months; 200,000 IU for children more than 12 months)
Prolonged diarrhea: more than two weeks: one dose immidiately after diagnosis (Note: one dose: 100,000 IU for children aged 6-<12 months; 200,000 IU for children more than 12 months)
Severe malnutrition: one dose immidiately after diagnosis (Note: one dose: 100,000 IU for children aged 6-<12 months; 200,000 IU for children more than 12 months)
For pregnant women with nightblindness: 25000 IU once a week for four weeks (4 doses)
Aspirin should be taken with which of the following drinks?
A. Milk
B. Orange juice
C. Soda
D. Full glass of water
The first branch of the human aorta is:
A. Left subclavian artery
B. Brachiocephalic artery
C. Coronary artery
D. Left common carotid artery
The least blood pressure is found in:
A. Aorta
B. Capillary
C. Vein
D. Vena cava
Extracellular fluids are rich in the following except:
A. K+
B. HCO3-
C. Na+
D. Ca2+
The left border of the heart is formed by:
A. Right ventricle
B. Left atrium
C. Left atrium and left ventricle
D. Left ventricle
Which of the following is the correct pathway for the propagation of the
cardiac impulse?
A. AV node → Bundle of His → SA node → Purkinje fibers
B. SA node → Purkinje fibers → AV node → Bundle of His
C. SA node → AV node → Bundle of His → Purkinje fibers
D. Purkinje fibers → AV node → SA node → Bundle of His
The blood in the mammalian heart pumped by the right ventricle passes out
of the orifice guarded by:
A. Bicuspid valve
B. Tricuspid valve
C. Aortic arch
D. Pulmonary valve
Fibrous cords called ___________ connect the free valve margins and
ventricular surfaces of the valve cusps to papillary muscles and
ventricular walls.
A. Chordae tendineae
B. Lunulae
C. Bundle of His
D. Kent bundles
Intra-aortic balloon pump therapy is used for the treatment of:
A. Congestive heart failure
B. Cardiogenic shock
C. Pulmonary edema
D. Aortic insufficiency
Which of the following assessment findings would elicit specific
information regarding the left ventricular function of a patient with left
ventricular failure?
Which of the following ECG findings indicates the presence of
hypokalemia?
A. Tall, peak T wave
B. ST segment depression
C. Widening of the QRS complex
D. Prolonged PR interval
TU Staff Nurse Mode Questions 21-40
Bruce protocol is related to:
A. CABG
B. Echocardiogram
C. Angiogram
D. Exercise ECG test
A patient has developed atrial fibrillation and his ventricular rate is
150 beats per minute. What should the patient be assessed for
next?
A. Flat neck veins
B. Complaints of nausea
C. Complaints of headache
D. Hypotension
Which of the following beverages can be included in the menu of a patient
with myocardial infarction?
A. Coffee
B. Tea
C. Cola
D. Lemonade
A patient is undergoing cardiac catheterization. Which of the following
sensations reported by the patient during the procedure has the highest
priority?
A. Pressure at the insertion site
B. Urge to cough
C. Warm, flushed feeling
D. Chest pain
A patient recovering from cardiac surgery has a pleural effusion on the
left side and is having thoracentesis. The patient should be placed in
which position for the procedure?
A. Upright and leaning forward with the arms on the over-the-bed table
B. Right-side lying with legs curled up into a fetal position
C. Left-lateral with the right arm supported by a pillow
D. Dorsal recumbent
Which of the following statements about Prinzmetal’s (variant) angina is
correct?
A. Managed most effectively with beta-blocking drugs
B. Drug of choice in variant angina is nitrates
C. Generally treated with calcium channel blockers
A patient with myocardial infarction experiencing new multiform,
premature contractions. The patient is allergic to lidocaine
hydrochloride. What is the next drug of choice for immediate use?
A. Digoxin
B. Metoprolol
C. Verapamil
D. Procainamide
A patient with complete heart block has had a permanent demand pacemaker
inserted. The pacemaker function is considered to be proper if the ECG
rhythm strip shows the presence of a pacemaker spike:
A. Just after each T wave
B. Before each QRS complex
C. Just after each P wave
D. Before each P wave
Which of the following interventions is contraindicated in a patient with
deep vein thrombosis of the right leg?
A. Elevation of the limb
B. Ambulation in the hall every 4 hours
C. Application of moist heat to the right leg
D. Administration of analgesics
The circumflex artery is a branch of:
A. Right coronary artery
B. Anterior descending artery
C. Left coronary artery
D. Descending aorta
Apical pulse is taken by placing the diaphragm of the stethoscope at the
area of:
A. Right atrium
B. Right ventricle
C. Pulmonic valve
D. Mitral area
A female patient who has had a myocardial infarction asks the nurse why
she should not bear down or strain to ensure having a bowel movement. The
nurse informs her that this would trigger:
A. Vagus nerve stimulation, causing a decrease in heart rate and cardiac
contractility
B. Vagus nerve stimulation, causing an increase in heart rate and cardiac
contractility
C. Sympathetic nerve stimulation, causing an increase in heart rate and
cardiac contractility
D. Sympathetic nerve stimulation, causing a decrease in heart rate and
cardiac contractility
Which of the following interventions is NOT indicated in a patient with
stable ventricular tachycardia?
A. Assess airway, breathing, and circulation
B. Administer oxygen
C. Obtain an ECG
D. Defibrillate the patient
Which of the following manifestations differentiates pericarditis from
other cardiopulmonary problems?
A. Chest pain that worsens on expiration
B. Pericardial friction rub
C. Anterior chest pain
D. Weakness and irritability
Which of the following is NOT associated with cardiac tamponade?
A. Pulsus paradoxus
B. Distant heart sounds
C. Distended jugular veins
D. Bradycardia
Digitalis functions to improve congestive heart failure by:
A. Induction of emesis
B. Activation of beta-adrenergic receptors
C. Improving survival in patients with heart failure
D. Binding to and inhibiting the Na–K ATPase enzyme in cardiac myocytes
A nurse is caring for a client who is being discharged after cardiac
surgery. The client has a prescription for enoxaparin to take at home.
Which of the following discharge information should the nurse give to this
client?
A. Do not eat red meat or any substance that contains tyramine
B. Drink an eight-ounce glass of water each evening before going to bed
C. Use a soft toothbrush for brushing teeth and an electric razor for
shaving
D. Avoid wearing sandals or shoes for longer than 6 hours at a time
Nurse Kumari, a triage nurse, encountered a client who complained of
mid-sternal chest pain, dizziness, and diaphoresis. Which of the following
nursing actions should take priority?
A. Administer oxygen therapy via nasal cannula
B. Notify the physician
C. Complete history taking
D. Put the client on ECG monitoring
The emergency medical service has transported a client with severe chest
pain. As the client is being transferred to the emergency stretcher, you
note unresponsiveness, cessation of breathing, and an unpalpable pulse.
Which of the following tasks is appropriate to initiate first?
A. Establish an IV line and administer oxygen
B. Begin cardiopulmonary resuscitation (CPR)
C. Administer aspirin and morphine
D. Perform defibrillation if indicated
TU Staff Nurse Mode Questions 41- 50
The primary purpose of defibrillation is to:
A. Increase heart rate
B. Convert an irregular rhythm to normal sinus rhythm
C. Terminate a life-threatening arrhythmia
D. Slow down the heart rate
In the management of a patient with acute myocardial infarction (MI),
which of the following medications should be avoided in the acute
phase?
A. Nitroglycerin
B. Beta-blockers
C. Heparin
D. Thrombolytics
Which of the following is the most common cause of right-sided heart
failure?
A. Myocardial infarction
B. Pulmonary hypertension
C. Coronary artery disease
D. Aortic stenosis
Which of the following changes would you expect to find in the vital
signs of a patient in shock?
A. Bradycardia and elevated blood pressure
B. Tachycardia and decreased blood pressure
C. Hypothermia and increased blood pressure
D. Normal heart rate and decreased blood pressure
Which of the following is the best indicator of fluid overload in a
patient with heart failure?
A. Increased respiratory rate
B. Jugular vein distention
C. Decreased blood pressure
D. Decreased urinary output
What is the primary purpose of the pulmonary artery catheter in a
critically ill patient?
A. To assess central venous pressure (CVP)
B. To monitor oxygen saturation levels
C. To measure cardiac output and assess fluid status
D. To deliver medications to the heart
Which of the following is a complication of an acute myocardial
infarction?
A. Pneumothorax
B. Cardiac tamponade
C. Pericarditis
D. Gastrointestinal bleeding
Which of the following is most likely to cause a false low reading when
measuring blood pressure with a manual cuff?
A. Cuff too large for the arm
B. The cuff is inflated too quickly
C. The patient is sitting with the arm at heart level
D. The patient has an increased heart rate
Which of the following is an appropriate nursing action when
administering a diuretic to a patient with heart failure?
A. Restrict fluid intake to 1000 mL per day
B. Monitor potassium levels regularly
C. Instruct the patient to lie flat after administration
D. Monitor the patient for signs of hyperglycemia
A patient is receiving warfarin therapy for atrial fibrillation. Which
of the following lab values is most important to monitor?
A. Platelet count
B. Prothrombin time (PT) and International Normalized Ratio (INR)
C. Hemoglobin and hematocrit levels
D. Serum sodium levels
Answer Keys
B. Social communication
C. Audio cassette
C. Hepatitis B
A. Primary prevention
C. Carbon dioxide
C. Increased respiration rate
D. 280-295 mosl/kg H2O
B. 7.4
B. Maleficence
D. Full glass of water
B. Brachiocephalic artery
D. Vena cava
A. K+
C. Left atrium and left ventricle
C. SA node → AV node → Bundle of His → Purkinje fibers
D. Pulmonary valve
A. Chordae tendineae
B. Cardiogenic shock
D. Listening to lung sounds
B. ST segment depression
D. Exercise ECG test
D. Hypotension
D. Lemonade
D. Chest pain
A. Upright and leaning forward with the arms on the over-the-bed table
C. Generally treated with calcium channel blockers
C. Normal sinus rhythm
D. Procainamide
B. Before each QRS complex
B. Ambulation in the hall every 4 hours
C. Left coronary artery
D. Mitral area
A. Vagus nerve stimulation, causing a decrease in heart rate and cardiac
contractility
D. Defibrillate the patient
B. Pericardial friction rub
D. Bradycardia
D. Binding to and inhibiting the Na–K ATPase enzyme in cardiac myocytes
C. Use a soft toothbrush for brushing teeth and an electric razor for
shaving
D. Put the client on ECG monitoring
B. Begin cardiopulmonary resuscitation (CPR)
C. Terminate a life-threatening arrhythmia
D. Thrombolytics
B. Pulmonary hypertension
B. Tachycardia and decreased blood pressure
B. Jugular vein distention
C. To measure cardiac output and assess fluid status
C. Pericarditis
A. Cuff too large for the arm
B. Monitor potassium levels regularly
B. Prothrombin time (PT) and International Normalized Ratio (INR)
Intermittent fasting (IF) has become popular for its potential health
benefits. However, whether it is actually useful depends on various factors
such as individual goals, lifestyle, and health conditions. Here are some key
points on its usefulness:
Benefits of intermittent fasting
Here are some benefits of Intermittent fasting (IF).
Weight Loss
Improved Insulin Sensitivity
Cellular Repair and Autophagy
Mental Clarity and Cognitive Function
Hormonal Benefits
Heart Health
Simplicity and Flexibility
Potential Drawbacks
Sustainability
Scientific Support
Now lets discuss each in details:
1. Weight Loss
Supports Calorie Control:
By restricting the eating window, many people naturally consume fewer
calories, which can lead to weight loss.
Increases Fat Burning:
Fasting periods trigger hormonal changes that increase fat breakdown and
use it for energy.
2. Improved Insulin Sensitivity
Helps Manage Blood Sugar:
Intermittent fasting can improve insulin sensitivity, making it beneficial
for managing blood sugar levels, particularly for people with Type 2
diabetes or prediabetes.
Reduces Insulin Resistance: It may help reduce the risk of developing insulin resistance, which is
a key factor in obesity and type 2 diabetes.
3. Cellular Repair and Autophagy
Cellular Maintenance:
During fasting, the body enters a state of autophagy, where it breaks down
and removes dysfunctional proteins and cells, promoting cellular repair.
Boosts Longevity: Some
studies suggest that intermittent fasting may contribute to longevity by
stimulating autophagy and reducing oxidative stress.
4. Mental Clarity and Cognitive Function
Improved Brain Function: Fasting may support brain health by boosting the production of
brain-derived neurotrophic factor (BDNF), which plays a role in cognitive
function and mood regulation.
Reduced Inflammation:
Intermittent fasting may help reduce inflammation, which is linked to
neurological diseases like Alzheimer’s and Parkinson’s.
5. Hormonal Benefits
Increases Growth Hormone: Fasting increases the secretion of human growth hormone (HGH), which
plays a role in fat loss and muscle preservation.
Improved Fat Metabolism: It enhances the breakdown of stored fat for energy, making it easier to
burn fat rather than carbohydrates.
6. Heart Health
Reduces Blood Pressure:
Some studies suggest intermittent fasting can help lower blood pressure
and reduce the risk of heart disease.
Improves Lipid Profiles: IF may reduce LDL cholesterol, triglycerides, and other markers of
heart disease, contributing to overall cardiovascular health.
7. Simplicity and Flexibility
Easy to Follow: Many
people find intermittent fasting simple because it doesn’t require complex
meal plans or calorie counting.
Fits Various Lifestyles: It offers flexibility in terms of when to eat, making it easier to
adopt into different routines.
8. Sustainability
Long-Term Commitment:
For IF to be effective, it needs to be practiced consistently over time,
and some individuals may find it difficult to maintain.
Possible Plateaus: Some
people experience weight loss plateaus after extended periods of fasting,
requiring adjustments in the routine.
9. Scientific Support
Positive Research:
Numerous studies support the benefits of intermittent fasting for weight
loss, metabolic health, and disease prevention.
More Research Needed:
While there is promising evidence, more long-term research is needed to
fully understand the long-term effects of intermittent fasting.
Potential Drawbacks of Intermittent fasting (IF)
Hunger and Cravings:
Initially, people may struggle with hunger and cravings, which could
lead to overeating during eating windows.
Disrupts Social Life:
IF may interfere with social gatherings or family meals, as it requires
strict eating windows.
Not Suitable for Everyone: It may not be appropriate for people with certain health conditions
like eating disorders, low blood pressure, or pregnant and breastfeeding
women.
Types of Intermittent Fasting (How to do intermittent fasting?)
Intermittent fasting includes different strategies, with alternate-day
fasting and time-restricted feeding (TRF) being two of the most popular
approaches. Both have been shown to be effective for weight loss, but
they do not appear to offer significant benefits over other
calorie-restricting diets.
Alternate-Day Fasting
Alternate-day fasting involves alternating between fasting days and
eating days. On fasting days, a person consumes about 25% of their daily
caloric needs, while on feast days, they can eat more freely, typically
around 125% of their caloric needs.
Effectiveness for Weight Loss: Studies show that alternate-day fasting is an effective strategy
for weight reduction. A network meta-analysis of 24 randomized trials
found that alternate-day fasting was comparable to regular caloric
energy restriction diets in terms of weight loss.
Example Study: In a
trial involving 100 individuals with obesity, those following
alternate-day fasting (25% of total energy needs on fast days and 125%
on feast days) experienced a weight loss of 6.8% of their body weight
over six months. This was comparable to those following a regular
calorie restriction diet (75% of energy needs daily), who lost 6.0% of
their body weight.
Time-restricted feeding is a type of intermittent fasting where eating
is limited to a specific window of time, usually between 8 to 10 hours a
day (e.g., eating between 12 PM to 8 PM). The extended fasting period
between meals aligns with natural circadian rhythms and has been
associated with various health benefits.
Simplicity and Benefits: TRF offers a simplified meal-planning approach as it doesn’t
require calorie counting. The focus is on limiting the eating window,
which naturally leads to prolonged periods of fasting.
Weight Loss and Metabolic Benefits: Short-term studies have suggested that TRF, when aligned with
circadian rhythms, can help with weight loss and improve metabolic
parameters, such as insulin sensitivity and fat metabolism.
Effectiveness Compared to Calorie Restriction: Some trials have shown that TRF may be beneficial, but its efficacy
compared to regular calorie restriction remains uncertain. For
instance, in a randomized trial with 139 adults with obesity,
participants who followed calorie restriction with TRF (eight
hours/day) lost 8 kg, while those who followed calorie restriction
without TRF lost 6.4 kg. However, the difference in weight loss
between the two groups was not statistically significant at 12 months.
Mechanisms of Action
The mechanisms by which intermittent fasting, including TRF, influences
health are still not completely understood. However, some key factors
include:
Caloric Restriction: Both alternate-day fasting and TRF lead to reduced overall caloric
intake, contributing to weight loss.
Improved Insulin Sensitivity: Intermittent fasting may enhance insulin sensitivity, which can
lead to better metabolic control and a reduced risk of Type 2
diabetes.
Anti-inflammatory Effects: Both fasting methods may exert anti-inflammatory effects,
potentially lowering the risk of chronic diseases such as
cardiovascular disease.
High Altitude Pulmonary Edema (HAPE) in Nepal: A Silent Killer in the
Himalayas
Nepal, home to eight of the world’s fourteen highest peaks, including Mount
Everest, is a paradise for trekkers and mountaineers. However, the
breathtaking landscapes also pose serious health risks, one of the most
dangerous being High Altitude Pulmonary Edema (HAPE). This
life-threatening condition affects individuals who ascend to high altitudes
too quickly without proper acclimatization, leading to fluid accumulation in
the lungs and potentially fatal respiratory failure.
What is HAPE?
HAPE is a severe form of altitude sickness caused by exposure to low oxygen
levels at high elevations, typically above 2,500 meters (8,200 feet).
It is characterized by fluid
leakage from pulmonary capillaries into the lungs due to hypoxic pulmonary
vasoconstriction, which increases pulmonary arterial pressure.
Unlike other
forms of altitude sickness, HAPE can develop even in healthy individuals with
no prior history of altitude illness.
How does HAPE occur?
Essentially, elevated mean pulmonary artery pressure (>35-40 mmHg) plays a
crucial role in initiating HAPE, but it is not sufficient by itself. The
second key factor is uneven vasoconstriction in the pulmonary circulation.
The process can be explained as follows:
Elevated Pulmonary Artery Pressure:
The increase in pulmonary artery pressure is triggered by the lower oxygen
levels at high altitudes, which causes hypoxic pulmonary vasoconstriction.
This elevated pressure is a significant factor in HAPE but is not the only
cause.
Uneven Vasoconstriction:
In the lungs, hypoxia induces vasoconstriction, but this response is not
uniform across the pulmonary vasculature. Certain capillary beds in the
lungs constrict less than others, and those areas are exposed to higher
microvascular pressures (>20 mmHg).
Overperfusion and Capillary Stress:
These areas of uneven vasoconstriction receive disproportionately more
blood flow, leading to overperfusion. This increases the stress on the
alveolar-capillary barrier, which eventually fails under the pressure.
Alveolar-Capillary Barrier Failure and Pulmonary Edema:
The failure of the alveolar-capillary barrier results in leakage of fluid
into the alveoli, leading to pulmonary edema. This edema tends to be
patchy, which is characteristic of HAPE.
Risk Factors for HAPE
Several factors contribute to the development of HAPE, including:
Rapid Ascent: Climbing too quickly without proper
acclimatization.
Individual Susceptibility: Genetic predisposition can make
some individuals more prone.
Cold Temperatures: Cold exposure can exacerbate pulmonary
hypertension.
Strenuous Physical Activity: Excessive exertion at high
altitudes increases oxygen demand and stress on the lungs.
History of HAPE: Those who have had HAPE before are at
higher risk.
Symptoms of HAPE
HAPE symptoms usually appear within 1-4 days of ascent and worsen if ignored.
Early signs include:
Shortness of breath at rest
Persistent dry cough or frothy sputum
Rapid heart rate and breathing
Cyanosis (bluish skin or lips)
Fatigue, confusion, or difficulty walking
Crackling sounds in the lungs on auscultation
Without prompt intervention, HAPE can rapidly progress to respiratory failure and death.
HAPE in Nepal: A Major Concern
Nepal’s trekking routes, such as Everest Base Camp (5,364m), Annapurna Circuit (5,416m), and Manaslu Circuit
(5,106m), attract thousands of adventurers yearly. However, many suffer from
altitude-related illnesses due to poor acclimatization and underestimating the
risks. HAPE cases are frequently reported in places like Lukla, Namche Bazaar, and Gorak Shep, where rapid altitude
gain is common.
Prevention: The Key to Safety
Preventing HAPE is crucial, as it is easier to avoid than to treat in remote
areas. Follow these guidelines:
Gradual Ascent: Follow the “300-500 meters per day” rule above 3,000m.
Acclimatization Days: Spend an extra night at intervals to
allow your body to adjust.
Hydration and Nutrition: Drink plenty of fluids and consume
high-energy foods.
Avoid Alcohol and Sedatives: These can depress breathing
and worsen symptoms.
Recognize Symptoms Early: Immediate descent is the best
treatment.
Medications: Acetazolamide (Diamox) can aid
acclimatization, and nifedipine may help prevent HAPE in susceptible
individuals.
Treatment and Emergency Response
If HAPE develops, immediate action is critical:
Descend Immediately: The single most effective treatment.
Oxygen Therapy: Supplemental oxygen can relieve symptoms.
Portable Hyperbaric Chambers: These simulate lower altitude
conditions and are used in remote trekking areas.
Medications: Nifedipine, a calcium channel blocker, reduces
pulmonary artery pressure.
Conclusion
HAPE remains a significant yet preventable hazard for
trekkers and climbers in Nepal. Proper acclimatization, awareness, and timely
intervention can save lives. Whether you are trekking to Everest Base Camp or exploring the Annapurna Circuit,
respecting the altitude and listening to your body can ensure a safe and
memorable journey in the majestic Himalayas.
Stay informed, climb responsibly, and enjoy Nepal’s mountains
safely!
How to wear a stethoscope: how to use a stethsocope
doctors showing stethoscope
Introduction
The stethoscope is an iconic symbol of healthcare professionals and plays a
vital role in diagnosing and monitoring patients’ conditions.
While it may seem like a straightforward accessory, properly wearing a
stethoscope is crucial to ensure accurate sound transmission and optimal
functionality.
In this guide, we will walk you through the steps of wearing a stethoscope,
with a particular focus on how to wear it in your ears for maximum
effectiveness.
How to wear a stethoscope or store it (and how not to)
Proper Ways to Wear a Stethoscope
Around the Neck (Correctly)
– Place the tubing behind your neck and let the chest piece hang in front.
This prevents unnecessary kinking of the tubing.
Over the Shoulders –
Drape it over your shoulders if you need quick access, but avoid excessive
stretching.
Use a Dedicated Holster or Pouch
– Some healthcare professionals prefer clip-on stethoscope holders to
prevent neck strain.
Keep Earpieces Facing Forward
– When inserting the earpieces, angle them forward to match the natural
anatomy of your ear canals.
Adjust the Fit – Ensure
the headset tension is comfortable by gently squeezing or pulling apart
the ear tubes.
Clean It Regularly – Wipe
the diaphragm and tubing with an alcohol swab after use to prevent
contamination.
doctor listening to chest
How NOT to Wear a Stethoscope
Around the Neck for Long Periods
– Prolonged hanging around the neck can cause oil buildup and degrade the
tubing.
Dangling from One Shoulder
– This can cause it to slip and fall, leading to damage.
Stuffing into a Tight Pocket
– Bending the tubing too much can cause cracks or deformation.
Proper Ways to Store a Stethoscope
Flat in a Drawer or Case
– Lay it flat in a clean drawer or a dedicated case when not in use.
Hanging on a Hook –
Hang it in a relaxed position to avoid kinking the tubing.
Using a Stethoscope Case
– A hard or soft case can protect it from dust and physical damage.
Room-Temperature Storage
– Store in a cool, dry place to prevent tubing degradation.
How NOT to Store a Stethoscope
Leaving it in a Hot Car
– Heat exposure can make the tubing brittle and shorten its lifespan.
Coiling Too Tightly –
Over-bending can cause cracks in the tubing.
Placing Heavy Objects on It
– Pressure can damage the diaphragm and tubing.
Hanging Near Sharp Edges
– Avoid hooks or surfaces that could damage the tubing.
Before we delve into the proper way to wear a stethoscope, it’s important to
select the right instrument for your needs.
Consider factors such as your area of expertise, comfort, and sound quality
when purchasing a stethoscope.
Opt for a high-quality model from reputable brands to ensure accurate
auscultation.
Image : Two pioneers of stethoscope industry viz littman nad MDF
Familiarizing Yourself with the Parts:
A stethoscope typically consists of three main parts: the chestpiece, tubing,
and earpieces. The chestpiece contains the diaphragm and the bell, which are
used to listen to different types of sounds. The tubing connects the
chestpiece to the earpieces, and the earpieces are inserted into the ears for
sound transmission.
stethoscope parts diagram
Adjusting the Earpieces of stethoscope:
To wear a stethoscope properly, begin by adjusting the earpieces.
Each earpiece should fit comfortably in your ears without exerting excessive
pressure.
Gently squeeze or pull the earpieces to adjust the tension, ensuring a snug
fit while avoiding discomfort or pain.
Improperly adjusted earpieces can hinder sound transmission and lead to
inaccurate auscultation.
Incorrect Position
Correct Position
(Images credit: 3M littman)
Positioning the Earpieces:
Insert the earpieces into your ears at the appropriate angle. The earpieces
should be positioned pointing forward, aligning with the natural angle of your
ear canal.
Ensure that they are not twisted or facing backward, as this can impede sound
conduction and cause distortion.
Positioning the Earpieces (credit wikihow)
Checking Tubing Length:
Next, check the length of the tubing. Ideally, the tubing should be long
enough to allow you to auscultate different areas of the patient’s body
comfortably.
However, excessively long tubing can result in sound loss or interference.
Adjust the length according to your height and arm length, ensuring that it
doesn’t tangle or drag on the floor.
Securing the Chestpiece:
Once the earpieces are in place, secure the chestpiece onto the patient’s
body. Ensure that the diaphragm or bell is correctly positioned over the area
of interest.
For example, use the diaphragm for high-frequency sounds such as heart and
lung sounds, and the bell for low-frequency sounds like murmurs or bowel
sounds.
Press the chestpiece lightly against the patient’s skin for optimal sound
transmission.
Testing Sound Transmission:
To verify that the stethoscope is correctly positioned and functioning well,
perform a quick sound check.
Listen for the desired sounds and adjust the pressure, angle, or position if
necessary. Familiarize yourself with the specific sounds produced by your
hearts and lungs.
Listening and interpreting the sounds in stethoscope:
Then listen to the desired organ of the patient and interpret the sound
accordingly. Once you have your stethoscope in place, it’s time to start
listening.
To get the best results, you should listen carefully and focus on the sounds
you hear. Make sure that you are in a quiet environment and that there are no
distractions that could affect your reading.
It’s also important to use the correct technique when listening, such as using
the diaphragm to listen to high-frequency sounds and the bell for
low-frequency sounds.
Basic Sounds of Auscultation
Crackles Audio
Friction Rub Audio
Bowel Sounds Audio
Abnormal (increased) Bowel Sounds Audio
Normal Breath Sounds Audio
Normal Bronchial Breath Sounds Audio
Stridor Audio
Wheeze Audio
Conclusion
In conclusion, wearing a stethoscope correctly is essential for medical
professionals. By following these steps, you can ensure that your stethoscope
is properly fitted and that you can get accurate readings.
Remember to clean your stethoscope regularly and to listen carefully to the
sounds you hear.
With the right technique, you can make the most of this valuable tool
and provide the best care for your patients.
The parotid is a large salivary gland located near the jaw that helps produce saliva.
The parotid glands are the largest of the salivary glands, situated just in front of and below each ear. They secrete saliva into the mouth through ducts, aiding in digestion and oral health by moistening food and helping to break it down.
Pain or Tenderness: Discomfort or pain in the area near the jaw or ear.
Swelling: Noticeable enlargement of the gland, causing visible or palpable lumps.
Redness or Warmth: Skin over the swollen gland may appear red or feel warm to the touch.
Dry Mouth: Reduced saliva production can lead to dryness in the mouth.
Difficulty Swallowing: Swelling can make swallowing food or liquids uncomfortable.
Fever: An increase in body temperature, often indicating infection or inflammation.
Bad Breath: Resulting from reduced saliva flow and potential infection.
Difficulty Opening Mouth: Limited movement due to pain or swelling.
Taste Changes: Altered sense of taste or unusual taste in the mouth.
Differential diagnosis of Parotid gland swelling
Parotid swelling can have various differential diagnoses (DDx), and they can be categorized based on whether the swelling is unilateral (one-sided) or bilateral (both sides).
Unilateral Parotid Swelling:
Benign Tumors:
Pleomorphic adenoma: Most common benign tumor of the parotid gland.
Warthin’s tumor: Another benign tumor, more common in older males and smokers.
Malignant Tumors:
Mucoepidermoid carcinoma: The most common malignant tumor of the parotid gland.
Adenoid cystic carcinoma: Slow-growing but potentially aggressive tumor.
Infections:
Bacterial sialadenitis: Usually due to Staphylococcus aureus or Streptococcus species.
Viral sialadenitis: Most commonly mumps, especially in unvaccinated individuals.
Obstructive Causes:
Sialolithiasis (salivary gland stones): Leads to obstruction of the salivary duct, causing painful swelling.
Inflammatory Conditions:
Sarcoidosis: Can present with parotid gland involvement.
Sjögren’s syndrome: Autoimmune disease that affects salivary glands, though typically bilateral, it can sometimes present unilaterally.
Trauma:
Post-traumatic swelling: Due to direct injury to the parotid gland.
Bilateral Parotid Swelling:
Infections:
Mumps: The most common viral cause, often accompanied by fever and malaise.
HIV-associated salivary gland disease: May cause bilateral enlargement.
Autoimmune and Inflammatory Conditions:
Sjögren’s syndrome: Chronic autoimmune disorder affecting the salivary and lacrimal glands.
Sarcoidosis: Systemic granulomatous disease that may involve the parotid glands bilaterally.
sjogren syndrome (from odmosis)
Metabolic Conditions:
Alcoholic parotitis: Chronic alcohol abuse can lead to bilateral parotid swelling.
Diabetes mellitus: Can sometimes be associated with bilateral parotid enlargement.
Medications:
Drug-induced parotid enlargement: Certain medications like antihypertensives (e.g., clonidine) can cause bilateral gland enlargement.
Idiopathic:
Idiopathic sialadenosis: Non-inflammatory, non-neoplastic bilateral swelling of the parotid glands, often associated with metabolic conditions or malnutrition.
Identifying the underlying cause of parotid swelling requires a careful clinical evaluation, including history, physical examination, imaging studies (such as ultrasound or MRI), and sometimes biopsy or fine-needle aspiration (FNA).
Lu lagnu- heat stroke -prevention, diagnosis and treatment लु लाग्नु also loo disease nepali
Recently, Lu, commonly known as heat stroke has been seen very commonly in Nepal and India during summertime. In this article we will discuss regarding pathophysiology, symptoms, and treatment of lu.
What is lu lagnu? लु लाग्नु meaning of lu in nepali, loo meaning लु लाग्नु भनेको के हो?
Heat stroke is a range of diseases in which our body is not able to cope with heat and temperature of the environment especially occurring in summertime in the hot, humid climates, like the region of Nepal and India.
It may cause edema, cramps, rashes, spasm and tetany to syncope, neurological disturbance and death. It is associated with increasedbody temperature more than 40° centigrade.
लु लाग्नु भनेको अत्यधिक गर्मीका कारणले शरीरले सहन नसकेर देखिने लक्षण हो जसमा ज्यान सुनिने, दुख्ने, मासु बाउँडिने, बेहोस हुने र मानसिक समस्या आउने सम्म हुन सक्छ। यो प्राय शरीरको तापक्रम ४०° भन्दा बढी भएर हुन्छ।
Causes of loo disease or lu disease: Hyperthermia लु लाग्नुका कारण
लु लाग्नुको कारण वातावरणको तापक्रम लामो समय सम्म अत्यधिक भएर हो। प्राय तराई तथा गर्मी हुने ठाउँ हरुमा यो हुने गर्दछ।
अर्कोथरी हिट स्ट्रोक अत्यधिक कडा शारीरिक काम गर्नाले हुने गर्दछ।
यो दुवै थरीले प्राय बच्चा र वृद्धाहरुलाई बढी असार गर्दछ। यसले ज्यान जाने खतरा हुन्छ।
Both exertional and non exertional heat stroke affect young and old individuals more. Both are associated with high morbidity and mortality rates.
A hot humid sunmy day
Pathophysiology of lu disease, loo diasease
Heat stroke is defined as temperature more tha. 40°C or 104°F associated with neurological dysfunction. Anhidrosis, that is lack of sweating is key feature of geat stroke.
लु लाग्नु लाई शरीरको तापक्रम ४०° से वा १०४° फ भन्दा बढी भएर मानसिक समस्या भएको अवस्थालाई बुझिन्छ। यसमा पसिना नआउनु मुख्य चिन्ह हो।
अत्यधिक गर्मी मौसममा शरीर चिस्याउन पसिना आउने गर्दछ।तर शरीरको कशमाट भन्दा बढी गर्मी भयो भने शरीरले तापक्रम नियन्त्रण गर्न सक्दैन र ।वातावरण सँगै शरीर पनि तातिदैं जान्छ सो को कारणले लक्षणहरू देखिन्छ।
How to prevent under 2 years age children from lu
Meaning of lu lagnu, lu disease or loo disease
लु लाग्नु भनेको अत्यधिक गर्मीले शरीरको तापक्रम सामान्य भन्दा बढी हुनु हो। यो ज्वरो हैन। किन भने यो बाह्य तापक्रमले गर्दा शरीरको तापक्रम बढेको हो र शरीरको तापक्रम नियन्त्रण गर्ने क्षमता असफल भएको अवस्था हो।
Lu is due to excessive external heat and is not fever. In lu body has lost ability to control temperature.
What are symptoms of loo, lu symptoms, heatstroke symptoms
It can be seen in warm climates and more commonly in people who have excessive hard ore exercises. गर्मी मौसम या अत्यधिक व्यायाम, शारीरिक काम गरेर तलका लक्षण देखिन सक्छ:
Eat fruits containing water like cucumber, watermelon etc
Do not go outside during daytime
Do not drink alcohol
Do not drink caffeine containing drinks
लु लाग्नु भनेको अत्यधिक गर्मीले शरीरको तापक्रम सामान्य भन्दा बढी हुनु हो। यो ज्वरो हैन। किन भने यो बाह्य तापक्रमले गर्दा शरीरको तापक्रम बढेको हो र शरीरको तापक्रम नियन्त्रण गर्ने क्षमता असफल भएको अवस्था हो।
There i actual medical treatment except cooling the patient. Some medications used are benzodiazepine, and IV fluids. Diuretics like mannitol may also be needed with large volume infusion to prevent volume overload. Antipyretics and analgesics have no role in heat stroke. The complication include
Short term morbidity
Hospitalization
Infection
Renal failure
Neurological deficit
Permanent disability
Growth retardation
Death
BMI calculator here
The organs mainly affected by heat are
Brain
Liver
Kidney
Lungs
Muscle
Heart
Blood vessels
Skin
Sensory organs
Heat stroke death in nepal: epidemiology
Every year a sigificant number of children and old age peole die in teria region of nepal due to heat stroke or loo. Many adults are also impacted.
Anesthetic Agents of Choice in Various Conditions and Their Contraindications
Table of Contents(toc)
1. Ketamine: The Ideal Agent for Bronchial Asthma
Ketamine is a potent bronchodilator, making it the anesthetic agent of choice in bronchial asthma. Its ability to maintain airway reflexes and provide both analgesia and sedation makes it a preferred option in asthmatic patients undergoing surgery.
Contraindications:
Ketamine increases heart rate (HR), blood pressure (BP), cardiac output (CO), intraocular pressure (IOP), and intracranial tension (ICT), so it should be avoided in conditions such as:
Isoflurane is the preferred anesthetic for neurosurgery and cardiac surgery due to its ability to maintain cerebral perfusion and cause minimal myocardial depression. It also provides good muscle relaxation and reduces brain metabolic demand.
Contraindications:
Patients with severe hypotension, as Isoflurane can cause vasodilation and drop BP further.
Patients with coronary artery disease (CAD) should be monitored closely due to the risk of coronary steal phenomenon.
3. Hepatic Anesthesia: Isoflurane > Desflurane
Isoflurane is preferred over desflurane in patients with hepatic dysfunction because it has a more favorable hepatic metabolism profile. While both agents have minimal liver metabolism, Isoflurane is less likely to cause hepatotoxicity compared to halothane.
Contraindications:
Patients with liver failure, where all volatile anesthetics should be used with caution.
Desflurane should be avoided in hepatic insufficiency due to its potential to increase liver enzyme levels in susceptible individuals.
4. Pediatric Anesthesia: Sevoflurane
Sevoflurane is the anesthetic agent of choice in pediatric anesthesia due to its pleasant odor, rapid induction, and minimal airway irritation. It allows for smooth induction, which is especially useful in uncooperative children.
Contraindications:
Patients at risk of malignant hyperthermia (like those with a genetic predisposition).
Patients with severe renal impairment, as sevoflurane metabolism produces fluoride ions, which could potentially affect kidney function.
5. Daycare Anesthesia: Desflurane & Propofol
Desflurane is the volatile agent of choice for daycare surgeries due to its low blood-gas solubility, allowing for rapid emergence from anesthesia.
Mnemonic:D for D (Desflurane for Daycare)
Propofol is the IV agent of choice for daycare surgery due to its rapid onset, short duration of action, and antiemetic properties.
Contraindications:
Desflurane is not suitable for induction due to its pungency, which can cause airway irritation and coughing.
Propofol should be avoided in patients with egg or soy allergies (although true allergies are rare).
Not ideal for hemodynamically unstable patients due to its hypotensive effects.
Conclusion
Selecting the right anesthetic agent depends on patient-specific conditions and surgical requirements. Understanding the contraindications of each anesthetic is essential for optimizing patient safety and surgical outcomes.
Manage Consent
To provide the best experiences, we use technologies like cookies to store and/or access device information. Consenting to these technologies will allow us to process data such as browsing behavior or unique IDs on this site. Not consenting or withdrawing consent, may adversely affect certain features and functions.
Functional
Always active
The technical storage or access is strictly necessary for the legitimate purpose of enabling the use of a specific service explicitly requested by the subscriber or user, or for the sole purpose of carrying out the transmission of a communication over an electronic communications network.
Preferences
The technical storage or access is necessary for the legitimate purpose of storing preferences that are not requested by the subscriber or user.
Statistics
The technical storage or access that is used exclusively for statistical purposes.The technical storage or access that is used exclusively for anonymous statistical purposes. Without a subpoena, voluntary compliance on the part of your Internet Service Provider, or additional records from a third party, information stored or retrieved for this purpose alone cannot usually be used to identify you.
Marketing
The technical storage or access is required to create user profiles to send advertising, or to track the user on a website or across several websites for similar marketing purposes.
To provide the best experiences, we use technologies like cookies to store and/or access device information. Consenting to these technologies will allow us to process data such as browsing behavior or unique IDs on this site. Not consenting or withdrawing consent, may adversely affect certain features and functions.
