R. Roy. California College of the Arts.
Iron is a component of cytochromes (involved in cell respiration) discount 60 caps serpina with mastercard anxiety 24 hour hotline; component of xanthine oxidase (involved in catabolism of purines which make nucleic acids) discount serpina 60 caps overnight delivery anxiety symptoms in women. Iron is a component of aconitase (involved in the Krebb’s Cycle) and many other enzymes such as peroxidase and catalase buy serpina 60 caps without a prescription anxiety symptoms 3-4. While Hb concentration is used to define anaemia, it does not define the body’s iron status. Depletion of iron stores: the body’s storage pool (deposits in the liver, spleen and bone marrow) diminishes due to insufficient dietary intake. Iron deficiency erythropoiesis: storage levels substantially reduced, inadequate iron is available in the bone marrow for the synthesis of Hb. Iron deficiency anaemia: last and most severe stage of iron deficiency – iron stores are insufficient to maintain Hb synthesis. Also when food is boiled in water iron is leached and is lost if the water is discarded. The hormones have profound influence on energy metabolism, protein synthesis, growth and development. They also play part in the conversion of carotene to Vitamin A and synthesis of cholesterol. This, in turn, affects brain development, physical growth and functioning of muscles, heart, liver and kidneys. Goitre is an enlarged thyroid gland – a result of thyroid over-activity as it strives to capture sufficient iodine from the blood. The iodine is retained in the body tissues for a long period of time (three to five years), maintaining the thyroid hormones at normal levels Iodinated oil capsules: 400 mg iodine administered orally, repeated after one to two years Lugol’s solution: 3 drop (21 mg) once a month, up to one year 4. It plays important roles in the body, including role in vision, maintenance of epithelial tissue, synthesis of mucous secretion, growth, reproduction and immunity. It, contributes to body’s supply of niacin (another B vitamin) by facilitating in the conversion of tryptophan (an amino acid) to niacin. Deficiency is commonly caused by consumption of highly polished cereals or foods containing thiaminase (anti-thiamine factor). Signs and symptoms of deficiency Characterized by enlargement of nerves, weight loss (due to loss of appetite), oedema and disturbance in heart function Lack of energy Lesions in nervous tissues. Also it plays part in synthesis of corticosteroids and production of red blood cells. Signs and symptoms of deficiency It characterized by sore throat, pharyngeal and oral mucous membrane hyperaemia, angular stomatitis, cheilosis, glossitis and anemia Riboflavin deficiency almost invariably occurs in combination with other vitamin deficiencies. Dietary measures Animal products (milk, meat liver, fish, eggs, cheese) Vegetable products (green leafy vegetables) Cereal grains and pulses Drug treatment C: Vitamin B-complex 1 tablet 8 hourly for 1 month. In Tanzania deficiency occurs in communities whose main staple food is maize or sorghum and particularly during rainy season when food diversification is at its lowest. Signs and symptoms of deficiency It is a disease characterized by a triad, referred to as three Ds: o Dermatitis (darkened scaly skin on the parts exposed to the sun) o Diarrhea o Dementia (memory loss) Some patients may present also with glossitis 372 | P a g e Dietary measures Animal products (especially liver), pork, poultry Groundnuts, beans, peas, other pulses, yeast Cereal grains (but not maize or sorghum) Note Treatment of maize with alkalis such as limewater makes the niacin much more available Protein is good source as the amino acid tryptophan can be converted to niacin in the gut. Drug treatment C: Nicotinamide: Adult gives 100 mg every 6 hours for 7 days followed by multivitamin preparation containing 50 to 60 mg of nicotinamide daily for 1 month. Children: 10 to 25 mg every 8 hours for 7 days, followed by multivitamin preparation as above. It plays part in the metabolism of fatty acids, hence in the formation of myelin (the sheathing around the axons of nerve cells). The vitamin is involved also in the carbohydrate metabolism (stabilizes glutathione – a component of enzymes needed in carbohydrate metabolism). Signs and symptoms of deficiency Macrocytic megaloblastic anaemia Decreased white blood cells Angular stomatitis, glossitis Delusions, nerve problems, unsteady gait. Dietary measures Main source is animal foods – meat, liver, seafood, eggs, milk, and cheese. Note Animals or plants do not synthesize the vitamin – it is synthesized by bacteria in animals. Intramuscular injection: Initially 1mg, repeated 10 times at intervals of 2 – 3 days. Signs and symptoms of deficiency Macrocytic megaloblastic anaemia Stomatitis, glossitis Diarrhea Neural tube defects (spina bifida, anencephaly, encephalocele) 374 | P a g e Dietary measures Green leafy vegetables Legumes Liver, meat, fish, poultry Drug treatment Adults and children over one year A: Folic acid 5 mg (O) daily for 4 months, then maintenance dose of 5 mg every 1-7 days depending on underlying disease. Signs and symptoms of deficiency Scurvy (bleeding gums, dry skin, dry mouth, impaired wound healing). Note: Substantial vitamin C can be lost during food processing, preservation and preparation. Signs and symptoms of deficiency Rickets – a disease of bones in infants and children Osteomalacia in adults 375 | P a g e Prevention Exposure of the skin to sunshine (vitamin D is produced by the action of the sun on the skin) Vitamin D rich foods: wheat germ, fish, liver, egg yolk, organ meats, cheese, milk (breast milk other milks), butter, margarine, mayonnaise. It plays role in reproductive health (enhances fertility) and also in haemoglobin synthesis. Signs and symptoms of deficiency Leg cramps, Muscle weakness, Nerve problems and Hearing problems. Dietary measures Consumption of vegetable oils Whole grain cereals Drug treatment Adult C: Alpha tocopherol acetate 50 - 100mg daily until recovery Below 1 yr: 50mg until recovery 14. Secondary deficiency may be associated with malabsorption syndrome, liver cirrhosis and the use of Coumarin derivatives such as dicumarol, warfarin and other analogues. Signs and symptoms of deficiency Slow growth Loss of smell and taste Loss of appetite Diarrhoea Poor wound healing Skin lesions Dietary measures Zinc is present in most foods of animal and plant origins. Also phytates found in whole grain products and vegetables reduces the bioavailability of zinc. Treatment A: Zinc tablets 50mg 2 to 3 times daily until recovery Zinc supplementation- Refer to National Guideline Micronutrient supplementation 16. Kwashiorkor children have shown improved weight gain with selenium supplementation. In China selenium deficiency has led to “Kesharis disease” – a serious condition affecting heart muscle. Meats, seafoods, egg yolk and milk are good sources of selenium In cereals, selenium content depends on the concentration of the mineral in the soil Mushrooms and asparagus are rich sources. But highest concentrations are in the liver, brain, heart, kidneys and in the blood. Copper in the form of ceruloplesmin (a copper-protein complex in the blood plasma) is involved in various stages of iron nutrition. Copper enhances iron absorption and stimulates mobilization of iron from stores (in the liver and other tissues). Plays part in the conversion of ferrous iron to ferric (important during various stages of iron metabolism). Copper deficiency has been linked to anaemia in premature infants and in people with severe protein- energy malnutrition. Menke’s disease (a rare congenital condition) is caused by failure of copper absorption. Dietary measures Foods richest in copper are nuts, shellfish, liver, kidney, raisins and legumes. Many of the physiological functions of Mg are based on the mineral’s ability to interact with calcium, phosphate and carbonate salts. Magnesium catalyses many essential enzymatic reactions (glucose, fatty acid, amino acid metabolism), takes part in bone metabolism and protein synthesis.
Guideline 26: Nurses administering investigational or special access program medication must have the necessary information (e buy cheap serpina 60caps on line anxiety 5 weeks pregnant. Placebos The administration of placebos to clients without their knowledge and consent is inappropriate and unethical order serpina 60caps free shipping anxiety of death. Cosmetic Procedures The number of clients who receive cosmetic procedures in Canada is on the rise order cheapest serpina anxiety symptoms. Some examples of the services provided are Botox injections, dermal fillers, use of laser for a number of purposes, fat and cellulite manipulation, chemical peels and hair transplants. Nurses require additional education and experience to ensure that they are competent if they engage in these interventions. Nurses are responsible for attaining, maintaining and evaluating their competence in the performance of any intervention or activity. Nurses involved in these procedures need to carefully consider whether they: fully understand all of the risks and benefits associated with the procedures and equipment are aware of the possible complications and what is required to deal with such complications can provide appropriate recommendations and counseling to clients considering those procedures have the technical capacity to provide the service skillfully and safely have liability protection for their practice Any Schedule 1 medication such as Botox requires a client-specific order to administer it. The authorized prescriber is responsible for assessing the client, determining the need for medication and providing the order. Guideline 27: Any Schedule 1 medication such as Botox requires a client assessment and a client specific order from the authorized prescriber prior to the administration of the medication. Immunizations Additional knowledge, skill, and competence are required to administer vaccines. For information on medication and vaccine schedules please see the Schedule Drugs Regulation under the Pharmacy and Drug Act (2000) at http://www. For nurses employed in public health and some other settings, the Medical Officer of Health provides authority to nurses to administer Schedule 1 and 2 vaccines and epinephrine as part of a provincial immunization program and Alberta Immunization Policy. The nurse administering immunizations is responsible for following the applicable legislation and regulation and for ensuring that a client-specific order is obtained when required. Guideline 28: The nurse administering immunizations is responsible for following the applicable legislation and regulation and for ensuring that a client specific order is obtained when required. Alberta has a comprehensive immunization program where universal immunization coverage is provided (Alberta Health and Wellness, 2007). For information on Alberta Health’s immunization policy go to their website at: www. Nurses who immunize clients must have knowledge of the scientific evidence supporting the effectiveness of vaccines, understand the immunization process and must have the knowledge, skill and judgment to assess the appropriateness of administering the vaccine to an individual client. The medication/drug scheduling categories are outlined by the Alberta Pharmacy and Drug Act (2000) and are aligned with the national drug schedule. The four categories are: Alberta Drug Schedules Schedule I Drugs that require a prescription from an authorized prescriber. Can be self-selected by clients for use from a pharmacy but the pharmacist must be present to offer assistance if needed. These clients may be completely independent or require some assistance, such as help with opening containers, mechanical aids or preparing/ preloading medication. Practice settings should have appropriate policy in place and safe medication storage areas to support self-administration of medication by clients. Guideline 32: Nurses are responsible for assessing and documenting the client’s ability for self-administration of medication. In order for a client or nurse to administer a client’s own medications in these practice settings, the nurse needs to verify the medication with a pharmacist, have an authorized prescriber’s order for the medication, and be supported by the practice setting policy. Home Care and Supportive Living Settings In settings such as home care and supportive living, the client may not be able to manage their medications on their own and require assistance. Nurses offer support in these practice areas and can assign assistance or administer a client’s own medication when the following criteria are met: practice setting policy supports the use of the client’s own medications a medication reconciliation process is in place to verify that the medication list (or medication profile generated by the pharmacy involved in care) is current and accurate the medication list is verified by the most responsible health-care practitioner who is authorized to prescribe the medication is: legibly labeled labelled according to the dispensing standards from the Alberta College of Pharmacists and in their original containers, or prepared by a pharmacy (e. If there is a discrepancy between the dispensing label and the client’s or family member’s directions for administration, or there are questions about the identity of the medication or the label, the nurse must clarify the order with the prescriber and document the discrepancy and the rationale for following the selected direction. In these instances, consultation with a pharmacist or with the Alberta College of Pharmacists is recommended to ensure that an appropriate system is established to meet the needs of clients. Guideline 33: The dispensing label affixed to a medication container is not the order from the authorized prescriber. Management of Controlled Drugs and Substances The requirements for safe handling and administration of narcotics and controlled substances are outlined in federal legislation. Pharmacists, in consultation with other stakeholders, develop policies at the practice setting level regarding storage, control and access to controlled substances and narcotic counts. Nurses should follow organizational policy related to the management of controlled drugs and substances. These regulations allow for authorized individuals to possess cannabis for medical purposes and for others to possess cannabis for the sake of aiding the authorized individual to take the cannabis. As of September 2017, a registered nurse and a nurse practitioner can administer and assist with the administration of cannabis for medical purposes in a ‘hospital’ as defined in the Narcotic Control Regulations provided all the requirements identified below are met: the individual is a hospital employee or an individual acting as the agent or mandatary of a hospital employee there is a prescription or written order or a cannabis medical authorization document signed and dated by a physician indicating the medical cannabis is to be administered to a particular person. Disposal and Transportation Nurses safely dispose of medications according to the practice setting policy or return expired medications to the pharmacy for environmentally safe disposal. There are instances where a nurse may be involved in the transport of medications for disposal. Examples of such situations include a nurse returning unused medication to a pharmacy for proper disposal for a client, or a nurse carrying medication for administration during the transfer of a client (e. Practice setting policies should identify health professionals authorized to perform these activities and outline criteria for appropriate storage, safe handling and disposal of medication. Guideline 34: Practice setting policies and procedures need to be in place to support those nurses whose role and responsibilities include medication transport and disposal. Nurses must also comply with relevant documentation requirements arising from legislation and practice setting policies. Appropriate documentation related to medication administration should include: client name drug name drug dose and route date/time of actual administration signature of the nurse who administered the medication, including professional designation effectiveness of the medication Guideline 35: Nurses document medication they have administered as soon as possible following the administration. In emergency situations, such as a cardiac arrest, documentation may be by a designated recorder. There should be established procedures and documentation policies for emergency situations that support the designated recorder to document medication administration by others. A nurse clearly documents when a client self-administers their own medication and the reason. In settings where a point of care electronic health record system is implemented, care providers must log onto the system using their own name and personal password. There must be a process in place for identifying the full name and designation of the care provider who administers medication. Dispensing Dispensing medication is a restricted activity defined in the Government Organization Act (2000). However, nurses in Alberta are given the authority to dispense in some circumstances. This authorization provides flexibility to meet client needs when a pharmacist is unavailable.
Scheduled sampling and testing for Change dose controller settings generic serpina 60caps on-line anxiety 300mg, if Insufficient Calculated Chlorine residual chlorine on surface water operating correctly buy cheap serpina 60caps on line anxiety in spanish. Implement feedback control of following changes of water quality dosing using residual monitoring Is the calculated dose adequate for Digital display of dose rate in required target Ct value? Setpoint alarm generation on colour Consider additional feedback Insufficient Flow proportional Is the chlorine demand variable? Is contact time to residual monitoring overly residual working properly calibration long? Is possible hypochlorite decay taken Regular monitoring of hypochlorite account of in dose? Increase dose pending corrective Insufficient Feedback dose Is the chlorine demand variable? Regular monitoring of hypochlorite action chlorine control at re- concentrations Consider relative positions of Is chlorine properly mixed at residual residual chlorination stations dosing and residual sampling monitoring? Proper mixing at residual sampling not working properly points Is possible hypochlorite decay taken point account of in dose? Regular checking of calibration Increase dose pending corrective Insufficient Dose controller not action buy 60caps serpina overnight delivery anxiety and depression association of america. Programme the controller based residual on revised calibration Water Treatment Manual: Disinfection Malfunction: Possible Cause Fault Analysis Possible prevention Corrective action Pathogens detected in supply? Use of a dose control strategy capable of reacting to raw water poor water quality. Is chlorination equipment adequate when quality changes with feedback Replace chlorinator and/or dosing chlorine demand is highest? A properly designed chlorination Manual monitoring and manual dosing system to cater for expected chlorine control during poor water range of organics in the water quality episodes. Is chlorine residual less than target level at High level set point on a pH monitor Increase chlorine dose pending Insufficient Dose correct but pH disinfection point for adequate chlorination further action and testing waters to detect drift in pH chlorine level too high of water to consumers? Provision of adequate spare Emergency dosing using Appendix Insufficient Chlorine gas or cylinders or level monitoring on bulk 3. Unblock or replace filters on dosing residual injectors Order only high purity salt with Are dosing pumps operating properly? Change salt for electrolytic Adequate pressure at chlorine generation to higher purity In electrolytic system what is the purity of solution injection point the salt used? How high is free chlorine concentration at Routine maintenance of dosing Analyse fault and repair Chlorine Dosing Pump pump, regular calibration of pump consumers? Lower chlorine dose pending pump dose and malfunction due to delivery curve and checking of pump residual too incorrect calibration Incomplete maintenance record? Recalculate dosage rate and check high Supervisor review of dose calculation for adequate Ct. Water Treatment Manual: Disinfection Malfunction: Possible Cause Fault Analysis Possible prevention Corrective action Chlorine How high is free chlorine concentration at Recording of percentage solution of Lower the hypochlorite dose Higher % Sodium pending a investigation of solution residual consumers? Monitoring and recording of ongoing dosed Was a higher strength solution transferred hypochlorite testing to the solution tank? Check sludge blanket to determine boosting as required complete with points as required to obviate re- detected in coagulation settling if carryover has occurred. Have reservoir levels with history of sediment deposition been severely lowered Monitor efficiency of previous due to hydraulic demand? Ozone as a powerful oxidant is also used for remove/reduction of inorganic contaminants (such as iron and manganese), algae and compounds that produce taste and odour, phenolic compounds and some pesticides as part of drinking water treatment process, upstream of disinfection. In conjunction with its oxidation role, it can be used for primary disinfection of drinking water supplies. Due to the fact that ozonation residual are short lived as part of the oxidation/treatment process, chlorination is usually used following ozonation for residual generation to quality assure water within the distribution network to consumers Chapter 5 of this Manual details the use and efficacy of ozonation as either as an oxidant or a primary disinfectant ahead of a secondary disinfection using a residual generating disinfectant. The following Tables explore the possible causes for each of the foregoing ozonation malfunctions. In the case of each possible cause, it sets out what the likely symptoms of malfunction and the remedial action to be taken together with possible preventative operational practices or maintenance to be taken Water Treatment Manual: Disinfection Malfunction: Possible Cause Fault Analysis Possible prevention Corrective action What is ozone residual after contactor? Regular maintenance and re- Increase the ozone dose manually Low Ozone Dose controller not calibration of ozone sensor and dose or dose supply with chlorine residual in operating properly or Is the air drier operating properly? Is the water vapour content of air above equipment operation, monitoring and Maintain air drier to ensure dry air manufacturer’s instructions? Obtain proof that the contactor as Process redesign to assess the Low Ozone Inadequate designed has been effective in most cost effective way to increase residual in equipment design Is the ozonator and contactor suitably sized operation in similar water quality the required design Ct – usually by contactor to maintain the required log inactivation of applications. Is ozone residual after contactor only low A properly designed and optimised Turn up ozone dose manually Low Ozone High Ozone demand during periods of poor water quality? Process redesign to assess the demand most cost effective way to reduce If very high - is the ozone generator able to Dose control strategy with feedback ozone demand e. Establish bromide ion content of water to Ozonation of water at low pH to Optimise upstream pre- treatment High level of High level of be ozonated minimise bromate formation. As ClO2 cannot be compressed or stored commercially as a gas because it is explosive under pressure, chlorine dioxide requires to be generated on site using a variety of generation methods, which are set out in Section 6. ClO2 generates a residual which is used for the calculation of Ct as a measure of disinfection performance. Chapter 6 of this Manual details the use and efficacy of chlorine dioxide as either as an oxidant or a primary disinfectant which is often followed by chlorine as a residual generating secondary disinfection. As a disinfectant, ClO2 can inactivate most waterborne microorganisms over a wide pH range between 5 and 10. The Ct values for the inactivation of protozoa are generally much higher than ozone. However due to the formation of chemically stable chlorate by-product in water dosed with ClO2, dose rates are limited by regulation internationally. Further information on chlorite and chlorate by-product formation and on the possibility of halogenated by-product formation consequent to downstream secondary chlorine disinfection are detailed in section 6. In the case of each possible cause, it sets out what the likely symptoms of malfunction and the remedial action to be taken together with possible preventative operational practices or maintenance to be taken Water Treatment Manual:Disinfection Malfunction: Possible Cause Fault Analysis Possible prevention Corrective action What is ClO2 residual? Regular maintenance and re- Increase the ClO2 dose manually Low ClO2 Dose controller not calibration of ClO2 sensor and dose or dose supply with chlorine residual operating properly or Check maintenance record for the most control calibration pending rectification. ClO2 sensor or controller as Is the water vapour content of air above appropriate. Monitoring of ClO2 residuals particularly following water quality Train staff in the correct method for Check preventative maintenance log variability dose calculations Check records of dose calculation – are Checking of dose calculation by Recalculate dose rates and alter frequent errors recorded? Obtain proof from suppliers that the Use alternative or larger ClO2 Low ClO2 Inadequate system as designed has been generator to increase the required residual equipment design Is the ClO2 system suitably sized to effective in operation in similar water design Ct maintain the required log inactivation of quality applications especially for targeted waterborne pathogens especially sources with high risk of protozoa and Cryptosporidium in Cryptosporidium. Can the required disinfection inactivation be achieved given the internationally recommended maximum dose rates? Can the generator deliver the maximum recommended dose rate at the highest ClO2 demand? Low level set point alarms on Dose supply with chlorine pending Low ClO2 No ClO2 from constituent generation chemicals rectification. A log of chemical deliveries and Install low set point alarms on expected replacement dates. Adequate spare chemical deliveries Water Treatment Manual:Disinfection Malfunction: Possible Cause Fault Analysis Possible prevention Corrective action Check deliver record for ClO2 generation Comprehensive commissioning tests Train staff in the correct chemical Low ClO2 ClO2 generation chemical concentrations i.