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Dust Mites

Posted by on Monday, 19 December, 2011

What is a dust mite allergen?

Dust mites are microscopic organisms that can live and thrive throughout homes and schools. The mites and their waste products thrive in the following:

  • Bedding
  • Upholstered furniture
  • Carpets

dust mite

Dust mites thrive in warm, humid conditions and feed on the shed scales of human skin. The waste products of the dust mite are what produce allergic reactions and asthma. The best way to prevent dust mites is to limit your child’s exposure. Be sure to pay special attention to the bedroom, especially the mattress and pillows.
iconWays to decrease dust mite exposure include the following:

Beds
 – Every bed in your house should have wooden or metal frames. Do not allow your child to sleep on a couch, sofa, or hide-a-bed. If your child has asthma and sleeps in a bunk bed, he/she should sleep in the top bunk.

Mattress/Box Spring
 – Place all mattresses and box springs in a zippered, and tape over the zippers with electrical or duct tape.

Pillows -
 Encase pillows in zippered, dust-proof covers. Pillows should be made of Dacron or other synthetic fiber. Do not use foam, feather, or “Down” pillows.

Bedding
 – Avoid wool or down blankets. Wash all bedding (sheets, pillowcases, blankets)
in hot water. Cold water will not kill the dust mites. Dry all clothes and bedding in the dryer to avoid pollen sticking to them when on a clothesline.

Floor coverings
 – If possible, remove wall-to-wall carpeting. If not, vacuum the carpet frequently (at least twice a week). If your child has asthma, only vacuum when your child is away and will not return to the room for several hours after you have finished. Substitute multi-layered vacuum bags for regular single layer bags. Small, washable cotton rugs may be used if washed often. Wood, tile, or vinyl flooring without a rug is best, and they should be mopped at least weekly.

Furnace (heating) – 
Electric or gas heat is recommended. Do not use wood stoves or kerosene heaters. Change the air filters on the furnace every month. Cover all furnace outlets in the room with or cover the outlets with 10 thicknesses of cheesecloth or muslin. This will catch dust in the furnace air. Change the cheesecloth when it gets dusty underneath (about every two weeks).

Stuffed animals
 – Limit the number of stuffed animals to 2 or 3. Keep all stuffed animals off of the bed and wash them about once a month to remove dust mite allergens. Stuffed animals can also be put in a hot dryer for 20 minutes to remove dust mites.


Nebulizers

Posted by on Monday, 24 January, 2011

Nebulizers are commonly used for treatment of cystic fibrosis, asthma, COPD and other respiratory diseases. The common technical principle for all nebulizers is to either use oxygen, compressed air or ultrasonic power, as means to break up medical solutions/suspensions into small aerosol droplets, for direct inhalation from the mouthpiece of the device. When using a nebulizer for inhalation therapy with medicine to be administered directly to the lungs, it is important to note that inhaled aerosol droplets can only penetrate into the narrow branches of the lower airways, if they have a small diameter of 1-5 micrometers. Otherwise they are only absorbed by the mouth cavity, where the effect is low. They also accept their medicine in the form of a liquid solution, which is often loaded into the device’s difuser chamber upon use.

Cleaning procedures for medical nebulizer equipment

After each use, disassemble the nebulizer as directed and rinse arts thoroughly in hot running water.

The mouthpiece should be washed in a detergent solution once a day.

The following disinfecting procedure should be followed twice a week:

Disassemble the nebulizer and immerse all parts in a warm detergent solution (Ivory, Joy, etc,) and scrub with a soft bottle-brush. If the tube, which connects the compressor to the nebulizer, is clear and dry, it does not have to be washed. If it has moisture inside or is dirty, wash it along with the other parts. Do not immerse compressor in water!

Rinse all articles in hot water and shake off excess.

Completely immerse all articles in a white vinegar solution and allow soaking for 30 minutes. Vinegar solution is 1 part vinegar to 2-3 parts water.

Rinse well in hot water and shake off excess and drain small parts on a clean towel.

When everything is completely dry, it may be reassembled for the next use.

It is also a good idea to dip a cloth in the vinegar solution and wipe down the outside of the compressor machine.


Short Bowel Syndrome

Posted by on Monday, 4 October, 2010

What is Short Bowel Syndrome?

Short bowel syndrome (SBS) occurs after congenital (before birth) or postnatal loss of at least half of the small intestine, with or without loss of a large part of the intense carmine. The loss of the bowel may be due to disease or surgical removal. Short Bowel Syndrome (SBS) produces malabsorption, a condition where the body can not break and / or absorb sugars, proteins or fats.

short bowel syndrome

The extent of the problems associated with SBS depends mostly articles from the small intestine are affected. The small intestine normal height ranges between 10 and 28 meters and is divided into three sections.

Few conditions in pediatric gastroenterology pose as great a challenge as short bowel syndrome (SBS).

Short bowel syndrome is the result of the alteration of intestinal digestion and absorption that occurs following extensive bowel resection. It represents a complex disorder that affects normal intestinal physiology with nutritional, metabolic, and infectious consequences.

Few conditions in pediatric gastroenterology pose as great a challenge as short bowel syndrome (SBS).
The small intestine of the newborn is about 250 cm in length. In adulthood, small intestine, grows to about 750 cm. Consequently, infants and toddlers have a favorable long-term prognosis compared with an adult in terms of growth potential of the intestine after intestinal resection. Intestinal adaptation can take weeks or months to achieve, in the meantime, children who underwent intestinal resection require nutritional support through a variety of therapies, including parenteral nutrition. The duodenum and jejunum are responsible for the absorption of most dietary components with the exception of vitamin B-12 and bile acids.

Jejunum is characterized by long and wild large absorbent surface. Tight junctions are relatively large, so that the epithelium of larger molecules to pass more, and the free circulation and quick water and electrolytes. Comparison of the ileum is less wild, and the absorption capacity of surfaces unless the jejunum. In addition, tight connections are more stringent, reducing the flow of water and electrolytes in the vascular space into the intestinal lumen and, consequently, the ileum is a more efficient absorption into the water. Although nutrients are not as well absorbed in the small intestine, which has specific receptors on the site, the absorption of bile acid and vitamin B12. In addition, many hormones that affect the gastrointestinal tract, intestine, including enteroglucagon and peptide YY, produced in the ileum. 

Sites of nutrient absorption:

  • Duodenum – Iron
  • Jejunum – Carbohydrates, proteins, fat, vitamins
  • Ileum – Bile acids, vitamin B-12

In general, virtually all digestion and absorption is completed within the first 100-150 cm of jejunum in a healthy individual. In the absence of an intact colon, the minimum length of healthy bowel necessary to avoid parenteral nutrition is approximately 100 cm. Patients who have less than 100 cm of jejunum exhibit significant malabsorption. Although the ileum is limited in its capacity to form chylomicrons compared to the jejunum, studies have shown that the ileum has greater adaptive function as far as improving its absorptive function in the presence of short bowel syndrome. Similarly, studies in animals have shown that intestinal transit time is more likely to improve (ie, increase) in patients with proximal small-bowel resection as opposed to patients with distal small-bowel resection.

Since the jejunum can not develop site-specific carriers for the transport of vitamin B12 and bile salts, and therefore poorly absorbs permanently in patients after ileal resection. In addition, the loss of enteroglucagon and peptide YY can not be stressed in the regulation of bowel motility.

The leading causes of death among infants with short bowel syndrome who are treated with parenteral nutrition include central line sepsis and liver failure with prolonged use of parenteral nutrition.

The history of patients with short bowel syndrome (SBS) is usually a child born with a congenital anomaly, such as omphalocele, gastroschisis, intestinal atresia or, requiring small bowel resection. In addition, premature infants with necrotizing enterocolitis and require extensive bowel resection, with or without loss of the ileocecal junction also contribute to this patient population.

Other patients have a history of malrotation and volvulus, ischemic bowel, which had to undergo a bowel resection. Congenital short bowel syndrome is a rare cause of short bowel syndrome.

Children with short bowel syndrome may have various medical problems, according to the degree of intestinal resection and the level of medical complexity. The history should consider all potential ramifications of clinical case management of short bowel syndrome, including:

Parenteral nutrition

  • The degree of home nutrition support necessary in the management of a child on total parenteral nutrition (TPN) is noteworthy.
  • Guidelines for the safe use of parenteral nutrition have been established by the American Society for Parenteral and Enteral Nutrition.
  • Patients may present with issues entirely separate from the medical problems related to short bowel syndrome, including problems associated with intravenous access, infection, and signs and clinical symptoms associated with TPN-related liver disease.

Enteral Feeding

  • Quickly initiate enteral feeding for all children with short bowel syndrome.
  • Once again, patients can present a full history of medical problems associated with short bowel syndrome, including questions gastrostomy tube or nasogastric tube. For example, gastrostomy tubes may fall accidentally. In these patients, the immediate replacement of these tubes is important to maintain patency of the tube entry site.
  • Although complications are rare, be aware of the potential of gastric ulcer migration, and tube gastrostomy, intestinal obstruction, which may be associated with bilious vomiting and the risk of pancreatitis.

Nutrition

  • Supervise all children in enteral and parenteral long-term specific nutritional problems.
  • Patients may present with various symptoms related to specific nutritional deficiencies, including vitamins specific (or mineral) deficiencies and associated signs, symptoms and electrolyte disturbances and possible complications.

Medical and surgical histories: get a detailed account of past medical and surgical patient.

  • Pathology that leads to surgical resection
  • The extent and location of intestinal resection, the presence or absence of ileocecal valve.
  • Medical complications
  • RPT dependence
  • Enteral nutrition
  • enteral access
  • Type nutritional formula used
  • Dietary Supplements
  • Drugs
  • Allergies

History of complications associated with short bowel syndrome

  • Malabsorptive diarrhea
  • Dehydration
  • Vomiting
  • Bloating
  • Gastroesophageal reflux
  • Failure to thrive
  • Drug toxicities

Welcome to The Medically Fragile Child

Posted by on Sunday, 4 April, 2010

Welcome to our newly designed website, we would like to thank all of our members for sharing their interest in wanting an easier site to navigate through and the ability to subscribe to our blog and read and post comments. Returning members and new visitors, you’re welcome to comments on any topic. We are still working on a next Newsletter that we have scheduled for next month.

For those of you just arriving here for the very first time I’ll start be giving you  brief history about myself and why I decided to write a book on caring for medically fragile children. After being a registered nurse and licensed for 25 years with the state of California as a small family home for medically fragile children. In my continuing work in this area, I saw a growing need for a Medically Fragile Training Manual for foster, adoptive parents and other child-care professionals.

This manual is directed to the basic level of care that is needed for the medically fragile child. A few examples of what this manual contains are common medical diagnosis with signs and symptoms, paperwork required, medications, procedures explained, definitions and sample forms. The Medically Fragile Training Manual is available for purchase and soon will be available in an down loadable e-book format. I hope you find our site useful as well as informative towards your medically fragile child care needs. Please browse our site and don’t hesitate to send us comments on what we could do to improve your viewing experience and any topics you feel may help yourself and others caring for medically fragile children.