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AFRICAN COLLEGE OF HEALTH (ACH)

BNS YEAR 2 SEMESTER 3; WEEK 8 NOTES:


MONDAY: Maternal-Child Nursing (pg.2)
TUESDAY:

Nutrition, Health & Wellness (pg.5)

WEDNESDAY: Maternal-Child Nursing (pg.10)


THURSDAY: Nutrition, Health & Wellness (pg.13)
FRIDAY: Maternal-Child Nursing

(pg.17)

QUESTIONS? Email: africancollegeofht@nokiamail.com

MATERNAL - CHILD NURSING (MONDAY)


Lower chest indrawing;
If the lower chest of the sick child indraws while
breathing, then we say that the child has lower chest
indrawing. The sign has to be clearly seen and must be
seen all the time. We can see this sign only when the
child is silent and in a stable condition. If this sign
is seen, then the child has pneumonia or another
serious illness and must be urgently referred.
Classification of cough or breathing problem:
Sign
If he has any
sign of a
dangerous
disease.
- If he has
lower chest
indrawing.
If wheezing
is observed
on a child
that is
silent.
Fast
breathing
If no sign of
pneumonia or
serious
diseases

Action to be taken
Classification
Severe pneumonia
or other very
serious disease.

Pneumonia

No pneumonia,
simple coughs or
can be common
cold

Urgently refer to
the next health
facility.

Urgently refer to
the next health
facility.
Refer the child to
the next health
facility if cough
has been for more
than 30 days.
Advice the family to

bring the child, if


there are suggestive
signs that the
illness is getting
worse.
See the child again
if no improvement in
5 days.

Actions to be taken:
Refer the child to the next health facility if he has
severe pneumonia or any other serious illness. Advice
mother/parents to take the child to a health facility
if child has pneumonia. If conditions worsen as he
takes the prescribed drug i.e;
o If he has breathing problem
o If he has high fever
o If he fails to drink or suck breast
o Gets weak or is unconscious.
The mother or guardian should be strongly advised to
urgently take him back to the health facility.
If the problem of the child is common cold or simple
cough, the mother or the guardian should be advised to
give him fluids such as tea, gruel etc and breast milk.
If he can suck breast, he should be breast fed more
than the other times. Since the condition of a child
with simple cough or common cold can worsen, strong

advice can be given to take him to a health facility


when the following signs are observed;
- high fever
- failing to drink or breast feed
- dizziness or unconscious
- fast breathing.

NUTRITION, HEALTH AND WELLNESS (TUESDAY)


Secretion of PTH:
When the plasma calcium level falls below the normal
lower limit calcium receptors present in parathyroid
cells interact with G-proteins. This leads to increased
intracellular calcium due to formation of IP3 by the
action of phospholipase-C which in turn causes release
of PTH by increasing intracellular cAMP. Calciumcalmodulin complex increases cAMP probably by
inhibiting phosphodiesterase.
Actions of PTH:
Parathyroid hormone enters target cells through
specific receptor present on membrane surface. The
action of PTH on target tissues is mediated by cAMP.
PTH increases intracellular cAMP level in target
tissues by activating adenyl cyclase. PTH acts on three
organs to increase plasma calcium level. Its main
action is on bone. Dissolution of bone by PTH increases
the movement of calcium from bone to plasma. PTH
increases calcium reabsorption in kidney. PTH increases
absorption of calcium in the intestine indirectly
through the formation of calcitriol.
Secretion and action of calcitonin:
When plasma calcium level is more than the upper value
of normal range calcitonin is produced by the C cells
of thyroid gland. Calcitonin lowers plasma calcium
level by acting on bone. It enters osteoclasts of bone

through receptor mediated process. Its action is also


mediated by cAMP. It increases intracellular cAMP
level. It decreases release of calcium from bone by
preventing bone resorption by osteoclasts.
Deficiency of calcium:
Nutritional deficiency of calcium causes growth
failure, hyperplasia of parathyroid glands,
osteoporosis, hyper irritability and tetany. However it
is rare.
Hypocalcemia;
The decrease in calcium level leads to tetany and
related muscle and neurological disorders
(convulsions). It occurs in vitamin D deficiency,
hypoparathyroidism, pseudohypoparathyriodism, renal in
sufficiency, rickets and osteomalacia. Symptoms of
tetany are muscle spasms and hyper excitability of
nerves of face and extremities.
Hypercalcemia;
It occurs in hyper parathyroidism and hyper
vitaminosis of vitamin D. Small increase in plasma
calcium is observed in sarcoidosis, milk alkali
syndrome, respiratory acidosis and bone cancer.
Idiopathic hypercalcemia has been reported in some
infants. It occurs within 10 months after birth.
Symptoms are depression, mental confusion, anorexia,
cardiac arrhythmias, coma and cardiac arrest.
Sources;
Milk, sea same seeds, green leafy vegetables, fish are
good sources. Egg, nuts, fruits and vegetables are fair
sources. Rice is a poor source.

Daily requirement (RDA);


Adults. 800 mg/day (0.8 gm/day).
Children. 0.8-1.2 gm/day.
Phosphorus:
Human body contain about 500-700 gm of phosphorus. In
the body phosphorus is present as inorganic phosphate
complexed with calcium and magnesium in bone and teeth
and as organic phosphate associated with phospholipids
of membranes, nucleic acids and metabolites.
Absorption;
Phosphatases present in the lumen hydrolyzes
phosphates from organic substances. Free phosphate is
absorbed in jejunum and enters blood by way of portal
circulation.
Factors affecting absorption of phosphate:
1. Calcitriol increases absorption of phosphate in the
intestine by sodium and glucose dependent mechanism.
2. High calcium diet decreases the absorption of
phosphate by forming in soluble calcium phosphate.
3. Phosphorus of animal foods is absorbed easily than
plant food phosphorus.
4. Antacids if taken excess interferes with phosphate
absorption.
Functions:
1. It is present in bone and teeth as hydroxyapatite.
2. It is required for the formation of nucleic acids.
3. It is constituent of blood buffers.

4. It is required for the synthesis of phospholipids.


5. It is constituent of high energy compounds like at
ATP, GTP etc.
6. It is involved in modification of several enzymes
and cellular proteins.
7. It is required for the formation coenzymes of water
soluble vitamins like pyridoxine, thiamine etc.
8. It is constituent of metabolic intermediates like
glucose-6 phosphate etc.
9. It is required for the synthesis of milk protein
casein which is a phosphoprotein.
10. It is constituent of secondary messengers like
cAMP, cGMP etc.
Blood phosphate homeostasis:
The normal plasma inorganic phosphorus level is 2.54.5
mg%. In children it is slightly higher and ranges from
4-6 mg. Since phosphorus is a constituent of several
macromolecules maintenance of its normal level in
plasma is essential. Plasma phosphorus level is
balanced by several factors under normal conditions.
However PTH, calcitonin and calcitriol mainly
influences plasma phosphorus level. They maintain
phosphorus level by acting on kidney. PTH and
calcitonin diminishes phosphorus reabsorption where as
calcitriol increases reabsorption of phosphorus in the
renal tubules.
Deficiency;
The deficiency of phosphate occurs due to impaired
absorption or excessive loss through kidney.

Hypophosphatemia:
The plasma phosphorus level is decreased in hyper
parathyroidism, Fanconi syndrome and vitamin D
deficiency. Insulin overdose may cause low plasma
phosphorus level.

MATERNAL - CHILD NURSING (WEDNESDAY)


Lower chest indrawing;
If the lower chest of the sick child indraws while
breathing, then we say that the child has lower chest
indrawing. The sign has to be clearly seen and must be
seen all the time. We can see this sign only when the
child is silent and in a stable condition. If this sign
is seen, then the child has pneumonia or another
serious illness and must be urgently referred.
Classification of cough or breathing problem:
Sign
If he has any
sign of a
dangerous
disease.
- If he has
lower chest
indrawing.
If wheezing
is observed
on a child
that is
silent.
Fast
breathing
If no sign of
pneumonia or
serious

Action to be taken
Classification
Severe pneumonia
or other very
serious disease.

Pneumonia

No pneumonia,
simple coughs or
can be common

Urgently refer to
the next health
facility.

Urgently refer to
the next health
facility.
Refer the child to
the next health
facility if cough

diseases

cold

has been for more


than 30 days.
Advice the family to
bring the child, if
there are suggestive
signs that the
illness is getting
worse.
See the child again
if no improvement in
5 days.

Actions to be taken:
Refer the child to the next health facility if he has
severe pneumonia or any other serious illness. Advice
mother/parents to take the child to a health facility
if child has pneumonia. If conditions worsen as he
takes the prescribed drug i.e;
o If he has breathing problem
o If he has high fever
o If he fails to drink or suck breast
o Gets weak or is unconscious.
The mother or guardian should be strongly advised to
urgently take him back to the health facility.
If the problem of the child is common cold or simple
cough, the mother or the guardian should be advised to
give him fluids such as tea, gruel etc and breast milk.

If he can suck breast, he should be breast fed more


than the other times. Since the condition of a child
with simple cough or common cold can worsen, strong
advice can be given to take him to a health facility
when the following signs are observed;
- high fever
- failing to drink or breast feed
- dizziness or unconscious
- fast breathing.

NUTRITION, HEALTH AND WELLNESS (THURSDAY)


Hyperphosphatemia:
It occurs when kidney fails to remove phosphorus.
Therefore hyper phosphatemia is seen in chronic
nephritis which progress to renal failure. Hypo
parathyroidism and hyper vitaminosis of vitamin D are
other diseases in which hyperphosphatemia occurs.
Sources:
Pulses, cereals, coconut, groundnut and eggs are good
sources. Milk and green leafy vegetables are fair
sources.
Daily requirement (RDA);
Adults. 200-300 mg/day.
MAGNESIUM:
Human body contains about 25 g of magnesium. Of this
50% is present in bone in combination with phosphate
and carbonate. Soft tissues contain about one fifth of
total body magnesium. Remaining is present in body
fluids.
Absorption:
About 40% of ingested magnesium is absorbed in jejunum
and ileum. High magnesium content of diet decreases

magnesium absorption. Alcohol also interferes with


absorption of magnesium. Inverse relationship exists
between intake of magnesium and absorption. It suggests
that magnesium deficiency treatment requires an
extended period.
Functions:
1. Magnesium is major intracellular cation like
potassium.
2. It is constituent of bone and teeth.
3. It is essential for phosphate group transfer
reactions catalyzed by kinases and RNA polymerase. It
is not part of enzyme molecule. But it act as bridge
between enzyme and nucleoside phosphates. Hence
magnesium is involved in carbohydrate metabolism,
nucleotide and nucleic acid metabolism, protein
synthesis and muscle contraction.
4. Transketolase, glucose-6-phosphate dehydrogenase,
enolase and lactonase also requires this metal for
activity.
5. Magnesium is involved in several processes such as
hormone receptor binding, gating of calcium channels,
trans membrane ion flux, regulation of adenylate
cyclase, muscle contraction and neuronal activity,
control of vascular tone, cardiac excitability and
neurotransmitter release.
6. Magnesium increases bodys ability to utilize other
minerals like calcium, phosphorus, sodium and potassium
and vitamins like vitamin C, vitamin E and vitamin Bcomplex.
7. Magnesium is involved in insulin secretion, binding
to receptors and activity.

Regulation of plasma magnesium:


Plasma magnesium is carefully regulated within normal
range. Kidney is primary regulator of body magnesium
balance. Renal magnesium regulation is essentially a
filtration and re- absorption process. Normal intake of
magnesium is about 300-350 mg per day and about one
third is absorbed by gastrointestinal tract. Over a 24
hour period 3500 mg of magnesium is filtered by
kidneys. However only 3 to 4% of this amount or about
100 to 150 mg per day is excreted in urine. It is equal
to the amount of absorbed magnesium per day.
Thus body magnesium balance is determined by renal
excretion of magnesium. Most remarkable change in renal
magnesium handling occurs in response to alterations in
plasma magnesium concentration. Renal cells are capable
of adopting to magnesium availability through receptors
which senses the concentration of this cation. Thus
when body magnesium status is below normal these
receptors senses the need for magnesium retention and
cause more reabsorption of magnesium. Deficiency of
magnesium leads to hypomagnesemia. Several other
diseases also cause hypomagnesaemia.
Hypomagnesaemia:
The normal serum magnesium level is 1.7-2.4 mg%.
Hypomagnesaemia occurs in hyper parathyroidism, chronic
alcoholism, kwashiorkor, malabsorption syndromes,
vomiting, diarrhoea and pancreatitis. Symptoms are
weakness, lethargy, paresthesias, muscle cramps and
confusion.
Magnesium deficiency, hypomagnesemia and diabetes:
Magnesium deficiency and hypomagnesemia are involved
in development of insulin resistance, carbohydrate

intolerance, accelerated atherosclerosis, hypertension,


diabetic neuropathy and cardiovascular complications.
Deficient intake of magnesium is a risk factor for
development of type-II diabetes mellitus independent of
age, body mass index, alcohol intake and family history
of diabetes. Close relationship between insulin,
glucose homeostasis and intracellular magnesium is
recognized.
Insulin induces opposite changes in plasma and
erythrocyte magnesium concentrations. Intracellular
magnesium deficiency impairs action of many magnesium
dependent glycolytic enzymes like hexokinase and
phosphofructokinase. Magnesium supplementation improves
insulin response and action in type-II diabetic
patients. Diabetic patients have low magnesium levels.
The mechanism responsible for magnesium deficiency in
diabetic patients is not known clearly. It is believed
that glycosuria that occurs in diabetic patients
impairs renal reabsorption of magnesium from filtrate.
Toxicity:
Magnesium overdose leads to hyper magnesaemia which
can also occur in other diseases.
Hypermagnesaemia:
It occurs in renal failure, diabetic coma and due to
excessive intake of antacids. Symptoms are muscle
weakness, nausea, decreased neuromuscular transmission
and depression. Death may occur due to respiratory
paralysis.
Sources:
Nuts, legumes, peas and whole grains are good sources.
Fish, meat and green leafy vegetables are fair sources.

Daily requirement (RDA);


Adults. 300-350 mg/day. More during pregnancy and
lactation.

MATERNAL - CHILD NURSING (FRIDAY)


Lower chest indrawing;
If the lower chest of the sick child indraws while
breathing, then we say that the child has lower chest
indrawing. The sign has to be clearly seen and must be
seen all the time. We can see this sign only when the
child is silent and in a stable condition. If this sign
is seen, then the child has pneumonia or another
serious illness and must be urgently referred.
Classification of cough or breathing problem:
Sign
If he has any
sign of a
dangerous
disease.
- If he has
lower chest
indrawing.
If wheezing
is observed
on a child
that is
silent.
Fast
breathing

Action to be taken
Classification
Severe pneumonia
or other very
serious disease.

Pneumonia

Urgently refer to
the next health
facility.

Urgently refer to
the next health
facility.

If no sign of
pneumonia or
serious
diseases

No pneumonia,
simple coughs or
can be common
cold

Refer the child to


the next health
facility if cough
has been for more
than 30 days.
Advice the family to
bring the child, if
there are suggestive
signs that the
illness is getting
worse.
See the child again
if no improvement in
5 days.

Actions to be taken:
Refer the child to the next health facility if he has
severe pneumonia or any other serious illness. Advice
mother/parents to take the child to a health facility
if child has pneumonia. If conditions worsen as he
takes the prescribed drug i.e;
o If he has breathing problem
o If he has high fever
o If he fails to drink or suck breast
o Gets weak or is unconscious.
The mother or guardian should be strongly advised to
urgently take him back to the health facility.

If the problem of the child is common cold or simple


cough, the mother or the guardian should be advised to
give him fluids such as tea, gruel etc and breast milk.
If he can suck breast, he should be breast fed more
than the other times. Since the condition of a child
with simple cough or common cold can worsen, strong
advice can be given to take him to a health facility
when the following signs are observed;
- high fever
- failing to drink or breast feed
- dizziness or unconscious
- fast breathing.

walesonmd@gmail.com

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