1.

What is dry heat sterilization?

In dry heat sterilization, heated air or fire is used for sterilizing different materials. As compared to the moist heat sterilization, the temperature in this method is higher. It helps kill the organisms using destructive oxidation method. Things such as glassware, metal instruments, paper wrapped things and syringes are effectively sterilized through dry heat.

2.

What is moist heat sterilization?

In moist heat sterilization, autoclave is utilized to maintain water at high pressure level in order to attain effective sterilization. The structural proteins and the organisms enzymes are destroyed through moist heat. This method is utilized for heat sensitive materials and materials through which steam is permeable.

3.

What is the first aid for burns?

First hold the burned area under cool running water for 10-15 minutes or immerse the burn in cool water or cool it with cold compresses. Do not put ice on the burn. Then wrap the gauze loosely on the burned skin. Heat burns (thermal burns): Smother any flames by covering them with a blanket or water. If your clothing catches fire, do not run: stop, drop, and roll on the ground to smother the flames. Cold temperature burns: Try first aid measures to warm the areas. Small areas of your body (ears, face, nose, fingers, toes) that are really cold or frozen can be warmed by blowing warm air on them, tucking them inside your clothing or putting them in warm water. Liquid scald burns (thermal burns): Run cool tap water over the burn for 10 to 20 minutes. Do not use ice.

 Electrical burns: After the person has been separated from the electrical source, check for breathing and a heartbeat. If the person is not breathing or does not have a heartbeat, call 911. Chemical burns: Natural foods such as chili peppers, which contain a substance irritating to the skin, can cause a burning sensation. When a chemical burn occurs, find out what chemical caused the burn. Tar or hot plastic burns: Immediately run cold water over the hot tar or hot plastic to cool the tar or plastic. 4. How to prevent constipation?

Hydration is the key to prevent constipation. Drink 6-8 glasses of water daily. Eat fiber rich foods such as grains, fruits and vegetables. And exercise regularly.

5.

Ways to burp a baby

Burping helps release air trapped in the babys stomach, making him more comfortable, less fussy and frees up room in your babys tummy so he can settle in and feed longer. Sit upright and hold your baby against your chest. Your baby's chin should rest on your shoulder as you support the baby with one hand. With the other hand, gently pat your baby's back. Sitting in a rocking chair and gently rocking with your baby while you do this may also help. Hold your baby sitting up, in your lap or across your knee. Support your baby's chest and head with one hand by cradling your baby's chin in the palm of your hand and resting the heel of your hand on your baby's chest (but be careful to grip your baby's chin, not throat). Use the other hand to pat your baby's back gently. Lay your baby on your lap on his or her belly. Support your baby's head and make sure it's higher than his or her chest. Gently pat your baby's back.

6.

Procedures in taking axillary temperature.

To obtain an axillary temperature, place the thermometer in a dry axilla. Keep the arm close to the body to ensure contact with the bulb or probe for 8 to 10 minutes. An axillary temperature is usually 0.5F (0.3C) to 1F (0.6C) lower than an oral temperature. Have the patient bring his arm down so that his upper arm is against the side of his chest and his forearm and hand lie across the top of his chest.

7.

Procedures in taking rectal temperature.

To obtain a rectal temperature, lubricate the bulb and the area up to 1 inch above it. Use a lubricated probe cover with an electronic thermometer. Turn the patient on his side, fold back the bedding and separate the buttocks so that you can easily see the anal opening. Insert the thermometer approximately 1.5 inches into the anus. Hold the thermometer in place for 3 to 4 minutes. If resistance is felt, do not force insertion. A rectal temperature is 0.5F (0.3C) to 1F (0.6C) higher than an oral temperature. The rectal method of obtaining the temperature is contraindicated if the patient has diarrhea, rectal disease, or has recently had rectal surgery.

8.

Procedures in taking tympanic temperature.

Position client in Sims or sitting position and turn the clients head to one side. For an adult, pull pinna upward and back; for a child, pull down and back. Gently insert probe with firm pressure into ear canal. A tympanic temperature is 0.5F (0.3C) to 1F (0.6C) higher than an oral temperature.

9.

Procedures in taking oral temperature.

To obtain an oral temperature, place the thermometer in the sublingual pocket and have the patient close his mouth around it. Instruct him not to bite down.

Leave the thermometer in place 3 to 4 minutes. If the patient has been eating, drinking, smoking, brushing his teeth, or chewing gum within the past 15 minutes, wait at least 15 minutes to take the temperature. An oral temperature is 0.5F (0.3C) to 1F (0.6C) lower than a rectal or tympanic temperature. Oral temperatures are contraindicated for an unconscious patient, for an infant, or when the patient must breathe through the mouth.

10. What are the signs and symptoms of impending heart attack? A heart attack usually occurs when there is blockage in one of the heart's arteries.

Chest discomfort that feels like pressure, fullness, or a squeezing pain in the

center of your chest; it lasts for more than a few minutes, or goes away and comes back.

Pain and discomfort that extend beyond your chest to other parts of your

upper body, such as one or both arms, back, neck, stomach, teeth, and jaw

Unexplained shortness of breath, with or without chest discomfort Other symptoms, such as cold sweats, nausea or vomiting, lightheadedness,

anxiety, indigestion, and unexplained fatigue 11. Oral hygiene for clients with dentures. To avoid accidentally dropping them, stand over a folded towel or a full sink of water when handling dentures. Brush and rinse dentures daily. Use a brush with soft bristles that is specifically designed for cleaning dentures. Clean with a denture cleaner. Hand soap or mild dishwashing liquid can be used for cleaning dentures. Dentures need to be kept moist when not being worn so they do not dry out or lose their shape. When not worn, dentures should be placed in a denture cleanser soaking solution or in water. However, if the denture has metal attachments, the attachments could tarnish if placed in a

soaking solution. Dentures should never be placed in hot water, as it can cause them to warp. Generally, complete dentures should be used for five to seven years before a replacement is necessary. Even with full dentures, it is important to brush your gums, tongue, and palate with a soft-bristled brush every morning before putting in dentures. Pay special attention to cleaning teeth that fit under the denture's metal clasps. If you have dentures, your dentist or prosthodontist will advise you about how often to visit, but every six months should be the norm.

12. Promoting self esteem and well being on an elderly client. Manifestations of low self esteem are being sad, or losing interest in hobbies, not taking care of oneself, not socializing or having suicidal thoughts, etc. Other symptoms may be narration of pleasant memories repetitively or trying to do things which they cannot cope with. There are many ways to help the elderly to regain their self esteem. The first is to offer emotional support. Ensure that they are given adequate medical attention for their ailments. Another good therapy would be to allow them to spend their time in the company of their grandchildren. Encourage them to meet their friends and to talk of the old times. As a caregiver, you can be compassionate and patient while dealing with their fears and anxieties.

13. Promoting self esteem in children. Self-esteem is similar to self-worth (how much a person values himself or herself). Parents and caregivers can promote healthy self-esteem by showing encouragement and enjoyment in many areas. Avoid focusing on one specific area; for example, success on a spelling test, which can lead to kids feeling that they're only as valuable as their test scores.

When promoting healthy self-esteem, it's important to not have too much or too little but "just enough." Make sure your kids don't end up feeling that if they're average or normal at something, it's the same as not being good or special. Be careful what you say. Kids can be sensitive to parents' and others' words. Remember to praise your child not only for a job well done, but also for effort. But be truthful and give praise often and honestly, but without overdoing it. Reward effort and completion instead of outcome. Sometimes, a child's skill level is just not there so helping kids overcome disappointments can really help them learn what they're good at and what they're not so good at. Be a positive role model. Help kids set more accurate standards and be more realistic in evaluating themselves will help them have a healthy self-concept. Be spontaneous and affectionate. Acknowledge the child's feelings, reward the choice made, and encourage the child to make the right choice again next time. Create a safe, loving home environment. Help kids become involved in constructive experiences and such Activities that will encourage cooperation rather than competition are especially helpful in fostering self-esteem. 14. Safety precautions in storing flammable liquids. When not in use, containers of flammable liquids needed for current work activities should be kept closed and stored in suitable cabinets or bins of fireresisting construction and which are designed to retain spills (110% volume of the largest vessel normally stored in it). These should be located in designated areas that are where possible away from the immediate processing area and do not jeopardise the means of escape from the workroom/working area. The flammable liquids should be stored separately from other dangerous substances that may enhance the risk of fire or compromise the integrity of the container or cabinet/bin; for example energetic substances, oxidizers and corrosive materials. It is recognised that these other dangerous substances may be flammable liquids in their own right or held in a flammable liquid.

However, it is still inappropriate to store these in the same cabinets or bins with other flammable liquids.

15. Vitamin D and its sources Vitamin D helps regulate the amount of calcium and phosphate in the body and is needed to keep bones and teeth healthy. Good food sources are oily fish, such as salmon, sardines and mackerel, eggs, fortified fat spreads, fortified breakfast cereals and powdered milk. If you take vitamin D supplements, do not take more than 25 micrograms (0.025mg) a day, as it could be harmful. However, taking less than this is unlikely to cause any harm. The Department of Health recommends:

all pregnant and breastfeeding women should take a daily supplement

containing 10 micrograms (0.01mg) of vitamin D to ensure the mother's requirements for vitamin D are met and to build adequate foetal stores for early infancy

all babies and young children aged six months to five years should take a

daily supplement containing vitamin D in the form of vitamin drops to help them meet the requirement set for this age group of 7-8.5 micrograms (0.007-0.0085mg) of vitamin D a day

babies fed infant formula will not need vitamin drops until they are receiving

less than 500ml (about a pint) of infant formula a day, as these products are fortified with vitamin D

breastfed infants may need to receive drops containing vitamin D from one

month of age if their mother has not taken vitamin D supplements throughout pregnancy

people aged 65 years and over and people not exposed to much sun should

also take a daily supplement containing 10 micrograms (0.01mg) of vitamin D

16. Vitamin A and its sources Vitamin A (retinol) helps strengthen immunity against infections, helps vision in dim light and keeps skin and the linings of some parts of the body, such as the nose, healthy. Good sources of vitamin A include cheese, eggs, fortified lowfat spreads and yoghurt. Liver is a particularly rich source of vitamin A, although limit eating to once a week. The amount of vitamin A adults need is 0.7mg a day for men and 0.6mg a day for women.

17. The B vitamins and its sources Thiamin (vitamin B1) works with other B-group vitamins to help break down and release energy from food and keeps the nerves and muscle tissue healthy. Good sources of thiamine are vegetables, peas, fresh and dried fruit, eggs, wholegrain breads, some fortified breakfast cereals and liver. The amount of thiamin you need is 1mg a day for men and 0.8mg a day for women. Riboflavin (vitamin B2) helps keeping skin, eyes and the nervous system healthy and helping the body release energy from carbohydrate. Good sources of riboflavin include milk, eggs, fortified breakfast cereals and rice.The amount of riboflavin you need is about 1.3mg a day for men and 1.1mg a day for women. Riboflavin cannot be stored in the body, so you need it in your diet every day. Niacin (vitamin B3) helps produce energy from the foods we eat and keeps the nervous and digestive systems healthy. There are two forms of niacin nicotinic acid and nicotinamide both of which are found in food. Good sources of niacin include meat, fish, wheat flour, maize flour, eggs and milk. The amount of niacin you need is about 17mg a day for men and 13mg a day for women. Pantothenic acid has several functions, such as helping release energy from the food we eat. It can be found in virtually all meat and vegetable foods. Good

sources include chicken, beef, potatoes, porridge, tomatoes, kidney, eggs, broccoli and wholegrains, such as brown rice and wholemeal bread. Pantothenic acid cannot be stored in the body, so you need it in your diet every day. Vitamin B6 (pyridoxine) has several important functions which includes allowing the body to use and store energy from protein and carbohydrates in food and helping form haemoglobin, the substance that carries oxygen around the body. Vitamin B6 is found in a wide variety of foods such as pork, poultry (such as chicken or turkey), fish, bread, whole cereals, such as oatmeal, wheat germ and rice, eggs, vegetables, soya beans, peanuts, milk, potatoes and some fortified breakfast cereals. The amount of vitamin B6 you need is about 1.4mg a day for men and 1.2mg a day for women. Folic acid (folate) has several important functions such as working together with vitamin B12 to form healthy red blood cells and helps reduce the risk of central nervous system defects such as spina bifida in unborn babies. Folic acid is found in small amounts in many foods. Good sources include broccoli, brussels sprouts, liver, spinach, asparagus, peas, chickpeas, brown rice and fortified breakfast cereals. Adults need 0.2mg of folic acid a day. However, if you are pregnant or thinking of trying to have a baby, take a 0.4mg (400 microgram) of folic acid supplement daily from the time you stop using contraception until the 12th week of pregnancy. Vitamin B12 has several important functions and is involved in making red blood cells and keeping the nervous system healthy, releasing energy from the food we eat and processing folic acid.Good sources of vitamin B12 includes meat, salmon, cod, milk, cheese, eggs and some fortified breakfast cereals. Adults need approximately 0.0015mg a day of vitamin B12. 18. Vitamin C and its sources

Vitamin C (ascorbic acid) and has several important functions such as helping protect cells and keeps them healthy, is necessary for the maintenance of healthy connective tissue, which gives support and structure for other tissue and organs and helps wound healing . Vitamin C is found in a wide variety of fruit and vegetables. Good sources include oranges and orange juice, red and green peppers, strawberries, blackcurrants, broccoli, brussels sprouts and potatoes. Adults need 40mg of vitamin C a day. 19. Vitamin E and its sources Vitamin E has several important functions. For example, it helps maintain cell structure by protecting cell membranes. Vitamin E is found in a wide variety of foods. The richest sources are plant oils such as soya, corn and olive oil. Other good sources include nuts and seeds and wheat germ, found in cereals and cereal products. The amount of vitamin E you need is 4mg a day for men and 3mg a day for women. 20. Vitamin K and its sources Vitamin K has several important functions. For example, it is needed for blood clotting, which means it helps wounds heal properly. Vitamin K is found in green leafy vegetables, such as broccoli and spinach, vegetable oils and cereals. Adults need approximately 0.001mg a day of vitamin K for each kilogram of their body weight.

21. Calcium and its sources There is more calcium in the body than any other mineral and it has several important functions. These include helping build strong bones and teeth, regulating muscle contractions, including heartbeat and ensuring blood clots normally. Good sources of calcium include milk, cheese and other dairy foods, green leafy vegetables, such as broccoli, cabbage and okra, but not spinach, soya beans, tofu, soya drinks with added calcium, nuts, bread and anything

made with fortified flour and fish where you eat the bones, such as sardines and pilchards. Adults need 700mg of calcium a day. 22. Iodine and its sources Iodine helps make the thyroid hormones. These hormones help keep cells and the metabolic rate healthy. Iodine is a trace element found in seawater, rocks and some types of soil. Good food sources include sea fish and shellfish. It can also be found in plant foods such as cereals and grains, but the levels vary depending on the amount of iodine in the soil where the plants are grown. Adults need 0.14mg of iodine a day.

23. Iron and its sources

Iron is an essential mineral that has several important roles in the body. For example, it helps make red blood cells, which carry oxygen around the body. Good sources of iron include liver, meat, beans, nuts, dried fruit, such as dried apricots, whole grains, such as brown rice, fortified breakfast cereals, soybean flour and most dark-green leafy vegetables, such as watercress and curly kale. The amount of iron you need is 8.7mg a day for men and 14.8mg a day for women.

24. First aid for bee sting If the person does not have severe allergy symptoms: 1. Remove the Stinger

Scrape the area with a fingernail or use tweezers to remove it. Don't pinch the stinger -- that can inject more venom.

2. Control Swelling

Ice the area. If you were stung on your arm or leg, elevate it. Remove any tight-fitting jewelry from the area of the sting. As it swells, rings

or bracelets might be difficult to remove. 3. Treat Symptoms

For pain, take an over-the-counter painkiller like acetaminophen or ibuprofen.

Do not give aspirin to anyone under age 18.

For itchiness, take an antihistamine. You can also apply a mixture of baking

soda and water or calamine lotion. If the person does have severe allergy symptoms (anaphylaxis): 1. Call 911 Seek emergency care if the person has any of these symptoms or a history of severe allergic reactions (anaphylaxis), even if there are no symptoms:

Difficulty breathing or wheezing Tightness in the throat or a feeling that the airways are closing Hoarseness or trouble speaking Nausea, abdominal pain, or vomiting Fast heartbeat or pulse Skin that severely itches, tingles, swells, or turns red Anxiety or dizziness Loss of consciousness

2. Inject Epinephrine Immediately If the person has an anaphylaxis action plan from a doctor for injecting epinephrine and other emergency measures, follow it. Otherwise, if the person carries an epinephrine shot or one is available:

Inject epinephrine if the person is unable to. If the person has a history of anaphylaxis, don't wait for signs of a severe

reaction to inject epinephrine.

Read and follow patient instructions carefully. Inject epinephrine into outer muscle of the thigh. Avoid injecting into a vein or

buttock muscles.

Do not inject medicine into hands or feet, which can cause tissue damage. If

this happens, notify emergency room staff.

The person may need more than one injection if there's no improvement after

the first. For an adult, inject again after 10 to 20 minutes. For a child, inject again after 5 to 30 minutes.

A person should always go to the ER after an epinephrine injection, even if

the symptoms subside. 25. CPR in children. Call 911

If youre alone with a child or baby who is unresponsive and not breathing (or

only gasping), call 911 after youve done 2 minutes of cardiopulmonary resuscitation (CPR).

If someone else is present, shout for the person to call 911 and locate an AED

(a defibrillator) right away while you begin CPR.

If a child or baby is unconscious but you see regular breathing, call 911 and

wait for help. A breathing child or baby does not need CPR, but one that is gasping does. 1. Check to see if the child is conscious.

Make sure you and the child are in safe surroundings. Tap the child gently.

Shout, Are you OK?" Look quickly to see if the child has any injuries or medical problems.

2. Check Breathing

Place your ear near the childs mouth and nose. Is there breath on your

cheek? Is the childs chest moving? 3. Begin Chest Compressions If the child doesnt respond and isnt breathing:

Carefully place child on back. For a baby, be careful not to tilt the head back

too far. If you suspect a neck or head injury, roll baby over, moving entire body at once.

For a baby, place two fingers on breastbone, For a child, place heel of one

hand on center of chest at nipple line. You also can push with one hand on top of the other.

For a child, press down about 2 inches. Make sure not to press on ribs. For a baby, press down about 1 1/2 inches, about 1/3 to 1/2 the depth of

chest. Make sure not to press on the end of the breastbone.

Do 30 chest compressions, at the rate of 100 per minute. Let the chest rise

completely between pushes.

Check to see if the child has started breathing. Continue CPR until emergency help arrives.

4. Do Rescue Breathing

To open airway, lift childs chin with one hand. At the same time, tilt head by

pushing down on forehead with other hand. Do not tilt the head back if the child may have a neck or head injury.

For a child, cover mouth tightly with yours. Pinch nose closed and give

breaths.

For a baby, cover mouth and nose with your mouth and give breaths. Give child two breaths, watching for chest to rise each time. Each breath

should take one second. 5. Repeat Compressions and Rescue Breathing if Child Is Still Not Breathing

Two breaths can be given after every 30 chest compressions. If someone else

is helping you, you should give 15 compressions, then 2 breaths.

Continue this cycle of 30 compressions and 2 breaths until the child starts

breathing or emergency help arrives.

If you are alone with the child and have done 2 minutes of CPR (about 5

cycles of compressions and breathing), call 911 and find an AED. 6. Use AED as Soon as Available For children under 9 years old, use a pediatric automated external defibrillator (AED), if available. If a pediatric AED is not available, or for children age 1 and older, use a standard AED.

Turn on AED. Wipe chest dry and attach the pads. The AED will give you step-by-step instructions. Continue compressions and follow AED prompts until emergency help arrives

or the child starts breathing. 26. CPR for adult. 1. Check Responsiveness

Tap the person's shoulder and shout, "Are you OK?" Look for normal breathing. Call 911 if there is no response. Start Hands-Only CPR.

Hands-Only CPR should not be used for adults whose cardiac arrest is due to

drug overdose, near-drowning, or an unwitnessed cardiac arrest. In these cases, do a conventional CPR combination of chest compressions and rescue breathing. 2. Do Chest Compressions

Place the heel of your hand on the center of the person's chest. Place the heel of your other hand on top of your first hand, lacing fingers

together.

Keep arms straight and your shoulders directly over your hands. Push hard and fast, compressing chest at least 2 inches. Let chest rise completely before pushing down again. Compress at least 100 times per minute.

3. Stop Only if:

The person starts breathing normally A trained responder or emergency help takes over You are too exhausted to continue There is an automated external defibrillator (AED) to use

4. Use an AED as Soon as One Is Available

Turn on the AED. It will give you step-by-step instructions. Wipe chest dry. Attach the pads. Plug in connector, if needed. Make sure no one is touching the person. Push the "Analyze" button if necessary. If a shock is advised, push the "Shock" button. Resume compressions and follow AED prompts.

27. Bottle feeding basics.

Sterilise your entire baby's feeding equipment before you make each feed.

Before making your baby's feed, wash all bottles, teats, retaining rings and caps in clean, hot, soapy water, and then sterilise them. Do this each time you use them. To sterilise your baby's feeding equipment, you will need an electric steam steriliser, or a microwave steriliser, or you can use sterilising solution. You can also boil the bottles and teats in a covered pan for at least 10 minutes to sterilise them.

To make up a bottle of powdered formula, follow the instructions on the

packet carefully. Here's what you'll need to do: Boil tap water and leave it to cool for no longer than half an hour. Pour the required amount of water into the bottle. Add the right number of scoops to the bottle with the scoop provided, using a

clean knife to level it off.

Put on the teat and cover and give the bottle a good shake until all the powder

has dissolved.

Test the temperature by tipping a little milk out of the teat onto the inside of

your wrist. It should feel just warm, not hot. When you are giving your baby her feed, tilt the bottle slightly so the end of

the teat is always full of milk, not air. You'll see bubbles inside the bottle as your baby feeds. If you hear a lot of noisy sucking sounds while your baby drinks, she may be taking in too much air. To help your baby swallow less air, hold her so she's propped up a little. Take care to tilt the bottle so that the teat and neck are always filled with formula. Your babys appetite will vary from day to day and month to month, so try

to let her set the pace. Your baby will feed as often as she needs to, as long as you learn to spot her cues and respond to them. If your baby is newborn she will need to feed little and often, so offer a bottle every two or three hours. Let

her feed for as long as she wants to. If she's had enough of a bottle, dont force her to drink more. As a general rule of thumb, your baby will want between 150ml and 200ml of formula per kilogram of her body weight per day. So, if your baby weighs 3kg, she'll need between 450ml and 600ml of formula over a 24-hour period to satisfy her hunger. If you are using expressed breastmilk or ready-made formula, you

can warm a bottle in a pan, jug or bowl of hot water. Leave it in the water for no more than 15 minutes. You can also buy an electric bottle warmer, which takes around four to six minutes to heat a bottle to the perfect temperature for your baby. It's best not to use a microwave to heat a bottle of breastmilk or ready-made formula milk. A microwave heats unevenly, so it can create hot pockets which could burn your baby's mouth. It's best to make a fresh bottle of formula each time your baby needs a

feed. Milk powder is not sterile, and bacteria may survive in milk even though you use sterile water to mix it. Even if you store formula milk in the fridge, bacteria can build up over a few hours. So, on those occasions when you really need to, prepare one feed in advance. Do this as safely as possible by putting the feed in the fridge or a cool bag as soon as you've made it. Make sure you use it within four hours if it's been stored in a cool bag, or within 12 hours if it's been in the fridge. 28. Breast feeding for beginners Is it true that breast is best?

Yes, breastmilk is the best food for your baby. Breastmilk is a complete food. It contains at least 400 nutrients, as well as hormones and disease-fighting compounds, that aren't present in formula milk. Its nutritional make-up even adjusts to your baby's needs as she grows. Feeding your baby only breastmilk for up to six months (exclusive breastfeeding) is particularly good for her. It can improve your babys cognitive development. Babies who are exclusively breastfed from birth are also much less likely to be ill in their first year of life.

Breastfeeding helps to build a special bond between you and your baby. And in the long term, breastfeeding may help your baby to stay healthy. Breastfeeding is good for you, too, and may help you to lose weight. In the long term, it also helps to:

lower your risk of breast cancer protect against ovarian cancer before the menopause reduce your risk of developing type 2 diabetes How long will I be breastfeeding for?

The Department of Health recommends that your baby has only breastmilk for the first six months of her life. It also recommends that you carry on breastfeeding after your baby has started on solid foods, until the end of her first year and beyond, if you'd like to. Continuing to breastfeed while introducing solid foods to your baby may benefit her immune system. How can I prepare for breastfeeding?

Staying healthy is as much as you can do to prepare your body for breastfeeding. But learning as much as you can about breastfeeding before your baby is born will help you when the time comes.

How do I start breastfeeding?

Feeds can take anything from five minutes to 40 minutes, so find a

comfortable place before you start. In the early days of breastfeeding, when you're still trying to get the hang of it, creating the right atmosphere is important.

If you're easily distracted by noise, find somewhere quiet. If you tend to get

bored, you may want to feed with the radio or television on, but only if breastfeeding is going well. Try different spots until you find what works for you.

Hold your baby in a position that won't make your arms and back ache. Have

cushions or pillows nearby to support you or your baby. Laid-back

breastfeeding involves lying on your back, so that your baby can rest on your body, while your hands are free to support her. Or try the cradle hold, which means cradling your baby across your chest, raised up on a cushion or pillow. It depends on what's most comfortable for you.

Get yourself and your baby in a relaxed position before you start feeding. Pay

attention to how your breasts feel when your baby latches on. She should take in a big mouthful of breast tissue.

If you have large breasts, you may find it more comfortable to lie on your side

while feeding, or you may want to try holding your baby under your arm in a rugby ball position.

If latching on hurts, break the suction by gently inserting your little finger

between your baby's gums and your nipple, and try again. Once your baby latches on properly, she'll be able to do the rest.

Can I breastfeed in public?

You may feel shy about breastfeeding in front of other people. You may feel comfortable about breastfeeding in front of others. However if you feel selfconscious, there are tops that allow you to breastfeed discreetly. Shirts that you have to unbutton will make you feel exposed as you feed, and buttons are fiddly to deal with. Stretchy tops you can pull up work well. If it makes you feel more comfortable, drape a scarf, muslin or blanket over your shoulder and chest while you feed. This will give you and your baby privacy. Make sure your baby can breathe easily, though.

What should I buy for breastfeeding?

Buy at least two or three comfortable breastfeeding or nursing bras so your breasts are properly supported. These have hooks or zips that you can easily undo when your baby needs to feed.

Make sure that your bras fit properly, and that any flaps open completely. If only a small part of your breast is exposed, the bra may press on breast tissue and lead to blocked ducts or mastitis. You may find that your breasts have a tendency to leak, as even another baby's cry or the sight of a baby can stimulate milk flow. Keep a supply of washable or disposable breast pads handy, and consider buying a light-weight nursing bra for night-time, so you can wear breast pads while you sleep. If you're planning to express your breastmilk, you may want to consider buying a breast pump.

29. Benefits of exercise Regular exercise can help protect you from heart disease and stroke, high blood pressure, noninsulin-dependent diabetes, obesity, back pain, osteoporosis, and can improve your mood and help you to better manage stress.

No. 1: Exercise controls weight - Exercise can help prevent excess weight gain or help maintain weight loss. No. 2: Exercise combats health conditions and diseases - regular physical activity can help you prevent or manage a wide range of health problems and concerns, including stroke, metabolic syndrome, type 2 diabetes, depression, certain types of cancer, arthritis and falls. No. 3: Exercise improves mood - Physical activity stimulates various brain chemicals that may leave you feeling happier and more relaxed. You may also feel better about your appearance and yourself when you exercise regularly, which can boost your confidence and improve your self-esteem. No. 4: Exercise boosts energy - Exercise and physical activity deliver oxygen and nutrients to your tissues and help your cardiovascular system work more efficiently. And when your heart and lungs work more efficiently, you have more energy to go about your daily chores. No. 5: Exercise promotes better sleep - Regular physical activity can help you fall asleep faster and deepen your sleep. Just don't exercise too close to bedtime, or you may be too energized to fall asleep. No. 6: Exercise puts the spark back into your sex life - Regular physical activity can leave you feeling energized and looking better, which may have a positive effect on your sex life. No. 7: Exercise can be fun - It gives you a chance to unwind, enjoy the outdoors or simply engage in activities that make you happy. Physical activity can also help you connect with family or friends in a fun social setting. 30. Safety precautions of a child in the car The most important things to consider when shopping for a car seat are:

Choose the car seat that fits your baby properly.

Choose the car seat that fits your car correctly. Not all car seats fit well in

every car or with other child restraints. Check your vehicle's owners manual for the manufacturer's recommendations for installing child car seats.

Choose the car seat that you will use correctly every time you use it. Make sure the seat is properly installed according to the manufacturer's

instructions. A properly installed car seat should not move more than one inch in any direction.

Place the rear-facing car seat in the back seat. Riding in a rear-facing car seat

is the safest position for your baby.

Keep your baby rear-facing in the back seat until she is 2 years old, or until

she reaches the maximum height 54 and weight for the car seat.

Use car seats that are less than 6 years old. Never use a car seat after it has been in an accident. Never put your baby's car seat in the front seat, especially if your car has an

air bag.

Make sure all straps and buckles are securely and properly adjusted. The

harness straps should be snug and should lie flat against your baby's shoulders.

After your baby is buckled, position the chest clip between the nipples and

collarbone as part of securing your baby into the car seat.

Cover the car seat with a towel or blanket in hot or cold weather. If the seat has any metal parts that may touch your baby, cover them in hot

weather so they don't burn your baby.

Never leave your child alone in a car. Do not let your child get out of his car seat while in a moving vehicle. To avoid boredom on a long trip, take along games, activities, books and story

tapes. Have snacks and water handy, and make lots of stops along the way. Praise your child for sitting so well in the car seat.

Don't let your child give in to pressure. If he is with a friend or relative who

does not use seat belts, stress how important seat belts are to your child.

And remember, all adults and all children riding in a car, truck, van, mini-van

or SUV should be buckled at all times. Buckling up is a habit you want to pass on to your children.

Booster seats with the vehicle's shoulder belt are recommended for children

until they reach 4 feet 9 inches tall and are between 8 and 12 years old.

If the shoulder strap runs across the child's neck, a booster seat is needed. Never let any child put the shoulder strap under her arms. Never let any child younger than age 12 sit in front of an air bag. Prevent falls in children.

31.

It's a simple fact: children fall. But there are a few precautions you can take to help prevent falls in your home.

Keep your stairways free of clutter. Make sure your child cannot open any window. If you do raise your windows,

make sure they do not go any farther than 12 inches. Always keep screens in place.

If you have hardwood floors, use nonskid rugs and floor mats. If your baby is

learning to walk, put nonskid socks on his feet.

Put gates or other secure mesh around open railings. Put gates at the top of all stairways including deck stairs. Do not let your baby use a walker. It poses safety hazards. Do not let your child climb on chairs, tables, furniture, bookcases or

cupboards.

32.

What is fat? Give food sources.

Fats are a type of nutrient that you get from your diet. It is essential to eat some fats, though it is also harmful to eat too many.

Types of Fat Saturated fats raise your LDL ("bad") cholesterol level. High LDL cholesterol puts you at risk for heart attack, stroke, and other major health problems. You should avoid or limit foods that are high in saturated fats.

Keep saturated fats to only 10% of your total daily calories. Foods with a lot of saturated fats are animal products, such as butter, cheese,

whole milk, ice cream, cream, and fatty meats.

Some vegetable oils -- coconut, palm, and palm kernel oils -- also contain

saturated fats. These fats are solid at room temperature.

A diet high in saturated fat increases cholesterol build up in your arteries

(blood vessels). Cholesterol is a soft, waxy substance that can cause clogged, or blocked, arteries. Eating unsaturated fats instead of saturated fats can help lower your LDL cholesterol. Most vegetable oils that are liquid at room temperature have unsaturated fats. There are 2 kinds of unsaturated fats:

Mono-unsaturated fats, which include olive and canola oil Polyunsaturated fats, which include safflower, sunflower, corn, and soy oil

Trans fatty acids are unhealthy fats that form when vegetable oil hardens in a process called hydrogenation. Hydrogenated fats, or "trans fats," are often used to keep some foods fresh for a long time.

33.

What is the importance of water in the body?

1. Drinking Water Helps Maintain the Balance of Body Fluids. Your body is composed of about 60% water. The functions of these bodily fluids include digestion, absorption, circulation, creation of saliva, transportation of nutrients, and maintenance of body temperature.

2. Water Can Help Control Calories. For years, dieters have been drinking lots of water as a weight loss strategy. While water doesn't have any magical effect onweight loss, substituting it for higher calorie beverages can certainly help. 3. Water Helps Energize Muscles. Cells that don't maintain their balance of fluids and electrolytes shrivel, which can result in muscle fatigue. "When muscle cells don't have adequate fluids, they don't work as well and performance can suffer," says Guest. Drinking enough fluids is important when exercising. Follow the American College of Sports Medicine guidelines for fluid intake before and during physical activity. These guidelines recommend that people drink about 17 ounces of fluid about two hours before exercise. During exercise, they recommend that people start drinking fluids early, and drink them at regular intervals to replace fluids lost by sweating. 4. Water Helps Keep Skin Looking Good. Your skin contains plenty of water, and functions as a protective barrier to prevent excess fluid loss. But don't expect over-hydration to erase wrinkles or fine lines, says Atlanta dermatologist Kenneth Ellner, MD. "Dehydration makes your skin look more dry and wrinkled, which can be improved with proper hydration," he says. "But once you are adequately hydrated, the kidneys take over and excrete excess fluids." You can also help "lock" moisture into your skin by using moisturizer, which creates a physical barrier to keep moisture in. 5. Water Helps Your Kidneys. Body fluids transport waste products in and out of cells. The main toxin in the body is blood urea nitrogen, a water-soluble waste that is able to pass through the kidneys to be excreted in the urine, explains Guest. "Your kidneys do an amazing job of cleansing and ridding your body of toxins as long as your intake of fluids is adequate," he says.

When you're getting enough fluids, urine flows freely, is light in color and free of odor. When your body is not getting enough fluids, urine concentration, color, and odor increases because the kidneys trap extra fluid for bodily functions. If you chronically drink too little, you may be at higher risk for kidney stones, especially in warm climates, Guest warns. 6. Water Helps Maintain Normal Bowel Function. Adequate hydration keeps things flowing along your gastrointestinal tract and prevents constipation. When you don't get enough fluid, the colon pulls water from stools to maintain hydration -- and the result is constipation.

34.

First aid in choking

If the Person Is Conscious but Not Able to Breathe or Talk: 1. Give Back Blows

Give up to 5 blows between the shoulder blades with the heel of your hand.

2. If Person Is Still Choking, Do Thrusts

If the person is not pregnant or too obese, do abdominal thrusts:

Stand behind the person and wrap your arms around the waist. Place your clenched fist just above the persons navel. Grab your fist with

your other hand.

Quickly pull inward and upward. Continue cycles of 5 back blows and 5 abdominal thrusts until the object is

coughed up or the person starts to breathe or cough.

Take the object out of his mouth only if you can see it. Never do a finger

sweep unless you can see the object in the person's mouth.

If the person is obese or pregnant, do high abdominal thrusts:

Stand behind the person, wrap your arms them, and position your hands at

the base of the breast bone.

Quickly pull inward and upward. Repeat until the object is dislodged.

3. Give CPR, if Necessary - If the obstruction comes out, but the person is not breathing or if the person becomes unconscious. 4. Follow Up - When emergency medical personnel arrive, they will take over and may do CPR or take the person to the hospital, if needed. 35. First aid in choking (children)

Call 911 if the child is:

Unconscious Not able to breathe because something is blocking the airway or has caused it

to close off

Wheezing or gasping Not able to cry, talk, or make noise Turning blue in the face Grabbing at the throat Looking panicked

Young children are prone to choking. If the child is coughing and gagging but can breathe and talk, don't do anything. But if he can't breathe, you must act quickly to stop a life-threatening situation. If the Child Is Unconscious: 1. Start CPR

Move the child to the floor and start CPR. Take the object out of his mouth

only if you can see it.

For a Child Younger Than 1 Year Who Is Conscious but Not Breathing: 1. Get the Child Into Position

Hold the child face down on your forearm, supported by your thigh. Keep the child's torso higher than the head.

2. Give Forceful Blows

Use the heel of your free hand to thump the child in between the shoulder

blades up to five times. 3. Turn the Child Over

Turn the child face up, and keep supporting the head and neck. If the object is

not out yet, go to step 4. 4. Press the Chest

Place the child on a firm surface, which may still be your forearm. Put two or three fingers in the center of the child's breastbone and push

quickly up to five times.

Repeat the back thumping and chest pushes until the object comes out or the

child loses consciousness.

If the child is still not breathing, open the airway by putting your thumb in the

child's mouth and grasping the lower incisors or gums. The jaw should lift up so you can look for the object.

Do not try to pull the object out unless you see it clearly. You could

accidentally push the object deeper in the child's throat. 5. Start CPR, If Needed

If the child loses consciousness, perform CPR and take the object out of his

mouth only if you can see it. Never do a finger sweep unless you can see the object in the child's mouth. For a Child Older Than 1 Year Who Is Conscious: 1. Get the Child Into Position

Stand behind the child and wrap your arms around his waist. Place a fist just above the child's belly button.

2. Try to Dislodge the Object

Hold the fist with your free hand and quickly push in and up. Repeat until the object comes out or the child loses consciousness.

3. Start CPR, If Needed

If the child loses consciousness, move the child to the floor and start CPR.

Take the object out of his mouth only if you can see it. Never do a finger sweep unless you can see the object in the child's mouth.

36.

Disinfection vs Sterilization

Disinfection and sterilization are both decontamination processes. Whiledisinfection is the process of eliminating or reducing harmful microorganisms from inanimate objects and surfaces, sterilization is the process of killing allmicroorganisms. That is the main difference between sterilizing and disinfecting. Sterilization also destroys the spores of various organisms present on surfaces, in liquids, in medication, or in compounds such as biological culture media. Such "extreme" forms of decontamination are needed during critical times like surgery, or in

environments like industrial, laboratory or hospital. It is more practical to use disinfection in everyday life. Methods of Sterilization and Disinfection Disinfection is usually carried out by using disinfectants (chemicals). Some disinfectants may be very effective and have a wide spectrum (have the capability of destroying a wide variety of microorganism) while others may have a narrow spectrum but, they may be easy to use, be non toxic or inexpensive. Sterilization can be done by three methods: physical, chemical and physiochemical. Physical method includes heat, radiation, and filtration. Chemical methods involve using liquid and gaseous chemicals. Physiochemical is a combination of physical and chemical method. Types Disinfection

Air disinfectants - disinfectant is dispersed as either as an aerosol or vapour

at a sufficient concentration in the air to cause the number of viable infectious microorganisms to be significantly reduced. Chemicals used propylene glycol and triethylene glycol.

Alcohols - high-concentration can effectively inactivate viruses such

as HIV, hepatitis B, and hepatitis C. Chemicals present usually ethanol or isopropanol. It is safe and inexpensive to use in household environment, care has to be taken around inflammable items.

Aldehydes are somewhat effective on spores and fungus also. Oxidizing agents Cause the microorganism to collapse. Chlorine and

Chemicals - formaldehyde and glutaraldehyde.

oxygen are strong oxidizers, so their compounds are used for e.g. common

household bleach. In fact it is the most cost-effective home disinfectant (sodium hypochlorite solution) is used to clean toilets, drains, surfaces, swimming pool.

Phenolics It is oldest known disinfectant for e.g. mouthwashes, Dettol. Quaternary ammonium compounds ("quats") These are effective low

Chemicals - Phenol, Chloroxylenol

level disinfectants. Chemicals - benzalkonium chloride.

Biguanide polymer polyaminopropyl biguanide - bactericidal at very low

concentrations (10 mg/l)

High-intensity shortwave ultraviolet light are used to disinfect smooth,

opaque materials.

Common sodium bicarbonate (NaHCO3) has disinfectant properties.

Sterilization

Steam - Used in machines called autoclaves. Autoclaves use steam heated

to 121134 C (250273 F). To achieve sterility, a holding time of at least 15 minutes at 121 C (250 F) or 3 minutes at 134 C (273 F) is required. Autoclave treatment inactivates all fungi, bacteria, viruses and also bacterial spores. Pressure cooking food is also steam sterilization though it is not that thorough.

Heating Under heating flaming, incineration, boiling in water, tindalization,

dry heat. These methods inactivate and kill microorganisms in objects like glass, metals. Boiling in water for 15min inactivates viruses and kills most vegetative bacteria. However it has no effect on the spores. Tindilization means boiling for 20 minutes and then cooling, again re-boiling and cooling for three times. This method is more effective on sporulating bacteria than just boiling. Dry heat method can be used on powders and items that bear very high them of heat.

Chemical sterilization Chemicals like Ethylene oxide, Ozone, Bleach,

Glutaraldehyde and Formaldehyde, Phthalaldehyde, Hydrogen Peroxide, Dry sterilization process, Peracetic acid and Silver are used in varying degrees. Products that can get damaged due to heat are subjected to chemical sterilization for e.g. biological materials, fiber optics, electronics, and plastics. Ethylene oxide gas and Ozone gas oxidize most organic matter. Though bleach and Glutaraldehyde and formaldehyde solutions is used as a disinfectant, its a much more concentrated in sterilization also infected item is left immersed for long duration for effective sterilization. Dry sterilization process with chemicals is useful for sterilizing plastic bottles medical and pharmaceutical applications.

Radiation sterilization - Electron beams, X-rays, gamma rays, or

subatomic particles are used for sterilizing disposable medical equipment, such as syringes, needles, cannulas, IV sets and biological safety cabinets between uses.

Sterile filtration - Clear liquids that would be damaged by heat, irradiation

or chemical sterilization can be sterilized by mechanical filtration. Fileration is done through pores that are smaller in size than the organism in question and this has to be done very slowly. 37. First aid for chemical burns.

1. Protect Yourself

Put on gloves or apron, if possible. Avoid exposing yourself to chemicals.

2. Rinse and Clear Burn Area

Flood area with cool water for at least 20 minutes or until help arrives.

Make sure water doesn't flow onto another part of the person's body or onto

you.

Don't use a strong stream of water, if possible. As you flush the burn (not before), remove jewelry or articles of clothing with

chemical on them, unless they're stuck to the person's body.

After flushing the burn, follow instructions on the label of the chemical product,

if available.

Don't try to neutralize the burn with acid or alkali. This could cause a chemical

reaction that worsens the burn.

Don't put antibiotic ointment on the burn.

3. Cover a Small Burn Area

You can wrap a small burn with dry, sterile gauze or clean cloth.

Chemicals that touch skin can lead to a reaction on the skin, throughout the body, or both. Considerations Chemical exposure is not always obvious. You should suspect chemical exposure if an otherwise healthy person becomes ill for no apparent reason, particularly if an empty chemical container is found nearby. Exposure to chemicals at work over a long period of time can cause changing symptoms as the chemical builds up in the person's body. If the person has a chemical in the eyes, see first aid for eye emergencies. Symptoms Depending on the type of exposure, the symptoms may include:

Abdominal pain Breathing difficulty Bright red or bluish skin and lips Convulsions (seizures) Dizziness Headache Hives, itching, swelling, nausea, vomiting, or weakness resulting from

an allergic reaction

Irritability Pain where the skin has come in contact with the toxic substance Rash, blisters, burns on the skin Unconsciousness

First Aid

Make sure the cause of the burn has been removed. Try not to come in

contact with it yourself. If the chemical is dry, brush off any excess. Avoid brushing it into your eyes. Remove any contaminated clothing or jewelry.

Flush the chemicals off the skin surface using cool running water for 15

minutes or more.

Treat the person for shock if he or she appears faint, pale, or if there is

shallow, rapid breathing.

Apply cool, wet compresses to relieve pain. Wrap the burned area with a dry sterile dressing (if possible) or clean cloth.

Protect the burned area from pressure and friction.

Minor chemical burns will generally heal without further treatment. However, if

there is a second or third degree burn or if there is an overall body reaction, get medical help immediately. In severe cases, don't leave the person alone and watch carefully for reactions affecting the entire body.

Note: If a chemical gets into the eyes, the eyes should be flushed with water immediately. Continue to flush the eyes with running water for at least 15 minutes. Get medical help immediately. DO NOT

DO NOT apply any household remedy such as ointment or salve to a

chemical burn.

DO NOT become contaminated by the chemical as you give first aid. DO NOT disturb a blister or remove dead skin from a chemical burn. DO NOT try to neutralize any chemical without consulting the Poison Control

Center or a doctor. When to Contact a Medical Professional Call for medical help immediately if the person is having difficulty breathing, is having seizures, or isunconscious. Prevention

All chemicals should be stored out of the reach of young children -- preferably

in a locked cabinet.

Avoid mixing different products that contain toxic chemicals such

as ammonia and bleach. The mixture can give off hazardous fumes.

Avoid prolonged (even low-level) exposure to chemicals. Avoid using potentially toxic substances in the kitchen or around food. Buy potentially poisonous substance in safety containers, and buy only as

much as needed.

Many household products are made of toxic chemicals. It is important to read

and follow label instructions, including any precautions.

Never store household products in food or drink containers. Leave them in

their original containers with the labels intact.

Store chemicals safely immediately after use. Use paints, petroleum products, ammonia, bleach, and other products that

give off fumes only in a well-ventilated area. 38. What is chest physiotherapy? Chest physiotherapy is a group of physical techniques that improve lung function and help you breathe better. Chest physiotherapy expands the lungs, strengthens breathing muscles, and loosens and improves drainage of thick lung secretions. Chest physiotherapy helps treat such diseases as cystic fibrosis and COPD (chronic obstructive pulmonary disease). It also keeps the lungs clear to prevent pneumonia after surgery and during periods of immobility. Types of chest physiotherapy

Chest percussion to help loosen lung secretions Controlled coughing techniques to help break up lung secretions so your

caregiver can suction them out or you can expectorate them

Deep breathing exercises to help expand the lungs and draw more air into

all areas of the lungs

Incentive spirometry to help improve lung function by inhaling strongly using

a special device. You may use it after surgery to re-expand your lungs and prevent pneumonia.

Positioning and turning from side to side to help improve lung expansion

and drainage of secretions. This is important for patients who are bedridden or hospitalized.

Postural drainage to help drain lung secretions Vibration to help break up lung secretions

Other procedures that may be performed Doctors generally recommend one or more other treatments to manage respiratory disease and breathing problems. Treatments vary depending on

the specific disease, the severity of the disease, your medical history, your age, and other factors. Treatments and procedures may include:

Expectorant medications to help loosen lung secretions and make them

easier to cough up

Nebulizer treatments to help moisten secretions and open the airways Suctioning to remove secretions that you cant cough out

Why is chest physiotherapy performed? Your doctor may recommend chest physiotherapy to help loosen and cough up thick or excessive lung secretions from such conditions as:

Atelectasis, in which some or all of your lung tissue collapses Bronchiectasis, in which the large airways in your lungs are damaged and

widened

COPD (chronic obstructive pulmonary disease), which includes

emphysema and chronic bronchitis

Cystic fibrosis, which is a genetic disorder that causes thick, sticky mucus

build-up in the lungs and other organs

Immobility, in which you have a low activity level due to being bedridden or in

a wheelchair. Chest physiotherapy can help prevent pneumonia and other breathing problems due to long-term immobility.

Lung infections, which include pneumonia, acute bronchitis, and lung

abscess

Neuromuscular diseases, which include cerebral palsy, muscular dystrophy,

multiple sclerosis, and Guillain-Barr syndrome

Surgery, which includes major surgery and other procedures that make it

difficult to take a deep breath. Some types of chest physiotherapy can help prevent pneumonia and other breathing problems after surgery. Who performs chest physiotherapy? A respiratory therapist or nurse performs chest physiotherapy. Respiratory therapists are healthcare professionals who assess, treat and care for patients

with breathing disorders. Depending on your condition, the respiratory therapist or nurse may also teach you and your family to perform the techniques at home. The following specialists often prescribe chest physiotherapy:

Hospitalists specialize in caring for hospitalized patients. Hospitalists are

usually doctors, but can also be a physician assistant (PA) or nurse practitioner (NP).

Primary care providers including internists, family practitioners (family

medicine doctors), pediatricians, geriatricians, physician assistants (PAs), and nurse practitioners (NPs). Primary care providers offer comprehensive healthcare services and treat a wide range of illnesses and conditions.

Pulmonologists are internists or pediatricians with specialized training in

treating diseases and conditions of the chest, such as pneumonia, asthma, tuberculosis, emphysema, or complicated chest infections.

39. How to prevent pressure ulcer? Pressure ulcers are also called bedsores and pressure sores. They can form when muscles and soft tissue press against a surface such as a chair or bed. This pressure cuts off your blood supply to that area. Lack of blood supply can cause the skin tissue in this area to die. When this happens, a pressure ulcer may form. You have a risk of developing a pressure ulcer if you:

Spend most of your day in a bed or a chair Are overweight or underweight Are not able to control your bowels or bladder Have decrease feeling in an area of your body Spend a lot of time in one position

You will need to take steps to prevent these problems.

Self-care You, or your caregiver, need to check your body every day from head to toe. Pay special attention to the areas where pressure ulcers often form. These are:

Your heels and ankles Your knees Your hips Your spine Your tailbone area Your elbows Your shoulders and shoulder blades The back of your head Your ears

Call your doctor or nurse if you see early signs of pressure ulcers. These are:

Skin redness Warm areas Spongy or hard skin Erosion of the top layers of skin or a sore

Treat your skin gently to help prevent pressure ulcers.

When washing, use a soft sponge or cloth. Do not scrub hard. Use moisturizing cream and skin protectants on your skin every day. Clean and dry areas underneath your breasts and in your groin Do not use talc powder or strong soaps Try not to take a bath or shower every day. It can dry out your skin more.

Eat enough calories and protein to stay healthy. Drink plenty of water every day.

Make sure your clothes are not increasing your risk of developing pressure ulcers.

Avoid clothes that have thick seams, buttons, or zippers that press on your

skin.

Do not wear clothes that are too tight. Keep your clothes from bunching up or wrinkling in areas where there is any

pressure on your body. After urinating or having a bowel movement:

Clean the area right away. Dry well. Ask your doctor about creams to help protect your skin in this area.

If You Use a Wheelchair Make sure your wheelchair is the right size for you.

Have your doctor or physical therapist check the fit once or twice a year. If you gain weight, ask your doctor or physical therapist to check how you fit

your wheelchair.

If you feel pressure anywhere, have your doctor or physical therapist check

your wheelchair. Sit on a foam or gel seat cushion that fits your wheelchair. Do NOT sit on donut-shaped cushions. You or your caregiver should shift your weight in your wheelchair every 15 - 20 minutes. This will increase blood flow and take pressure off certain areas:

Lean forward Move side to side

If you transfer yourself (move to or from your wheelchair), lift your body up with your arms. Do NOT drag yourself. If you're having trouble transferring into your wheelchair, see a physical therapist to learn proper technique.

If your caregiver transfers you, make sure they know the proper way to move you. When You Are in Bed Use a foam mattress or one that is filled with gel or air. Place pads under your bottom to absorb wetness to help keep your skin dry. Use a soft pillow or a piece of soft foam between parts of your body that press against each other or against your mattress. Some common pressure areas are:

When you are lying on your side, between your knees and ankles When you are lying on your back: your heels. Or, place a pillow under your calves to lift up your heels,

o Under

another way to relieve pressure on your heels.

o Under o Under o Under

your tailbone area your shoulders and shoulder blades your elbows

Some other tips are:

Do NOT put pillows under your knees. It puts pressure on your heels. NEVER drag yourself to change your position or get in or out of bed. Dragging

will cause skin breakdown. Get help if you need moving in bed or getting in or out of bed.

If someone else moves you, they should lift you or use a draw sheet (a

special sheet used for this purpose) to move you.

Change your position every 1 - 2 hours to keep the pressure off any one spot. Sheets and clothing should be dry and smooth, with no wrinkles. Remove any objects such as pins, pencils or pens, or coins from your bed. Do not raise the head of your bed to more than a 30-degree angle. Being

flatter keeps your body from sliding down. Sliding may harm your skin.

40. What is hyperglycemia? Hyperglycemia facts

Hyperglycemia is having an abnormally high blood glucose (blood sugar)

level.

Hyperglycemia is a hallmark sign of diabetes (both type 1 diabetes and type 2

diabetes) and prediabetes.

Diabetes is the most common cause of hyperglycemia. Other conditions that can cause hyperglycemia are pancreatitis,Cushing's

syndrome, unusual hormone-secreting tumors,pancreatic cancer, certain medications, and severe illnesses.

The main symptoms of hyperglycemia are increased thirstand a frequent need

to urinate.

Severely elevated glucose levels can result in a medical emergency like

diabetic ketoacidosis (DKA) or hyperglycemic hyperosmolar nonketotic syndrome (HHNS, also referred to as hyperglycemia hyperosmolar state).

Insulin is the treatment of choice for people with type 1 diabetes and for life-

threatening increases in glucose levels.

People with type 2 diabetes may be managed with a combination of different

oral and injectable medications.

Hyperglycemia due to medical conditions other than diabetes is generally

treated by treating the underlying condition responsible for the elevated glucose. What is Hyperglycemia? Hyperglycemia is the medical term describing an abnormally high blood glucose (blood sugar) level. Blood sugar is measured in a sample of blood taken from a vein or from a small finger stick sample of blood. It can be measured in a laboratory either alone or with other blood tests, or it can be measured using a handheld glucometer, a small device that allows frequent monitoring of blood glucose levels without the need for a doctor's office or laboratory.

Hyperglycemia is a hallmark sign of diabetes (both type 1 diabetes and type 2 diabetes) and prediabetes. Normal ranges for blood glucosemeasurements can vary slightly among different laboratories, but in general a fasting (early a.m. before breakfast) glucose level is considered normal if it is between 70100 mg/dL. Glucose levels may rise slightly above this range following a meal. Random blood glucose measurements are usually lower than 125 mg/dL. What causes hyperglycemia? A number of medical conditions can cause hyperglycemia, but the most common by far is diabetes mellitus. Diabetes affects over 8% of the total U.S. population. In diabetes, blood glucose levels rise either because there is an insufficient amount of insulin in the body or the body cannot use insulin well. Normally, the pancreas releases insulin after a meal so that the cells of the body can utilize glucose for fuel. This keeps blood glucose levels in the normal range. Type 1 diabetes is responsible for about 5% of all cases of diabetes and results from damage to the insulin-secreting cells of the pancreas . Type 2 diabetes is far more common and is related to the body's inability to effectively use insulin. In addition to type 1 and type 2, gestational diabetes is a form of diabetes that develops in pregnant women. Studies show that between 2% to 10% of all pregnant women get gestational diabetes. Sometimes, hyperglycemia is not the result of diabetes. Other medical conditions that can cause hyperglycemia include:

Pancreatitis (inflammation of the pancreas) Pancreatic cancer Hyperthyroidism (overactive thyroid gland) Cushing's syndrome (elevated blood cortisol level) Unusual tumors that secrete hormones, including

glucagonoma,pheochromocytoma, or growth hormone-secreting tumors

Severe stresses on the body, such as heart attack, stroke, trauma, or severe

illnesses, can temporarily lead to hyperglycemia

Taking certain medications, including prednisone, estrogens, beta-

blockers, glucagon, oral contraceptives, phenothiazines, and others, can elevate blood glucose levels What are the signs and symptoms of hyperglycemia? In addition to having elevated levels of glucose in the blood, people with hyperglycemia often have glucose detected in their urine (glycosuria). Ordinarily urine contains no glucose as it is all reabsorbed by the kidneys. The main symptoms of hyperglycemia are increased thirst and a frequent need to urinate. Other symptoms that can occur with hyperglycemia are headaches, tiredness,blurred vision, hunger, and trouble with thinking or concentrating. Severely elevated glucose levels can result in a medical emergency ("diabetic coma"). This can occur in both people with type 1 and those with type 2 diabetes. People with type 1 diabetes may develop diabetic ketoacidosis (DKA), and those with type 2 diabetes can develop hyperglycemic hyperosmolar nonketotic syndrome (HHNS, also referred to as hyperglycemia hyperosmolar state). These so-called hyperglycemia crises are serious conditions that can be life-threatening if not treated immediately. Hyperglycemic crises cause about 2,400 deaths each year in the U.S. Over time, hyperglycemia can lead to damage to organs and tissues. Long-term hyperglycemia can impair the immune response, leading to poor healing of cuts and wounds. It can also cause nerve damage, vision problems, and damage to the blood vessels and kidneys (see below). How is hyperglycemia diagnosed? There are different kinds of blood tests that can diagnose hyperglycemia. These include

Random blood glucose: this test reflects the blood sugar level at a given

point in time. Normal values are generally between 70 and 125 mg/dL, as discussed earlier.

Fasting blood glucose: this is a measurement of blood sugar level taken in

the early morning prior to eating or drinking anything since the night before. Normal fasting blood glucose levels are less than 100 mg/dL. Levels above 100 mg/dL up to 125 mg/dL suggest prediabetes, while levels of 126 mg/dL or above are diagnostic of diabetes.

Oral glucose tolerance test: this is a test that measures blood glucose levels

at given time points after a dose of sugar is consumed. This test is most commonly used to diagnose gestational diabetes.

Glycohemoglobin A1c: is a measurement of glucose that is bound to red

blood cells and provides an indication about blood sugar levels over the past 2 to 3 months. How is hyperglycemia treated? Mild or transient hyperglycemia may not need medical treatment, depending upon the cause. People with mildly elevated glucose or prediabetes can often lower their glucose levels by incorporating diet and lifestyle changes. To assure that you chose the right dietary and lifestyle changes , you should speak with your health care professional or use reliable resources such as the American Diabetes Association. Insulin is the treatment of choice for people with type 1 diabetes and for lifethreatening increases in glucose levels. People with type 2 diabetes may be managed with a combination of different oral and injectable medications. Some people with type 2 diabetes also take insulin. Hyperglycemia due to medical conditions other than diabetes is generally treated by addressing the underlying condition responsible for the elevated glucose. In some cases, insulin may be needed to stabilize glucose levels during this treatment.

What are the complications of hyperglycemia? Long-term complications of prolonged hyperglycemia can be severe. These occur in people with diabetes and are worse when the condition is poorly controlled. The long-term complications of diabetes tend to develop slowly over time. Some of the complications of hyperglycemia in poorly-controlled diabetes are:

Heart and blood vessel disease, that can increase the risk of heart attack,

stroke, and peripheral artery disease

Poor kidney function eventually leading to kidney failure Nerve damage, that can lead to burning, tingling, pain, and changes in

sensation

Eye diseases, including damage to the retina, glaucoma, and cataracts Gum disease

41. What are the 4 vital signs? Vital signs include the measurement of: temperature, respiratory rate, pulse, blood pressure and, where appropriate, blood oxygen saturation. These numbers provide critical information (hence the name "vital") about a patient's state of health. In particular, they: 1. 2. Can identify the existence of an acute medical problem. Are a means of rapidly quantifying the magnitude of an illness and how

well the body is coping with the resultant physiologic stress. The more deranged the vitals, the sicker the patient. 3. Are a marker of chronic disease states (e.g. hypertension is defined as

chronically elevated blood pressure). Temperature: Measured in either Celcius or Farenheit, with a fever defined as greater than 38-38.5 C or 101-101.5 F.

Respiratory Rate: Respirations are recorded as breaths per minute. They should be counted for at least 30 seconds as the total number of breaths in a 15 second period is rather small and any miscounting can result in rather large errors when multiplied by 4. Try to do this as surreptitiously as possible so that the patient does not consciously alter their rate of breathing. Normal is between 12 and 20. Pulse: This can be measured at any place where there is a large artery (e.g. carotid, femoral, or simply by listening over the heart), though for the sake of convenience it is generally done by palpating the radial impulse. You may find it helpful to feel both radial arteries simultaneously, doubling the sensory input and helping to insure the accuracy of your measurements.

Technique for Measuring the Radial Pulse

Upper extremity peripheral vascular disease is relatively uncommon, so the radial artery should be readily palpable in most patients. Push lightly at first, adding pressure if there is a lot of subcutaneous fat or you are unable to detect a pulse. If you push too hard, you might occlude the vessel and mistake your own pulse for that of the patient. During palpation, note the following: 1. Quantity: Measure the rate of the pulse (recorded in beats per minute).

Count for 30 seconds and multiply by 2 (or 15 seconds x 4). Normal is between 60 and 100. 2. Regularity: Is the time between beats constant? In the normal setting, the

heart rate should appear metronomic. Irregular rhythms, however, are quite common. If the pattern is entirely chaotic with no discernable pattern, it is referred to as irregularly irregular and likely represents atrial fibrillation. Extra

beats can also be added into the normal pattern, in which case the rhythm is described as regularly irregular. 3. Volume: Does the pulse volume (i.e. the subjective sense of fullness) feel

normal? This reflects changes in stroke volume Blood Pressure: Blood pressure (BP) is measured using mercury based manometers, with readings reported in millimeters of mercury (mm Hg). The size of the BP cuff will affect the accuracy of these readings. The inflatable bladder, which can be felt through the vinyl covering of the cuff, should reach roughly 80% around the circumference of the arm while its width should cover roughly 40%. If it is too small, the readings will be artificially elevated. The opposite occurs if the cuff is too large. 1. Put on your stethescope so that the ear pieces are angled away from your

head. Twist the head piece so that the bell is engaged. This can be verified by gently tapping on the end, which should produce a sound. With your left hand, place the bell over the area of the brachial artery. 2. Grasp the patient's right elbow with your right hand and raise their arm so

that the brachial artery is roughly at the same height as the heart. The arm should remain somewhat bent and completely relaxed. You can provide additional support by gently trapping their hand and forearm between your body and right elbow. If the arm is held too high, the reading will be artifactually lowered, and vice versa. 3. Turn the valve on the pumping bulb clockwise (may be counter clockwise

in some cuffs) until it no longer moves. This is the position which allows air to enter and remain in the bladder. 4. Hold the bell in place with your left hand. Use your right hand to pump the

bulb until you have generated 150 mmHg on the manometer. This is a bit above the top end of normal for systolic blood pressure (SBP). Then listen. If

you immediately hear sound, you have underestimated the SBP. Pump up an additional 20 mmHg and repeat. Now slowly deflate the blood pressure cuff (i.e. a few mm Hg per second) by turning the valve in a counter-clockwise direction while listening over the brachial artery and watching the pressure gauge. The first sound that you hear reflects the flow of blood through the no longer completely occluded brachial artery. The value on the manometer at this moment is the SBP. Note that although the needle may oscillate prior to this time, it is the sound of blood flow that indicates the SBP. 5. Continue listening while you slowly deflate the cuff. The diastolic blood

pressure (DBP) is measured when the sound completely disappears. This is the point when the pressure within the vessel is greater then that supplied by the cuff, allowing the free flow of blood without turbulence and thus no audible sound. These are known as the Sounds of Korotkoff. 6. Repeat the measurement on the patient's other arm, reversing the position

of your hands. The two readings should be within 10-15 mm Hg of each other. Differences greater than this imply that there is differential blood flow to each arm, which most frequently occurs in the setting of subclavian artery atherosclerosis. 7. Occasionally you will be unsure as to the point where systole or diastole

occurred and wish to repeat the measurement. Ideally, you should allow the cuff to completely deflate, permit any venous congestion in the arm to resolve (which otherwise may lead to inaccurate measurements), and then repeat a minute or so later. Furthermore, while no one has ever lost a limb secondary to BP cuff induced ischemia, repeated measurement can be uncomfortable for the patient, another good reason for giving the arm a break. 8. Avoid moving your hands or the head of the stethescope while you are

taking readings as this may produce noise that can obscure the Sounds of Koratkoff.

9.

You can verify the SBP by palpation. To do this, position the patient's right

arm as described above. Place the index and middle fingers of your right hand over the radial artery. Inflate the cuff until you can no longer feel the pulse, or simply to a value 10 points above the SBP as determined by auscultation. Slowly deflate the cuff until you can again detect a radial pulse and note the reading on the manometer. This is the SBP and should be the same as the value determined with the use of your stethescope. Normal is between 100/60 and 140/90. Hypertension is thus defined as either SBP greater then 140 or DBP greater than 90. It is important to recognize that blood pressure is rarely elevated to a level that causes acute symptoms. That is, while hypertension in general is common, emergencies resulting from extremely high values and subsequent acute end organ dysfunction are quite rare. Rather, it is the chronically elevated values which lead to target organ damage, though in a slow and relatively silent fashion. At the other end of the spectrum, the minimal SBP required to maintain perfusion varies with the individual. Therefore, interpretation of low values must take into account the clinical situation. Those with poorly functioning hearts, for example, can adjust to a chronically low SBP (e.g. 80-90) and live without symptoms of hypoperfusion. However others, used to higher baseline values, might become quite ill if their SBPs were suddenly decreased to these same levels. Many things can alter the accuracy of your readings. In order to limit their impact, remember the following: 1. Do not place the blood pressure cuff over a patients clothing or roll a tight

fitting sleeve above their biceps when determining blood pressure as either can cause elevated readings. 2. Make sure the patient has had an opportunity to rest before measuring

their BP. Try the following experiment to assess the impact that this can have.

Take a patient's BP after they've rested. Then repeat after they've walked briskly in place for several minutes. Patients who are not too physically active (i.e. relatively deconditioned) will develop an elevation in both their SBP and DBP. Also, see what effect raising or lowering the arm, and thus the position of the brachial artery relative to the heart, has on BP. If you have a chance, obtain measurements on the same patient with both a large and small cuff. These exercises should give you an appreciation for the magnitude of error that can be introduced when improper technique is utilized. 3. If the reading is surprisingly high or low, repeat the measurement towards

the end of your exam. 4. Instruct your patients to avoid coffee, smoking or any other unprescribed

drug with sympathomimetic activity on the day of the measurement. 5. Orthostatic (a.k.a. postural) measurements of pulse and blood pressure

are part of the assessment for hypovolemia. This requires first measuring these values when the patient is supine and then repeating them after they have stood for 2 minutes, which allows for equilibration. Normally, SBP does not vary by more then 20 points when a patient moves from lying to standing. In the setting of significant volume depletion, a greater then 20 point drop may be seen. Changes of lesser magnitude occur when moving from lying to sitting or sitting to standing. This is frequently associated with symptoms of cerebral hypoperfusion (e.g.. light headedness). Heart rate should increase by not more than 20 points in a normal physiologic attempt to augment cardiac output by providing chronotropic compensation. In the setting of GI bleeding, for example, a drop in blood pressure and/or rise in heart rate after this maneuver is a marker of significant blood loss and has important prognostic implications. Orthostatic measurements may also be used to determine if postural dizziness, a common complaint with multiple possible explanations, is the result of a fall in blood pressure. For example, patients who suffer from diabetes frequently have autonomic nervous system dysfunction and cannot generate appropriate

arteriolar vaosconstriction when changing positions. This results in postural vital sign changes and symptoms. The 20 point value is a rough guideline. In general, the greater the change, the more likely it is to cause symptoms and be of clinical relevance. 6. If possible, measure the blood pressure of a patient who has an indwelling

arterial catheter (these patients can be found in the ICU with the help of a preceptor). Arterial transducers are an extremely accurate tool for assessing blood pressure and therefore provide a method for checking your non-invasive technique. A few clinically relevant thoughts about high blood pressure: Hypertension is very common disease (> 25% in US affected) & defined on basis of severity:

Pre-hypertension : Systolic BP 120-140 or diastolic BP 80-90. Stage I hypertension: Systolic BP > 140-160 or diastolic BP >90-100. Stage II: Systolic BP > 160 or diastolic BP > 100.

Ideally, several measures on different occasions should verify the finding. One time measures > 160/100 also confirms the diagnosis. It's worth mentioning that normal is 110s/70s, and cardiovascular risk rises w/any values above these points. Hypertension (HTN) causes & accelerates the progression of: Renal dysfunction, coronary artery disease, systolic & diastolic heart, left ventricular hypertrophy, peripheral arterial disease, stroke, and retinopathy. The risk of HTN induced damage correlates both w/height of BP and chronicity of elevation (ie longer and higher =s worse). The treatment of HTN prior to the development of Target Organ Damage (aka TOD) is referred to as "primary prevention;" while treatment to prevent &/or slow progression once disease

has already been established is called "secondary prevention." Evaluation of patients w/HTN requires careful history, exam, labs, & other studies to search for co-morbid problems (diabetes, sleep apnea, etc) &/or occult TOD. Most patients w/HTN are asymptomatic, at least until they develop target organ damage, which can take years to occur. The majority of patients w/HTN (> 60%) will require at least 2 meds for treatment. For a BP between 140-160/80-100, best initial drug treatment is typically with hydrochlorthiazide, a very mild diuretic w/potent anti-hypertensive properties. For those w/starting values > 160/100, it's best to start w/2 meds simultaneously. A few more thoughts: 1. Where you start isn't where you end - so expect to reassess BP in a short

time (several weeks) and make adjustments as necessary 2. Most drugs w/in the same class (e.g. any of the 8 or so ACE-Inhibitors)

work equally well. 3. Effective treatment requires continual reassessment of medication

adherence - a major reason for lack of response to Rx. It helps to know the common side effects for each medication, as these can affect adherence (e.g. ACE-I cough; HCTZ mild increase in urination, erectile dysfunction; all anti-htn meds hypotension) 4. HTN is directly related to weight, inactivity, ETOH consumption, & salt

intake. As such, life style interventions are absolutely worth addressing, though they are relatively ineffective as sole treatments (due to the inability of patients & clinicians to achieve sustained and meaningful changes). That said, you'll never know the impact until you try to address - and readdress - and readdress @ each visit. 5. HTN "swims" in the same vascular risk factor "soup" as diabetes,

hyperlipidemia, and smoking. These other areas must also be addressed.

6.

Treatment goals vary a bit from patient to patient - those with established

vascular disease are treated w/goal of reaching BP 120s/70s. Those in primary prevention group w/o diabetes, target BP < 140/90. 7. Most patients have primary hypertension (ie the elevation in BP is the

primary disorder). Secondary HTN (elevation in BP secondary to another, treatable condition) is rather uncommon - though worth thinking about in the right situation. Secondary causes include: pheochromocytoma, excess cortisol production, hyper adlosteronism, hypo/hyper-thyroidism, renal artery stenosis, & chronic kidney disease. 8. Certain conditions favor particular meds - for example: Diabetes ACE-I or Angiotensin Receptor Blockers (ARBs); Coronary artery disease B blockers. 9. The use of 3 or more meds for refractory HTN isn't uncommon - in

particular w/very obese patients. 10. Acute interventions to immediately lower BP are largely reserved for those times when there is clear evidence of acute symptoms from acute TOD (e.g. CHF, coronary ischemia, increased intra-cranial pressure) secondary to very high values. 42. Aside from calling 911, what will you do in case of fire? Know Your Way Out An escape plan can help every member of a family get out of a burning house. The idea is to get outside quickly and safely. Smoke from a fire can make it hard to see where things are, so it's important to learn and remember the different ways out of your home. Safety Steps

If you're in a room with the door closed when the fire breaks out, you need to take a few extra steps:

Check to see if there's heat or smoke coming in the cracks around the door. If you see smoke coming under the door don't open the door! If you don't see smoke touch the door. If the door is hot or very warm don't open the door! If you don't see smoke and the door is not hot then use your fingers to

(You're checking to see if there's fire on the other side.)

lightly touch the doorknob. If the doorknob is hot or very warm don't open the door! If the doorknob feels cool, and you can't see any smoke around the door, you can open the door very carefully and slowly. When you open the door, if you feel a burst of heat, or smoke pours into the room, quickly shut the door and make sure it is really closed. If there's no smoke or heat when you open the door, go toward your escape route exit. Stay Low If you can see smoke in the house, stay low to the ground as you make your way to the exit. In a fire, smoke and poisonous air hurt more people than the actual flames do. You'll breathe less smoke if you stay close to the ground. Smoke naturally rises, so if there is smoke while you're using your escape route, staying low means you can crawl under most of it. You can drop to the floor and crawl on your hands and kneesbelow the smoke. Exiting through a door that leads outside should be your first choice as an escape route, but also ask your parents about windows and if they would be possible escape routes. Even windows on a higher floor could be safe escape routes if you had help, like from a firefighter or another adult.

Once you're out, do not go back in for anything even pets. You can tell the fire rescue people about any pets that were left behind and they may be able to help. What if You Can't Get Out Right Away? If you can't get out fast, because fire or smoke is blocking an escape route, you'll want to yell for help. You can do this from an open window or call 911 if you have a phone with you. Even if you're scared, never hide under the bed or in a closet. Then, firefighters will have a hard time finding you. Know that firefighters or other adults will be looking for you to help you out safely. The sooner they find you, the sooner you both can get out. In the meanwhile, keep heat and smoke from getting through the door by blocking the cracks around the door with sheets, blankets, and/or clothing. If there is a window in the room that is not possible to escape from, open it wide and stand in front of it. If you can grab a piece of clothing or a towel, place it over your mouth to keep from breathing in the smoke. This works even better if you wet the cloth first. A good rule of thumb during a home fire drill is to see if your family can safely get out the house using the escape routes and meet outside at the same place within 3 minutes. For an extra challenge, you might try variations, like pretending that the front door was blocked and you couldn't get out that way. If Your Clothes Catch Fire A person's clothes could catch fire during a fire or by accident, like if you step too close to a candle. If this happens, don't run! Instead, stop, drop to the ground, cover your face with your hands, and roll. This will cut off the air and put out the flames. An easy way to remember this is: Stop, Drop, and Roll!

43. Safety precautions when using oxygen.

Oxygen canisters should be kept at least 5-10 feet away from gas stoves,

lighted fireplaces, woodstoves, candles or other sources of open flames.

Do not use electric razors while using oxygen. (These are a possible source

of sparks.)

Do not use oil, grease or petroleum-based products on the equipment. Do not

use it near you while you use oxygen. These materials are highly flammable and will burn readily with the presence of oxygen. Avoid petroleum-based lotions or creams, like Vaseline, on your face or upper chest. Check the ingredients of such products before purchase. If a skin moisturizer is needed, consider using cocoa butter, aloe vera or other similar products. For lubrication or rehydration of dry nasal passages, use water-based products. Your pharmacist or care provider can suggest these.

Post signs in every room where oxygen is in use. Make sure that absolutely

NO SMOKING occurs in the home or in the car when oxygen is in use.

Secure an oxygen cylinder to a solidly fixed object to avoid creating a missile

out of the tank. This might happen if it was accidentally knocked over and gas was allowed to escape.

Use caution with oxygen tubing so you do not trip over it or become entangled

in furniture.

Be familiar with the equipment and the safety checks established by the

medical equipment provider. Keep their contact telephone numbers, and the numbers for other emergency services, posted near a phone. Do not try to repair broken equipment on your own. Request this service from the oxygen provider.

Make sure smoke detectors in the home are working. Have fresh batteries

installed. Perform monthly checks. Have a fire extinguisher available in the

home as well. (Use type ABC.) Create and practice an escape and rescue plan in the event of a fire.

Notify the local fire department, gas and electric companies and telephone

company when home oxygen therapy is started. Request a "priority service listing." This is for those times when there is a power or telephone failure or repairs are needed on any utility. 44. Management for colds. What Are Treatments for the Common Cold? Since there is no cure for the common cold, treatment has two goals: to make you feel better and to help you fight off the virus. Lots of rest is the key treating a cold. You may find you need 12 hours of sleep each night. You'll be most comfortable in a warm, humid environment. It's also important to stay hydrated by drinking lots of water and avoiding alcohol and caffeine. This makes mucus flow more freely and helps with congestion. Understanding the Common Cold No specific treatment exists for the virus that is causing your cold, but in treating the symptoms you can find relief. For aches and pains accompanied by a fever of 100.5 degrees or higher, give Tylenol rather than aspirin to avoid the risk of Reye syndrome, a sometimes fatal condition that occurs in children with viral illnesses, especially if they have taken aspirin. If your throat is sore, gargle as often as you like with salt water (1/2 teaspoon salt in 1 cup water). Think twice before using heavily advertised over-the-counter cold and flumedications, which likely contain drugs for symptoms you don't have and therefore may result in needless overtreatment. The FDA and manufacturers now say that over-the-counter cough and cold drugs should not be given to children under age 4.

Over-the-counter decongestants containing pseudoephedrine can help dry and clear nasal passages, but only temporarily. Decongestant nasal sprays can help, too, but if they're used for more than three to five days, they may cause a "rebound" effect. This means more mucus and worse congestion. Pseudoephedrine may increase blood pressure and heart rate. Do not take it without first checking with a doctor if you have heart disease, high blood pressure, prostate problems, diabetes, orthyroid problems. Over-the-counter decongestants containing phenylpropanolamine have been pulled voluntarily from the shelves because they increase the risk of stroke. If you have a drug containing this ingredient, also called PPA, throw it away. Over-the-counter cough suppressants, such as those containing dextromethorphan, can be helpful if your cough is so severe that it interferes with sleeping or talking. Otherwise, allow yourself to cough as you need to (always covering your mouth as you do), because coughing removes mucus and germs from your throat and lungs. Antihistamines seem to help some people, but their effect during colds remains controversial. Good nutrition is essential for resisting and recovering from a cold. Eat a balanced diet. Take supplements as needed to ensure you are receiving the recommended dietary allowances for vitamin A, the vitamin B complex (vitamins B1, B2, B5, B6,folic acid), and vitamin C, as well as the minerals zinc and copper. Both vitamin C and zinc are essential for production of infectionfighting neutrophils; without adequate levels, you're an easy mark for all types of infections. Evidence shows zinc may shorten the duration of a cold, especially in adults if taken within 24 hours of the onset of symptoms. Avoid zinc nasal spray as it may lead to permanent loss of smell. After much research, vitamin C is believed to have a small effect in preventing colds, and no benefit in treating a cold. There have been several large studies

in adults and in children, but the results have been inconclusive. Taking a lot of vitamin C over a long period of time can be harmful. Chicken soup has been heralded as a cold therapy since the 12th century. Recent scientific evidence shows mild support for the notion that chicken soup reducescold symptoms, especially congestion. Asian healing treatments often use hot soups to treat upper respiratory infections, making use of red pepper, lemongrass, and ginger, in particular. Any food spicy enough to make your eyes water will have the same effect on your nose, promoting drainage. If you feel like eating, a hot, spicy soup may help ease your cold symptoms. To ease cold symptoms, the essential oils of aromatherapy may be rubbed on the body, inhaled with steam, diffused into the air, or poured on a cloth to be used as a compress. Try rubbing diluted eucalyptus oil on the chest as a decongestant, or inhale eucalyptus or peppermint oil to clear stuffiness. Adding lavender, cedar, or lemon to steam may also soothe nasal passages. Inhaling menthol not only provides relief from nasal congestion, but might help inhibit infection as well. Rosemary, thyme, mint, basil, and tea tree oils can also provide relief from symptoms of a cold. Use caution if you have asthma, since aromatherapy can trigger an attack. 45. What is asthma and its management? Asthma is a chronic (long-term) lung disease that inflames and narrows the airways. Asthma causes recurring periods of wheezing (a whistling sound when you breathe), chest tightness, shortness of breath, and coughing. The coughing often occurs at night or early in the morning.

What Causes Asthma? The exact cause of asthma isn't known. Researchers think some genetic and environmental factors interact to cause asthma, most often early in life. These factors include:

An inherited tendency to develop allergies, called atopy Parents who have asthma Certain respiratory infections during childhood Contact with some airborne allergens or exposure to some viral infections in

infancy or in early childhood when the immune system is developing

Who Is at Risk for Asthma? Young children who often wheeze and have respiratory infectionsas well as certain other risk factorsare at highest risk of developing asthma that continues beyond 6 years of age. The other risk factors include having allergies, eczema (an allergic skin condition), or parents who have asthma. Among children, more boys have asthma than girls. But among adults, the disease affects men and women equally. It's not clear whether or how sex and sex hormones play a role in causing asthma. Most, but not all, people who have asthma have allergies. Some people develop asthma because of contact with certain chemical irritants or industrial dusts in the workplace. This type of asthma is called occupational asthma.

What Are the Signs and Symptoms of Asthma? Common signs and symptoms of asthma include:

Coughing. Coughing from asthma often is worse at night or early in the

morning, making it hard to sleep.

Wheezing. Wheezing is a whistling or squeaky sound that occurs when you

breathe.

Chest tightness. This may feel like something is squeezing or sitting on your

chest.

Shortness of breath. Some people who have asthma say they can't catch their

breath or they feel out of breath. You may feel like you can't get air out of your lungs. Not all people who have asthma have these symptoms. Likewise, having these symptoms doesn't always mean that you have asthma. The best way doctors have to diagnose asthma is to use a lung function test, ask about medical history (including type and frequency of symptoms), and do a physical exam. The type of asthma symptoms you have, how often they occur, and how severe they are may vary over time. Sometimes your symptoms may just annoy you. Other times, they may be troublesome enough to limit your daily routine. Severe symptoms can be fatal. Thus, treating symptoms when you first notice them is important, so they dont become severe. With proper treatment, most people who have asthma can expect to have few, if any, symptoms either during the day or at night. What Causes Asthma Symptoms To Occur? Many things can trigger or worsen asthma symptoms. Triggers can include:

Allergens from dust, animal fur, cockroaches, mold, and pollens from trees,

grasses, and flowers

Irritants such as cigarette smoke, air pollution, chemicals or dust in the

workplace, compounds in home dcor products, and sprays (such as hairspray)

Medicines such as aspirin or other nonsteroidal anti-inflammatory drugs and

nonselective beta-blockers

Sulfites in foods and drinks Viral upper respiratory infections, such as colds Physical activity, including exercise

Asthma is different for each person. Some of the triggers listed above may not affect you. Other triggers that do affect you might not be on the list. Talk with your doctor about the things that seem to make your asthma worse.

How Is Asthma Diagnosed? Your primary care doctor will diagnose asthma based on your medical and family histories, a physical exam, and test results. Your doctor also will figure out the severity of your asthmathat is, whether it's intermittent, mild, moderate, or severe. The treatment your doctor prescribes will depend on the level of severity. Your doctor may recommend that you see an asthma specialist if:

You need special tests to help diagnose asthma You've had a life-threatening asthma attack You need more than one kind of medicine or higher doses of medicine to

control your asthma, or if you have overall problems getting your asthma well controlled

You're thinking about getting allergy treatments

Medical and Family Histories Your doctor may ask about your family history of asthma and allergies. He or she also may ask whether you have asthma symptoms and when and how often they occur. Let your doctor know whether your symptoms seem to happen only during certain times of the year or in certain places, or if they get worse at night. Your doctor also may want to know what factors seem to trigger your symptoms or worsen them. Your doctor may ask you about related health conditions that can interfere with asthma management. These conditions include a runny nose, sinus infections, reflux disease, psychological stress, and sleep apnea. Physical Exam Your doctor will listen to your breathing and look for signs of asthma or allergies. These signs include wheezing, a runny nose or swollen nasal passages, and allergic skin conditions. Keep in mind that you can still have asthma even if you don't have these signs when your doctor examines you. Diagnostic Tests Lung Function Test Your doctor will use a test called spirometry to check how your lungs are working. This test measures how much air you can breathe in and out. It also measures how fast you can blow air out. Your doctor may give you medicine and then retest you to see whether the results have improved. If your test results are lower than normal and improve with the medicine, and if your medical history shows a pattern of asthma symptoms, your doctor will likely diagnose you with asthma.

Other Tests Your doctor may recommend other tests if he or she needs more information to make a diagnosis. Other tests may include:

Allergy testing to find out which allergens affect you, if any. A test to measure how sensitive your airways are. This is called a

bronchoprovocation test. Using spirometry, this test repeatedly measures your lung function during physical activity or after you receive increasing doses of cold air or a special chemical to breathe in.

A test to show whether you have another condition with symptoms similar to

asthma, such as reflux disease, vocal cord dysfunction, or sleep apnea.

A chest x ray or an EKG (electrocardiogram). These tests will help find out

whether a foreign object in your airways or another disease might be causing your symptoms. Diagnosing Asthma in Young Children Most children who have asthma develop their first symptoms before 5 years of age. However, asthma in young children (infants to children 5 years old) can be hard to diagnose. Sometimes it's hard to tell whether a child has asthma or another childhood condition. The symptoms of asthma are similar to the symptoms of other conditions. Also, many young children who wheeze when they get colds or respiratory infections don't go on to have asthma. A child may wheeze because he or she has small airways that become narrow during colds or respiratory infections. The airways grow as the child grows, so wheezing no longer occurs as the child gets older.

A young child who has frequent wheezing with colds or respiratory infections is more likely to have asthma if:

One or both parents have asthma The child has signs of allergies, including the allergic skin condition eczema The child has allergic reactions to pollens or other airborne allergens The child wheezes even when he or she doesn't have a cold or other infection

The most certain way to diagnose asthma is with a lung function test, a medical history, and a physical exam. However, it's hard to do lung function tests in children younger than 5 years. Thus, doctors must rely on children's medical histories, signs and symptoms, and physical exams to make a diagnosis. Doctors also may use a 46 week trial of asthma medicines to see how well a child responds.

How Is Asthma Treated and Controlled? Asthma is a long-term disease that has no cure. The goal of asthma treatment is to control the disease. Good asthma control will:

Prevent chronic and troublesome symptoms, such as coughing and shortness

of breath

Reduce your need for quick-relief medicines Help you maintain good lung function Let you maintain your normal activity level and sleep through the night Prevent asthma attacks that could result in an emergency room visit or

hospital stay To control asthma, partner with your doctor to manage your asthma or your child's asthma. Children aged 10 or olderand younger children who are ableshould take an active role in their asthma care.

Taking an active role to control your asthma involves:

Working with your doctor to treat other conditions that can interfere with

asthma management.

Avoiding things that worsen your asthma (asthma triggers). However, one

trigger you should not avoid is physical activity. Physical activity is an important part of a healthy lifestyle. Talk with your doctor about medicines that can help you stay active.

Working with your doctor and other health care providers to create and follow

an asthma action plan. An asthma action plan gives guidance on taking your medicines properly, avoiding asthma triggers (except physical activity), tracking your level of asthma control, responding to worsening symptoms, and seeking emergency care when needed. Asthma is treated with two types of medicines: long-term control and quickrelief medicines. Long-term control medicines help reduce airway inflammation and prevent asthma symptoms. Quick-relief, or "rescue," medicines relieve asthma symptoms that may flare up. Your initial treatment will depend on the severity of your asthma. Followup asthma treatment will depend on how well your asthma action plan is controlling your symptoms and preventing asthma attacks. Your level of asthma control can vary over time and with changes in your home, school, or work environments. These changes can alter how often you're exposed to the factors that can worsen your asthma. Your doctor may need to increase your medicine if your asthma doesn't stay under control. On the other hand, if your asthma is well controlled for several

months, your doctor may decrease your medicine. These adjustments to your medicine will help you maintain the best control possible with the least amount of medicine necessary. Asthma treatment for certain groups of peoplesuch as children, pregnant women, or those for whom exercise brings on asthma symptomswill be adjusted to meet their special needs. Follow an Asthma Action Plan You can work with your doctor to create a personal asthma action plan. The plan will describe your daily treatments, such as which medicines to take and when to take them. The plan also will explain when to call your doctor or go to the emergency room. If your child has asthma, all of the people who care for him or her should know about the child's asthma action plan. This includes babysitters and workers at daycare centers, schools, and camps. These caretakers can help your child follow his or her action plan. Avoid Things That Can Worsen Your Asthma Many common things (called asthma triggers) can set off or worsen your asthma symptoms. Once you know what these things are, you can take steps to control many of them. For example, exposure to pollens or air pollution might make your asthma worse. If so, try to limit time outdoors when the levels of these substances in the outdoor air are high. If animal fur triggers your asthma symptoms, keep pets with fur out of your home or bedroom. One possible asthma trigger you shouldnt avoid is physical activity. Physical activity is an important part of a healthy lifestyle. Talk with your doctor about medicines that can help you stay active.

If your asthma symptoms are clearly related to allergens, and you can't avoid exposure to those allergens, your doctor may advise you to get allergy shots. Medicines Your doctor will consider many things when deciding which asthma medicines are best for you. He or she will check to see how well a medicine works for you. Then, he or she will adjust the dose or medicine as needed. Asthma medicines can be taken in pill form, but most are taken using a device called an inhaler. An inhaler allows the medicine to go directly to your lungs. Not all inhalers are used the same way. Ask your doctor or another health care provider to show you the right way to use your inhaler. Review the way you use your inhaler at every medical visit. Long-Term Control Medicines Most people who have asthma need to take long-term control medicines daily to help prevent symptoms. The most effective long-term medicines reduce airway inflammation, which helps prevent symptoms from starting. These medicines don't give you quick relief from symptoms. Inhaled corticosteroids. Inhaled corticosteroids are the preferred medicine for long-term control of asthma. They're the most effective option for long-term relief of the inflammation and swelling that makes your airways sensitive to certain inhaled substances. Reducing inflammation helps prevent the chain reaction that causes asthma symptoms. Most people who take these medicines daily find they greatly reduce the severity of symptoms and how often they occur.

Inhaled corticosteroids generally are safe when taken as prescribed. These medicines are different from the illegal anabolic steroids taken by some athletes. Inhaled corticosteroids aren't habit-forming, even if you take them every day for many years. Like many other medicines, though, inhaled corticosteroids can have side effects. Most doctors agree that the benefits of taking inhaled corticosteroids and preventing asthma attacks far outweigh the risk of side effects. One common side effect from inhaled corticosteroids is a mouth infection called thrush. You might be able to use a spacer or holding chamber on your inhaler to avoid thrush. These devices attach to your inhaler. They help prevent the medicine from landing in your mouth or on the back of your throat. Check with your doctor to see whether a spacer or holding chamber should be used with the inhaler you have. Also, work with your health care team if you have any questions about how to use a spacer or holding chamber. Rinsing your mouth out with water after taking inhaled corticosteroids also can lower your risk for thrush. If you have severe asthma, you may have to take corticosteroid pills or liquid for short periods to get your asthma under control. If taken for long periods, these medicines raise your risk for cataracts and osteoporosis (OS-te-o-po-RO-sis). A cataract is the clouding of the lens in your eye. Osteoporosis is a disorder that makes your bones weak and more likely to break. Your doctor may have you add another long-term asthma control medicine so he or she can lower your dose of corticosteroids. Or, your doctor may suggest you take calcium and vitamin D pills to protect your bones.

Other long-term control medicines. Other long-term control medicines include:

Cromolyn . This medicine is taken using a device called a nebulizer. As you

breathe in, the nebulizer sends a fine mist of medicine to your lungs. Cromolyn helps prevent airway inflammation.

Omalizumab

(anti-IgE). This medicine is given as a shot (injection) one or

two times a month. It helps prevent your body from reacting to asthma triggers, such as pollen and dust. Anti-IgE might be used if other asthma medicines have not worked well.

Inhaled long-acting beta2-agonists . These medicines open the airways.

They might be added to low-dose inhaled corticosteroids to improve asthma control. Inhaled long-acting beta2-agonists should never be used for long-term asthma control unless they're used with inhaled corticosteroids.

Leukotriene modifiers . These medicines are taken by mouth. They help

block the chain reaction that increases inflammation in your airways.

Theophylline . This medicine is taken by mouth. Theophylline helps open the

airways. If your doctor prescribes a long-term control medicine, take it every day to control your asthma. Your asthma symptoms will likely return or get worse if you stop taking your medicine. Long-term control medicines can have side effects. Talk with your doctor about these side effects and ways to reduce or avoid them. With some medicines, like theophylline, your doctor will check the level of medicine in your blood. This helps ensure that youre getting enough medicine to relieve your asthma symptoms, but not so much that it causes dangerous side effects.

Quick-Relief Medicines All people who have asthma need quick-relief medicines to help relieve asthma symptoms that may flare up. Inhaled short-acting beta2-agonists choice for quick relief. These medicines act quickly to relax tight muscles around your airways when you're having a flareup. This allows the airways to open up so air can flow through them. You should take your quick-relief medicine when you first notice asthma symptoms. If you use this medicine more than 2 days a week, talk with your doctor about your asthma control. You may need to make changes to your asthma action plan. Carry your quick-relief inhaler with you at all times in case you need it. If your child has asthma, make sure that anyone caring for him or her has the child's quick-relief medicines, including staff at the child's school. They should understand when and how to use these medicines and when to seek medical care for your child. You shouldn't use quick-relief medicines in place of prescribed long-term control medicines. Quick-relief medicines don't reduce inflammation. Track Your Asthma To track your asthma, keep records of your symptoms, check your peak flow number using a peak flow meter, and get regular asthma checkups. Record Your Symptoms You can record your asthma symptoms in a diary to see how well your treatments are controlling your asthma. are the first

Asthma is well controlled if:

You have symptoms no more than 2 days a week, and these symptoms don't

wake you from sleep more than 1 or 2 nights a month.

You can do all your normal activities. You take quick-relief medicines no more than 2 days a week. You have no more than one asthma attack a year that requires you to take

corticosteroids by mouth.

Your peak flow doesn't drop below 80 percent of your personal best number.

If your asthma isn't well controlled, contact your doctor. He or she may need to change your asthma action plan. Use a Peak Flow Meter This small, hand-held device shows how well air moves out of your lungs. You blow into the device and it gives you a score, or peak flow number. Your score shows how well your lungs are working at the time of the test. Your doctor will tell you how and when to use your peak flow meter. He or she also will teach you how to take your medicines based on your score. Your doctor and other health care providers may ask you to use your peak flow meter each morning and keep a record of your results. You may find it very useful to record peak flow scores for a couple of weeks before each medical visit and take the results with you. When you're first diagnosed with asthma, it's important to find your "personal best" peak flow number. To do this, you record your score each day for a 2- to 3-week period when your asthma is well-controlled. The highest number you

get during that time is your personal best. You can compare this number to future numbers to make sure your asthma is controlled. Your peak flow meter can help warn you of an asthma attack, even before you notice symptoms. If your score shows that your breathing is getting worse, you should take your quick-relief medicines the way your asthma action plan directs. Then you can use the peak flow meter to check how well the medicine worked. Get Asthma Checkups When you first begin treatment, you'll see your doctor about every 2 to 6 weeks. Once your asthma is controlled, your doctor may want to see you from once a month to twice a year. During these checkups, your doctor may ask whether you've had an asthma attack since the last visit or any changes in symptoms or peak flow measurements. He or she also may ask about your daily activities. This information will help your doctor assess your level of asthma control. Your doctor also may ask whether you have any problems or concerns with taking your medicines or following your asthma action plan. Based on your answers to these questions, your doctor may change the dose of your medicine or give you a new medicine. If your control is very good, you might be able to take less medicine. The goal is to use the least amount of medicine needed to control your asthma. Emergency Care Most people who have asthma, including many children, can safely manage their symptoms by following their asthma action plans. However, you might need medical attention at times.

Call your doctor for advice if:

Your medicines don't relieve an asthma attack. Your peak flow is less than half of your personal best peak flow number.

Call 911 for emergency care if:

You have trouble walking and talking because you're out of breath. You have blue lips or fingernails.

At the hospital, you'll be closely watched and given oxygen and more medicines, as well as medicines at higher doses than you take at home. Such treatment can save your life. Asthma Treatment for Special Groups The treatments described above generally apply to all people who have asthma. However, some aspects of treatment differ for people in certain age groups and those who have special needs. Children It's hard to diagnose asthma in children younger than 5 years. Thus, it's hard to know whether young children who wheeze or have other asthma symptoms will benefit from long-term control medicines. Doctors will treat infants and young children who have asthma symptoms with long-term control medicines if, after assessing a child, they feel that the symptoms are persistent and likely to continue after 6 years of age. Inhaled corticosteroids are the preferred treatment for young children. Montelukast and cromolyn are other options. Treatment might be given for a trial period of 1 month to 6 weeks. Treatment usually is stopped if benefits

aren't seen during that time and the doctor and parents are confident the medicine was used properly. Inhaled corticosteroids can possibly slow the growth of children of all ages. Slowed growth usually is apparent in the first several months of treatment, is generally small, and doesn't get worse over time. Poorly controlled asthma also may reduce a child's growth rate. Many experts think the benefits of inhaled corticosteroids for children who need them to control their asthma far outweigh the risk of slowed growth. Older Adults Doctors may need to adjust asthma treatment for older adults who take certain other medicines, such as beta blockers, aspirin and other pain relievers, and anti-inflammatory medicines. These medicines can prevent asthma medicines from working well and may worsen asthma symptoms. Be sure to tell your doctor about all of the medicines you take, including over-the-counter medicines. Older adults may develop weak bones from using inhaled corticosteroids, especially at high doses. Talk with your doctor about taking calcium and vitamin D pills, as well as other ways to help keep your bones strong. Pregnant Women Pregnant women who have asthma need to control the disease to ensure a good supply of oxygen to their babies. Poor asthma control increases the risk that a baby will be born early and have a low birth weight. Poor asthma control can even risk the baby's life. Talk with your doctor if you have asthma and are pregnant or planning a pregnancy. Your level of asthma control may get better or it may get worse

while you're pregnant. Your health care team will check your asthma control often and adjust your treatment as needed. People Whose Asthma Symptoms Occur With Physical Activity Physical activity is an important part of a healthy lifestyle. Adults need physical activity to maintain good health. Children need it for growth and development. In some people, however, physical activity can trigger asthma symptoms. If this happens to you or your child, talk with your doctor about the best ways to control asthma so you can stay active. The following medicines may help prevent asthma symptoms caused by physical activity:

Short-acting beta2-agonists (quick-relief medicine) taken shortly before

physical activity can last 2 to 3 hours and prevent exercise-related symptoms in most people who take them.

Long-acting beta2-agonists can be protective for up to 12 hours. However,

with daily use, they'll no longer give up to 12 hours of protection. Also, frequent use of these medicines for physical activity might be a sign that asthma is poorly controlled.

Leukotriene modifiers. These pills are taken several hours before physical

activity. They can help relieve asthma symptoms brought on by physical activity.

Long-term control medicines. Frequent or severe symptoms due to physical

activity may suggest poorly controlled asthma and the need to either start or increase long-term control medicines that reduce inflammation. This will help prevent exercise-related symptoms.

Easing into physical activity with a warmup period may be helpful. You also may want to wear a mask or scarf over your mouth when exercising in cold weather. If you use your asthma medicines as your doctor directs, you should be able to take part in any physical activity or sport you choose. People Having Surgery Asthma may add to the risk of having problems during and after surgery. For instance, having a tube put into your throat may cause an asthma attack. Tell your surgeon about your asthma when you first talk with him or her. The surgeon can take steps to lower your risk, such as giving you asthma medicines before or during surgery.

How Can Asthma Be Prevented? You cant prevent asthma. However, you can take steps to control the disease and prevent its symptoms. For example:

Learn about your asthma and ways to control it. Follow your written asthma action plan. Use medicines as your doctor prescribes. Identify and try to avoid things that make your asthma worse (asthma

triggers). However, one trigger you should not avoid is physical activity. Physical activity is an important part of a healthy lifestyle. Talk with your doctor about medicines that can help you stay active.

Keep track of your asthma symptoms and level of control. Get regular checkups for your asthma.

46. Carbohydrates and its sources.

Carbohydrates are one of the main types of nutrients. They are the most important source of energy for your body. Your digestive system changes carbohydrates into glucose (blood sugar). Your body uses this sugar for energy for your cells, tissues and organs. It stores any extra sugar in your liver and muscles for when it is needed. Carbohydrates are called simple or complex, depending on their chemical structure. Simple carbohydrates include sugars found naturally in foods such as fruits, vegetables, milk, and milk products. They also include sugars added during food processing and refining. Complex carbohydrates include whole grain breads and cereals, starchy vegetables and legumes. Many of the complex carbohydrates are good sources of fiber. For a healthy diet, limit the amount of added sugar that you eat and choose whole grains over refined grains.

47.

Importance of hand washing.

Good hand washing is the first line of defense against the spread of many illnesses 1. Wash your hands in warm water. Make sure the water isn't too hot for little hands. 2. Use soap and lather up for about 20 seconds (antibacterial soap isn't necessary any soap will do). Make sure you get in between the fingers and under the nails where uninvited germs like to hang out. And don't forget the wrists! 3. Rinse and dry well with a clean towel. To minimize the germs passed around your family, make frequent hand washing a rule for everyone, especially:

before eating and cooking after using the bathroom after cleaning around the house

after touching animals, including family pets before and after visiting or taking care of any sick friends or relatives after blowing one's nose, coughing, or sneezing after being outside (playing, gardening, walking the dog, etc.)