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http://projects.csail.mit.edu/courseware/?term=dbq-essay-structure dbq essay structure B. Social service involvement is helpful in circumstances such as teenaged mothers. Lack of, or limited, prenatal care. History of domestic violence. Maternal substance abuse. And history of previous involvement with child protective services (cps) or similar agency. Viii. Feedings. The frequency, duration, and volume of each feed will depend on whether the infant is breastfeeding or bottle-feeding. A the breast-fed infant should feed as soon as possible after delivery, preferably in the ddivery room, and feed 8 to 12 times per day during the newborn hospitalization. Consultation with a lactation specialist during the postpartum hospitalization is strongly recommended for all breastfeeding mothers (see chap. 22). B. Standard 20 cal/oz, iron-containing infant formula is offered to infants for whom breastfeeding is contraindicated or at the request of a mother who desires to bottle-feed. Unless contraindicated by a strong family history, lactose-containing formulas with milk protein (whey and casein) can be given to all newborns. 1. Infants are fed at least every 3 to 4 hours. 2. During the first few days oflife, the well newborn should consume at least 0.5 to 1 oz/feed. 3. The frequency and volume of each feed is recorded in the baby's medical record. Ix. Newborn circumcision a the american academy of pediatrics (aap) states that scientific evidence exists that demonstrates potential medical benefits of newborn male circumcision.

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http://www.cs.odu.edu/~iat/papers/?autumn=iphone-wallpapers-for-writers iphone wallpapers for writers Monotherapy with nitrates may be appropriate in patients who have low bp at baseline or who experience symptomatic hypotension with low doses of β-blockers or ccbs. Common adverse effects of nitrates include postural hypotension, dizziness, flushing, and headache secondary to venodilation. Headache often resolves with continued therapy and may be treated with acetaminophen. Hypotension is generally of no serious consequence. However, in patients with hypertrophic obstructive cardiomyopathy or severe aortic valve stenosis, nitroglycerin may cause serious hypotension and syncope. Therefore, long-acting nitrates are relatively contraindicated in these conditions. Because life-threatening hypotension may occur with concomitant use of nitrates and phosphodiesterase type 5 inhibitors, nitrates should not be used within 24 hours of taking sildenafil or vardenafil or within 48 hours of taking tadalafil. Skin erythema and inflammation may occur with transdermal nitroglycerin administration and may be minimized by rotating the application site. Ranolazine  ranolazine is an anti-ischemic agent indicated for the management of chronic angina. The mechanism of action is unclear, but it is believed to inhibit the late inward sodium current during the plateau phase of the cardiac action potential. Under ischemic conditions, excess sodium may enter the myocardial cell during systole. The resultant intracellular sodium overload leads to intracellular calcium accumulation (calcium overload) through a sodium/calcium exchange mechanism. Calcium overload results in increases in left ventricular wall tension and myocardial oxygen consumption. By reducing intracellular sodium concentrations in ischemic myocytes, ranolazine decreases intracellular calcium overload, left ventricular wall tension, and myocardial oxygen consumption. Similar to other antianginal drugs, ranolazine reduces angina and increases exercise capacity but does not reduce incidence of mace. Ranolazine has minimal effects on heart rate or bp. Thus, it may be an option in ihd patients with low baseline bp or heart rate. Ranolazine is indicated as a first-line treatment for chronic stable angina. However, it is often reserved for patients table 7–10 contraindications and precautions with ranolazine contraindications liver cirrhosis increases ranolazine plasma concentrations by 30%–80%, resulting in increased risk for qt interval prolongation treatment with potent cyp3a4 inhibitors (including ketoconazole, clarithromycin, and nelfinavir) increases ranolazine concentrations (3. 2-fold with ketoconazole) treatment with cyp3a4 inducers (including rifampin, phenobarbital, phenytoin, carbamazepine, and st. John’s wart) may significantly decrease the efficacy of ranolazine (by 95% with rifampin) precautions treatment with moderate cyp3a4 inhibitors including diltiazem, verapamil, grapefruit juice, erythromycin, and fluconazole increases ranolazine plasma concentrations (twofold with diltiazem and verapamil) preexisting qt prolongation, history of torsades de pointes, or treatment with other qt-prolonging drugs as qt interval prolongation may occur with ranolazine treatment with a p-gp inhibitor, such as cyclosporine, may increase ranolazine absorption up to a 50% increase in ranolazine plasma concentration has been observed in renal impairment ranolazine may increase bioavailability of p-gp substrates (increases digoxin plasma concentrations by 1. 5-fold) ranolazine may cause reduced metabolism of cyp2d6 substrates ranolazine may increase exposure to drugs transported by oct2.

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career research paper help Iv. Tuberculosis of the fetus or newborn a. Pathogenesis (4,6,8,14,19,20). Although congenital tb is rare (~350 reported cases), it can be acquired in the following ways. 1. Hematogenous spread through the umbilical vein from an infected placenta to the fetal liver and lungs (can also involve the gastrointestinal tract, bone marrow, skin, or mesenteric nodes). 2. Inhalation or ingestion of infected amniotic fluid, in utero or at the time of birth, leading to primary infection in the lungs or gastrointestinal tract. Congenital tb is found at a higher incidence in neonates born to a mother with tuberculous endometritis or miliary tb (8) and in infants born to mothers with untreated tb during pregnancy (21). The risk of vertical transmission is likely independent of maternal hiv status (21). The diagnosis of congenital tb requires the presence of tuberculous lesion and at least one of the following. Lesions in the first week of life.

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