HEALTH CARE OF OLDER PEOPLE: MONITOR THE CARE IN THE HOME
MANAGEMENT OF SLEEP PROBLEMS: GENERAL PRINCIPLES
All parents wish for a child with an easy temperament, who is easy to manage, always agreeable, and especially one who, from a very early stage, sleeps through the night. Of course, this is not the reality. Just as there is great variation in the temperaments and personalities of different children, so is there great variation in children’s sleep habits. Often these are due to intrinsic elements in the child’s makeup. After a while, however, what is far more striking than these biological differences in children with sleep problems are the behaviours that the parents of these children have in common. Virtually without exception, parents of children with sleep problems will themselves have slipped into habits which serve to encourage and reinforce the problems in the children.
Many of a child’s ongoing problems are actually contributed to by parental intervention. For example, a child who is rocked to sleep every night will come to depend on this, and will not go to sleep without it. The child also soon learns that the rocking will cease as soon as he falls asleep, and will therefore fight to stay awake, thus making him even more irritable and difficult. Similarly, a child who is used to parents coming into the room if he wakes and cries or calls out during the night will come very quickly to depend on this. Many young children have thus never learnr how to get themselves off to sleep, either at the time of going to bed or else when they wake up during the night.
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CHILDREN’S SLEEPSLEEPLESS NIGHTS
Children’s sleep, or the lack of it, is a major preoccupation for many of today’s parents. “Does your child sleep through the night yet?” seems to be the first question everyone asks—if your puffy eyes do not speak for themselves. Someone else’s smug response, “My child has slept through the night ever since we brought him home from the hospital,” wakes up every hair on the back of your neck—even though they, like the rest of your body, can barely function.
It is, understandably, an issue charged with an entire range of emotions—anger, guilt, relief, and elation. All parenting issues seem intensely important, but this one seems even more so. Perhaps this is because sleep—or the need for it in both parent and child—can begin to affect one’s decision-making ability and undermine even the most confident parent. It can bring discord to ordinarily happy families and affect parents’ feelings toward their child.
But it is possible to look objectively at the problem, to define it as it appears in your family, and to determine a course of action with which you will feel comfortable. In order to devise a workable plan, you first need some solid information about young children’s sleep.
When a child’s sleep habits cause recurring or continuing problems for the child or his parents, there is a sleep problem.
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CONSTIPATION – GENERAL INFORMATION (SYMPTOMS)
As with all symptoms, it is quite common for more than one factor to play a part in producing constipation. Once the cause(s) have been found, consider tackling them directly. It may be possible to treat a blockage by surgery, radiation or chemotherapy. However, the cost of doing so may outweigh the benefit if, for example, the treatment is unpleasant and has only a small chance of shrinking the growth enough to relieve the symptoms. If you either can’t or don’t want to get rid of the cause of your constipation— for example, because it is due to painkillers which you want to keep taking — you will have to tackle the symptom itself. Prevention is better than cure here. Don’t wait until you are really badly constipated before doing something about it.
I suggest for a start you consider taking some form of laxative regularly. Laxatives work by softening the motion and/or stimulating the bowel muscle—good examples include liquid paraffin, phenolphthalein, dioctyl sodium sulphosuccinate, danthron, lactulose, and senna. If you normally take laxatives anyway, you will need much bigger doses now than someone who is not used to taking them. Other ways of helping the bowels to keep moving are by taking a high-fibre diet (but not if you have a blockage of the bowel), drinking plenty of fluids and exercising as much as is possible and comfortable.
If these measures don’t keep your bowels moving easily, you may also need to use suppositories or enemas, with the help of a nurse. By the way, most nurses know much more about treating constipation than most doctors. I suggest that you ask a nurse for help if you have this symptom. This should be easy if you are in hospital. If you are at home, just ask your doctor to arrange for a nurse to visit you there.
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RESUSCITATION – EXTERNAL CARDIAC MASSAGE
Make sure the heart has stopped before doing this. The pressure you exert on a patient’s chest — adult or child — may do damage. Some doctors think that external cardiac massage should only be done by someone trained in its procedure. However, YOU may have to use it in an emergency.
In a child, the most common causes for a cardiac arrest are drowning, electrocution and suffocation. In an adult, a heart attack is probably the most common. It may also result from poisoning or from gassing.
The signs of cardiac arrest are: loss of consciousness; the patient has gone blue or is pale; there is no pulse; the breathing has stopped or there may be some gasps for a while; the pupils of the eyes dilate and do not respond to light.
The heart is a pump, pumping blood to all the tissues in the body. The aim of treatment is to start this pump again by compressing the heart between the breastbone and the backbone.
Lie the patient on a hard, flat surface. Kneel at the side of his chest; tilt the head back to open the airway.
For an adult, place the heel of the hand on the lower part of the breastbone, or sternum, and cover it with the other hand. Rock forward and press down firmly on the breastbone — not on the ribs. The chest wall in an adult should move 2Óã-5 centimetres (1-2 inches).
Do it gently the first few times to assess the resistance of the chest wall. For an adult, keep it up at the rate of 60 a minute. For a child, use only one hand (two fingers for an infant), but increase the rate to 90 a minute. If someone else is present, get them to do mouth-to-mouth resuscitation at the same time as you do cardiac massage. One breath to every five pushes on the chest. If you are alone, you will need to do both actions yourself. Two breaths for every 15 pushes on the chest.
Check to see whether your work has any effect. The pulses will return, the color will improve and the pupils of the eyes will constrict.
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GOUT – DESCRIPTION
Some proteins are broken down, in the body, and uric acid is formed. This substance is normally present in the blood and is excreted by the kidney. In gout, there is either an over-production or an under-excretion of uric acid. In some, there is a combination of both.
Uric acid builds up in the blood and is deposited as urate crystals in joints and the tissues around them. Urates may also be deposited as gouty tophi in other tissues, such as the ear or around the elbow.
The first indication is usually an acute arthritis. In most cases this involves the big toe, but any other joint may be involved. Occasionally, several joints are involved at the same time.
The pain comes on suddenly and is severe and throbbing. The joint is usually swollen and the skin overlying it is hot, reddened and shiny. The whole area is tender, and even light pressure on the skin is painful. Fever may accompany the attack. Unless treated, each such attack may last from five to seven days.
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HYSTERECTOMY – FREQUENCY IN WOMEN
These cause the endometrium to build up to form a soft, thick, spongy tissue in which the fertilised ovum can implant and develop into a child.
When, as in most menstrual cycles, conception doesn’t occur, this thick layer of tissue is shed with some bleeding.
When the womb is removed, a woman no longer has periods nor can she become pregnant.
In the past, a partial hysterectomy was common. This removed the body of the womb but left the cervix in place.
This operation is rarely done now because it leaves the cervix and leaves the woman still vulnerable to develop cancer of the cervix. This cancer is second only to cancer of the breast in frequency in women.
The operation can be carried out through a cut made in the abdomen or by operating through the vagina, so there is no outside cut.
Which approach is used depends on what is wrong with the womb, how large it is and what other procedures are carried out at the same time. It is rarely due to the whim of the surgeon.
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THE G.I. FACTOR: A HIGH CARBOHYDRATE DIET IS ESSENTIAL FOR PEAK SPORTING PERFORMANCE
A high carbohydrate diet is a must for optimum sports performance because it produces the biggest stores of muscle glycogen. As we have previously described, the carbohydrate we eat is stored in the body in the form of glycogen in the muscles and liver. A small amount of carbohydrate (about 1 teaspoon) circulates as glucose in the blood. When you are exercising at a high intensity, your muscles rely on glycogen and glucose for fuel. Although the body can use fat when exercising at lower intensities, fat cannot provide the fuel fast enough when you are working very hard. The bigger your stores of glycogen and glucose, the longer you can go before fatigue sets in.
Unlike the fat stores in the body which can release almost unlimited amounts of fatty acids, the carbohydrate stores are small. They are fully depleted after two or three hours of strenuous exercise. This drying up of carbohydrate stores is often called ‘hitting the wall’. The blood glucose concentration begins to decline at this point. If exercise continues at the same rate, blood glucose may drop to levels which interfere with brain function and cause disorientation and unconsciousness. Some athletes refer to this as a ‘hypo’ and in cycling it is known as ‘bonking’.
All else being equal, the eventual winner is the person with the largest stores of muscle glycogen. Any good book on nutrition for sport will tell you how to maximise your muscle glycogen stores by ingesting a high carbohydrate training diet and by ‘carbohydrate loading’ in the days prior to the competition. In this chapter we provide instructions for increasing muscle glycogen as well as using the G.I. to your advantage in sport.
It was not until a highly respected British endocrinologist, professor David Jenkins, published the first list of G.I. Values that people began to listen. Now working in Canada, he and his colleagues showed that many foods containing starch gave blood sugar responses almost as high as an equivalent load of glucose. Further research showed that many sugary foods had lower blood sugar rises than starchy foods. In other words, scientists and medical practitioners all over the world had it the wrong way round. Unfortunately, many still do.
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FAT LOSS ENVIROMENTAL INFLUENCES: IMPLICATIONS
1. There is a need to take a wider view of the causes of overfatness and obesity than simple fat and/or energy imbalances.
2. Examine the influences in both the macro and micro environment that limit an individual’s ability to successfully reduce body fat; list these and attempt to plan counter approaches to them.
3. If possible, get spouses and partners involved in the modification of the micro environment for reducing body fat levels.
4. Keep fatty foods either out of the household environment, or not easily accessible.
5. Encourage the use of ‘person power’ through physical activity and ‘incidental activity’, rather than using machinery.
6. Modify the food supply at the micro-environmental level if this can’t be changed at the macro level, e.g. through reading food labels, learning appropriate shopping techniques, etc.
8. Encourage walking rather than the use of vehicles where possible (i.e. park away from the destination, walk up the stairs instead of using escalators).
9. Get group support to facilitate physical activity (e.g. walking with a friend or group).
10. Encourage an attitude which regards movement as an ‘opportunity’, rather than an ‘inconvenience’.
11. Discourage the use of labour saving electronic equipment in the home such as remote controls for the TV, automatic garage doors, electronic can openers, toothbrushes etc.
12. Don’t commence a fat loss program at times when social support is likely to be least, i.e. at the end of the week or end of the year in particular.
13. Recognise the potential for environmental change and support individual and public health programs.
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