Wednesday 29 March 2017

CARDIOPULMONARY RESUSCITATION



CPR stands for?

C = Cardio (heart)
P = Pulmonary (lungs)
R = Resuscitation (recover)


DEFINITION

Cardio pulmonary resuscitation (CPR) is a technique of basic life support for the purpose of oxygenation to the heart, lungs and brain until and unless the appropriate medical treatment can come and restore the normal cardiopulmonary function.
Cardio pulmonary resuscitation is a series of steps used to establish artificial ventilation and circulation in the patient who is not breathing and has no pulse.


PURPOSE
Ø Restore cardiopulmonary functioning.
Ø Prevent irreversible brain damage from anoxia.


INDICATION
Ø Cardiac arrest
Ø Respiratory arrest
Ø Combination of both

Definition of Cardiac arrest:
It is loss of cardiac function, breathing and loss of consciousness.

Diagnosis of cardiac arrest
1)    Loss of consciousness.
2)  Loss of apical & central pulsations (carotid, femoral).
3)  Apnea.

Causes of cardiac arrest   


1)    Hypoxia.
2)    Hypotension.
3)    Hypothermia
4)    Hypoglycemia
5) Tension pneumothorax.


Ø Respiratory arrest

This may be result of following:
         Stroke
         Foreign body in throat
         Smoke inhalation
         Accident, injury
         Suffocation

CPR procedure

Sequences of procedures performed to restore the circulation of oxygenated blood after a sudden pulmonary and/or cardiac arrest
Chest compression and pulmonary ventilation performed by anyone who knows how to do it, anywhere, immediately, without any other equipment.


A new order for CPR, spelled C-A-B American Heart Association Guidelines.

1.      APPROACH SAFETY
2.     CHECK RESPONSE
3.     SHOUT FOR HELP
4.    OPEN AIRWAY
5.     CHECK BREATHING
6.    30 CHEST COMPRESSIONS
7.     2 RESCUE BREATHS




          1.     APPROACH SAFETY

Ø Approach with care!
Ø Check out the scene
Ø Is it safe for you to approach?
Ø Is the victim safe?

Ø Are all bystanders safe?


CARDIOPULMONARY RESUSCITATION














2.   CHECK RESPONSE.

·        Shake shoulders gently

·        Ask “Are you all right?”

CHECK RESPONSE.




















3.    SHOUT FOR HELP.

Shout for help






















4.    OPEN AIRWAY

                      ·       Airway opening by neck extension
                      ·       Head tilt, chin lift + jaw thrust.



Open Airway


















              5.    CHECK BREATHING


                                            Look, listen and feel for normal breathing.
      Do not mistake agonal breathing for normal.



check breathing





            6.    30 CHEST COMPRESSIONS.

§  Place the heel of one hand in the centre of the chest
§  Place other hand on top
§  Interlock fingers
§  Compress the chest
§  Rate 100 min-1
§  Depth 4-5 cm
§  Equal compression : relaxation
§  When possible change CPR operator every 2 min.


30 chest compressions


                         
    7.    RESCUE BREATHS
  • Pinch the nose
  • Take a normal breath
  • Place lips over mouth
  • Blow until the chest rises
  • Take about 1 second
  • Allow chest to fall
  • Repeat.



Rescue breathing





 RECOMMENDATIONS:
    - Tidal volume 
       500 – 600 ml.
    - Respiratory rate
      give each breaths over about 1s with enough
      Volume to make the victim’s chest rise.
    - Chest-compression-only
      Continuously at a rate of 100 min.


 CONTINUE CPR

          
Continue CPR

















  THE RECOVERY POSITION.

If the victim starts to breath normally.

Recovery position




ü STOP CPR?
o   Spontaneous breathing is present.
o   The rescuer is exhausted.
o   Orders from the Doctor/DNR Order are presented.
o   Paramedics or advanced team arrives.
    o Patient obviously dead.

Tuesday 28 March 2017

Introduction to Human development, Life Span development.


Introduction to Human development, Life Span development.
Historical changes happening in periods of the Life span

Human Development: An Ever-Evolving Field
Human development: Scientific study of processes of change and stability throughout the human life span.


Human Growth & Development
Ø Growth and development begins at birth and ends at death
Ø During an entire lifetime, individuals have needs that must be met
Ø Health care workers need to be aware of the various stages and needs of the individual to provide quality health care.

Human Development:
An Ever-Evolving Field Human Development Today

   Describe: Scientists observe behavior in order to describe what happens in the lives of children and adults. Example: When do children say their first words?

       Explain: Scientists attempt to understand, or explain, why observed behavior occurs—the cause of observed behavior. Example: How do children learn to use language?

       Predict: Scientists make educated guesses about what might happen in the future to behavior. Example: Will delayed language development affect speech?

       Intervene: Scientists use the knowledge of causes of behavior to change or control behavior. Example: Can therapy help speech delays?




Periods of the Life Span Domains of Human Development

Physical development: Growth of the body and brain and change or stability in sensory capacities, motor skills, and health.Biological processes
Cognitive development: Change or stability in mental abilities, such as learning, memory, language, thinking, moral reasoning, and creativity.
Cognitive processes
Psychosocial development: Change and stability in emotions, personality, and social relationships.
Socio-emotional Processes
Biological, Cognitive, and Socioemotional Processes
Influences on Development
1) Individual differences
2) Heredity
3) Environment
4) Maturation: Unfolding of a natural sequence of physical and behavioral changes, including readiness to master new abilities.
          Nature:  The influence of heredity on development
          Nurture: The influence of environment on                        development
5) Culture
6) Ethnicity


Development is Contextual
Developmental Issues
Onset of Influences
Onset of Influences.

Imprinting
Phenomenon in which newly hatched birds instinctively follow the first moving object they see; usually mother - the result of the readiness of the nervous system to acquire certain information during a brief critical period in early life.
Konrad Lorenz & his ducklings
Indicates predisposition or readiness to learn
The Effects of Early Experience

Questions to consider:
How important are early experiences and how much of an effect do they have on a person’s later life?
Are there critical periods during which a child must be exposed to certain stimulations or experiences (or forever be disadvantaged)?
How “plastic” is the child? That is, how can a child take and still bounce back? How much can a child endure before his/her later development will be permanently impaired?

Critical & Sensitive Periods

   Critical and sensitive periods are both times when the organism is biologically ready to most benefit from a particular experience.

Sensitive Periods: adverse effects caused by missing a sensitive period may be overcome at a later time, although with great difficulty.

Critical Periods: adverse effects caused by missing a critical period are permanent.

   The only clearly demonstrated critical period in human beings involves early stimulation of certain neural and body cells. Without such stimulation, these cells atrophy and die e.g., visual neurons must have light during their early development or they will die.


Historical changes happening in periods of the Life span
1. Growth and Development Types
2. Physical: body growth
3. Mental: mind development
4. Emotional: feelings
5. Social: interactions and relationships with others

All four types above occur in each stage of life span

Ø Infancy
Dramatic and rapid changes
Physical development– roll over, crawl, walk, grasp objects
Mental development—respond to cold, hunger, and pain by crying. Begin to recognize surroundings and become aware of surroundings and people
Emotional development – show anger, distrust, happiness, excitement, etc.
Social development – self-centeredness concept of the newborn to recognition of others in their environment


Ø Early Childhood
Physical development – growth slower than in infancy. Muscle coordination allows the child to run, climb, move freely. Can write, draw, use a fork and knife
Mental development – verbal growth progresses, short attention span, at end of stage ask questions, recognize letters, and some words
Emotional development – develop self-awareness and recognize the effect they have on other people and things.  Children feel impatience and frustration as they try to do things beyond their abilities. 
Social development – at beginning of stage very self-centered one year old to sociable six year old.  Strong attachment to parents.  Needs are food, shelter, protection, love and security.


Ø Late Childhood
Physical development– slow but steady.  Muscle coordination is well developed and children can engage in physical activity that require complex motor-sensory coordination.
Mental development – developing quickly and much of the child’s life centers around school.  Reading and writing skills are learned, understand abstract concepts like honesty, loyalty, values and morals.


Ø Late Childhood
Emotional development -- the child achieves greater independence and a more distinct personality.  Fears are replaced by the ability to cope. 
Social development – focus on group oriented activities.  They are more ready to accept the opinions of others and learn to conform to rules & standards of behavior.  Need for reassurance, parental approval, and peer acceptance.


Adolescence
Physical development – growth spurts, muscle coordination slows. Onset of puberty. Body shape and form changes.
Mental development – most foundations have been set.  Development primarily involves an increase in knowledge and sharpening of skills.  Learn to make decisions and accept responsibility for actions.
Emotional development – emotional development is often stormy and in conflict. Adolescents try to establish their identities and independence.   They respond more and more to peer group influences.
Social development – spending less time with family and more time with peer groups.  They attempt to develop self-identity and independence and seek security from  their peers. Toward the end of this stage they develop a more mature attitude and develop patterns of behavior that they associate with adult behavior. 
Need for reassurance, support and understanding.  Problems that develop in this stage can be traced to conflict and feelings of inadequacy and insecurity.


Early Adulthood
Physical development – basically complete.  Muscles are developed, strong and motor coordination is at its peak.
Mental development – young adults seek additional education, choose careers and independence.
Emotional development – Young adults are subjected to many emotional stresses related to career, marriage, family, etc.
Social development – moving away from peer group, and tend to associate with others who have similar ambitions.
 

Middle Adulthood
Physical development – Graying of hair, skin wrinkles, muscle tone decreases, mild hearing loss, visual acuity losses, weight gain. 
Mental development – can continue to increase. Confident decision makers and excellent at analyzing situations.
Emotional development – can be a period of contentment and satisfaction.
Social development --  Family relationships can decline as children begin lives of their own and parents die. Friendships are with people with similar interests and lifestyles.


Late Adulthood
Physical development – on the decline. Skin becomes dry and wrinkles, “age spots” appear. Hair thins, muscles lose tone and strength.  Memory loss can occur and reasoning ability can diminish.
Mental development – varies.  People who remain mentally active and are willing to learn new things tend to show fewer signs of decreased mental ability
Emotional development – Emotional stability also varies. 
Social development – retirement can lead to loss of self esteem, lost identity.  Death of spouse and friends cause changes in social relationships.

Life-Span Developmental Approach
Paul B. Baltes
1) Development is lifelong (change never stops)
2) Development  is multidimensional (bio-psycho-social)
3) Development is multidirectional (gains and losses)
4) Relative influences of biology and culture shift over the lifespan (less physical strength, more cultural strength)
5) Development involves changing resource allocations (compensation)
6) Development shows plasticity (can change with practice/effort)
7) Development is influenced by the historical and cultural context.



 The stage of development in which Erikson believed that children must gain a greater sense of personal control is known as.
a) Trust vs Mistrust
b) Initiative vs Guilt
c) Autonomy vs Shame and Doubt
d) Industry vs Inferiority

          The issue in developmental psychology that involves debate over the relative contributions of inheritance and the environment is known as the.

Nature Vs Nurture Debate: 
    Early experiences Vs Later experiences debate.
    Continuity Vs Discontinuity debate.
    Abnormal behaviour Vs Individual behaviour debate.

A major strength of ecological theory is its framework for explaining.

A)     environmental influences on development.
          B)      Biological influences on development. 
          C)      Cognitive development.
          D)     Effective processes in development.





Ø
Origins of Child Development Theories
ž 6th - 15th centuries, Medieval period: Children seen as little adults. Their clothing, worked at adult jobs, could be married, were made into kings, were imprisoned or hanged as adults.
ž 16th Century, Reformation period: Children were considered to be born evil, and must be civilized.  A goal emerged to raise children effectively.
ž 17th Century, Age of Enlightenment: Children were thought to develop in response to nurturing.
ž Origins of Child Development Theories
ž 18th Century, Age of Reason: Children were considered noble savages, born with an innate sense of morality.
ž Origins of Child Development Theories
     19th Century, Industrial Revolution: Theories of natural selection and survival of the fittest.
ž “Those individuals that possess superior physical, behavioral, or other attributes are more likely to survive than those that are not so well endowed”
ž Selection
     Artificial
     Natural
     Darwin made parallels between human growth and other animals.
ž 20th Century: Theories about children's development expanded around the world.
ž Human Development: THEMES
ž The Nature / Nurture Theme
     Genetics versus environment
     Both interact to produce change
ž The Active / Passive Theme
     Children are active, determining how society treats them.
     Children are passive, being moulded by society

ž Human Development: THEMES
ž The Continuity / Discontinuity Theme
     Change occurs gradually and continuously
  Quantitative changes: change in degree or amount
     Change occurs with abrupt changes or stages (discontinuous)
  Qualitative changes: changes in form or kind.

Ø Five Theories (Perspectives) of Development
Psychological
ž Psychoanalytic (Freud)
ž Cognitive
ž Behavioral & Social Cognitive / Learning
Other
ž Ethological
ž Ecological
Ø THE PSYCHOANALYTIC VIEWPOINT
Freud’s Psychosexual Theory
ž Work based on his therapy with troubled adults. 
ž He emphasized that a child's personality is formed by the ways which his parents managed his sexual and aggressive drives.
ž Unconscious motives are repressed
ž Development is a conflictual process
ž Sexual and aggressive instincts that must be served, yet society dictates restraint

Ø Freudian Psychosexual Stages
Ø Erikson’s Psychosocial Theory
ž Eight stages of development
     Primary human motivation is social
     Eight stages unfold over the life span
     At each stage, unique developmental task confronts individuals with crisis that must be resolved
ž A Preview of Erikson’s Stages
Ø Piaget’s Cognitive Developmental Theory
ž Children actively construct their understanding of the world
     Assimilation: incorporation of new information into existing knowledge
     Accommodation: adjusting knowledge to fit new information and experience
Ø Vygotsky’s Sociocultural Cognitive Theory
ž Culture guides cognitive development
ž Memory, attention, reasoning involves learning to use society’s inventions
ž Cognitive growth is a socially mediated activity
ž Stresses children’s active interaction with social environments, proposed the Zone of Proximal Development (ZPD)

ž Learning Theory:
Behaviorism
ž We respond based on whether the situation is:
  Painful or Threatening
  Pleasurable
ž Behaviorism:
Classical Conditioning
ž John Watson: Conditioning of Fear
ž Orphan boy ‘Little Albert’
ž Behaviorism:
Operant Conditioning
ž Individual learns the consequences of ‘operating’ on the environment
ž Learned relationship between behavior and its consequences
ž B.F. Skinner formulated original ideas by working with animals, then applied them to humans
ž Skinner’s Operant Learning Theory
     Repeat acts if outcomes are favorable,  suppress acts if outcomes are unfavorable
  Operant – initial voluntary act
  Reinforcer – increases probability of act
  Punisher – decreases probability of act
     Development depends on external stimuli
ž Operant Conditioning: Reinforcement
ž Increases likelihood of behavior reoccurring
     Positive: Giving a reward
  Candy for finishing a task
     Negative: Removing something aversive
  No chores for getting an A+ on homework
ž Operant Conditioning:
Punishment
ž Decreases likelihood of behavior reoccurring
     Positive: Adding something aversive
  Getting scolded
     Negative: Removing something pleasant
  Taking away car keys
  Getting a ‘time out’
ž Social Learning Theory
ž Albert Bandura: Development is “bidirectional”
     Reciprocal determinism—person acts on world as the world acts on the person
ž Observational Learning or Modeling
     Children choose “models to” imitate

ž Ethological Theory
ž Science of character
ž Behavior
     Based on study of animal behavior
     Influenced by biology, tied to evolution
     Characterized by critical or sensitive periods
     Lorenz: imprinting is rapid, innate learning within a critical period of time
     Bowlby’s view of infant’s attachment to care giver
ž THE ECOLOGICAL SYSTEMS VIEWPOINT
ž Bronfenbrenner – ecological systems theory: a detailed analysis of environmental influences
     Contexts for Development
  Natural environments are the major source of influence for development
  Environment is a set of nested structures
ž Ecological Theory
ž Development is influenced by five (05) environmental systems,
ž Microsystem:  daily life
ž Mesosystem: relates microsystems
ž Exosystem:  influences from other social systems
ž Macrosystem:  culture
ž Chronosystem:  (time) personal/social history