By G. Grompel. National Technological University. 2018.
If the mother gains less than this purchase 30 gm elimite otc, the baby’s chances of survival and health declines discount 30 gm elimite otc. If she has already gained 11 kg after six–seven months purchase elimite 30 gm free shipping, she should continue to gain moderately until delivery. This is because the unborn baby puts on most of its weight during the last months of pregnancy. Therefore the following are essential nutrition actions related to maternal nutrition:. A pregnant or breastfeeding woman needs extra foods, especially those that are good sources of iron. Pregnant women need at least one additional meal (200 Kcal) per day during the pregnancy. She should reduce her involvement in strenuous household tasks that lead to higher energy expenditure. Pregnant women should take vitamin A rich foods (such as papaya, mango, tomato, carrot, and green leafy vegetable) and animal foods (such as ﬁsh and liver). In the malarious areas, pregnant women should sleep under an insecticide- treated bed net. Pregnant women during the third trimester of pregnancy should be de- wormed using mebendazole or albendazole (you will learn about the doses for this in Study Session 7 of this Module). This should include as far as possible food from the different food groups (animal products, fruits, vegetables, cereals and legumes). A pregnant or lactating woman can get extra foods by eating a little more of ordinary meals. She should increase the amount of nourishment at one or two meals, not every meal. They may be anaemic, which in turn means that they may have difﬁculty in pregnancy and childbirth. A pregnant or breastfeeding mother should have enough iron to keep herself and her baby healthy. She should eat plenty of iron-rich foods every day such as dried beans, legumes, dark green leafy vegetables, liver, kidney and heart. A pregnant mother should go for her ﬁrst antenatal care visit at the latest by the fourth month of her pregnancy. At the clinic, check her urine for excess sugar and proteins, and her blood for malaria (if she is showing signs of infection). You diagnose anaemia in the following way: Examine the lower eyelids, the inside of the lips and the palms which should be bright pink; if there is anaemia, all of these will be pale whitish. Give the mother iron tablets or tablets with iron and folate to build strong blood 27. If the iron tablets upset the mother or cause side effects, she should not stop taking iron, but eat more leafy vegetables. As a Health Extension Practitioner it is important that you identify the women who may need extra help and support. Encourage them to eat as good mixture of foods as they can afford (fruits, vegetables, animal source foods). Encourage other members of the household to do some of the work and lessen the work burden on the woman. The baby of an anaemic mother will not develop well and will have low birth weight. If there is anaemia, they will be pale whitish; if there is no anaemia they will be pinkish. When a baby sucks at the nipple, this causes the milk to come into the breast and continue to ﬂow. Breastmilk is food produced by the mother’s body especially for the baby, and it contains all the nutrients (nourishment) a healthy baby needs. A lactating woman needs at least two extra meals (550 Kcal) of whatever is available at home. This will enable the baby to get an adequate supply of vitamin A for the ﬁrst six months. During the ﬁrst six months the best way of feeding the baby is for the mother to breastfeed exclusively. In addition to extra meals and one high dose of vitamin A, a breastfeeding womanalsoneeds:. Vitamin A rich foods (such as papaya, mango, tomato, carrot and green leafy vegetables) and animal foods (such as ﬁsh and liver). You have learnt what pregnant and lactating women require to be healthy and well for themselves and their babies. Now you are going to look at the nutritional requirements of infants, children and adolescents. Small children and infants do not have a well developed body nutrient store, and therefore are more vulnerable to infection. During the pubertal growth spurt, they increase rapidly both in weight and height. Therefore, they need a nutrient intake that is proportional with their rate of growth. At about 15–16 years (the pubertal period) there is a sharp rise in growth rate/velocity. Requirements for macronutrients (proteins, carbohydrates and fats) and micronutrients are higher on a per kilogram basis during infancy and childhood than at any other developmental stage. These needs are inﬂuenced by the rapid cell division occurring during growth, which requires protein, energy and fat. Increased needs for these nutrients are reﬂected in daily requirements for these age groups, some of which are brieﬂydiscussedbelow.
However order elimite 30 gm, a slight difference in charge occurs right at the membrane surface generic 30 gm elimite amex, both internally and externally purchase elimite 30gm fast delivery. It is the difference in this very limited region that has all the power in neurons (and muscle cells) to generate electrical signals, including action potentials. Before these electrical signals can be described, the resting state of the membrane must be explained. When the cell is at rest, and the ion channels are closed (except for leakage channels which randomly open), ions are distributed across the + membrane in a very predictable way. The cytosol contains a high concentration of anions, in the form of phosphate ions and negatively charged proteins. Large anions are a component of the inner cell membrane, including specialized phospholipids and proteins associated with the inner leaflet of the membrane (leaflet is a term used for one side of the lipid bilayer membrane). With the ions distributed across the membrane at these concentrations, the difference in charge is measured at -70 mV, the value described as the resting membrane potential. The exact value measured for the resting membrane potential varies between cells, but -70 mV is most commonly used as this value. This voltage would actually be much lower except for the + + contributions of some important proteins in the membrane. Leakage channels allow Na to slowly move into the cell or K + + to slowly move out, and the Na /K pump restores them. The Action Potential Resting membrane potential describes the steady state of the cell, which is a dynamic process that is balanced by ion leakage and ion pumping. Because the concentration of Na is higher outside the cell than inside the cell by a factor of 10, ions will rush into the cell that are driven largely by the concentration gradient. Because sodium is a positively charged ion, it will change the relative voltage immediately inside the cell relative to immediately outside. The resting potential is the state of the membrane at a voltage of -70 mV, so the sodium cation entering the cell will cause it to become less negative. The electrical gradient also plays a role, as negative proteins below the membrane attract the sodium ion. These channels are 528 Chapter 12 | The Nervous System and Nervous Tissue + + specific for the potassium ion. As K starts to leave the cell, taking a positive charge with it, the membrane potential begins to move back toward its resting voltage. This is called repolarization, meaning that the membrane voltage moves back toward the -70 mV value of the resting membrane potential. Repolarization returns the membrane potential to the -70 mV value that indicates the resting potential, but it actually overshoots that value. Potassium ions reach equilibrium when the membrane voltage is below -70 mV, so a period of + + hyperpolarization occurs while the K channels are open. What has been described here is the action potential, which is presented as a graph of voltage over time in Figure 12. The change in the membrane voltage from -70 mV at rest to +30 mV at the end of depolarization is a 100-mV change. The change seen in the action potential is one or two orders of magnitude less than the charge in these batteries. What happens across the membrane of an electrically active cell is a dynamic process that is hard to visualize with static images or through text descriptions. The membrane potential will stay at the resting voltage until something This OpenStax book is available for free at http://cnx. A ligand-gated Na channel will open when a neurotransmitter binds + to it and a mechanically gated Na channel will open when a physical stimulus affects a sensory receptor (like pressure applied to the skin compresses a touch receptor). Whether it is a neurotransmitter binding to its receptor protein or a sensory stimulus activating a sensory receptor cell, some stimulus gets the process started. The channels that start depolarizing the membrane because of a stimulus help the cell to depolarize from -70 mV to -55 + mV. Any depolarization that does not change the membrane potential to -55 mV or higher will not reach threshold and thus will not result in an action potential. Also, any stimulus that depolarizes the membrane to -55 mV or beyond will cause a large number of channels to open and an action potential will be initiated. Because of the threshold, the action potential can be likened to a digital event—it either happens or it does not. If depolarization reaches -55 mV, then the action potential + continues and runs all the way to +30 mV, at which K causes repolarization, including the hyperpolarizing overshoot. Also, those changes are the same for every action potential, which means that once the threshold is reached, the exact same thing happens. A stronger stimulus, which might depolarize the membrane well past threshold, will not make a “bigger” action potential. All action potentials peak at the same voltage (+30 mV), so one action potential is not bigger than another. Stronger stimuli will initiate multiple action potentials more quickly, but the individual signals are not bigger. Thus, for example, you will not feel a greater sensation of pain, or have a stronger muscle contraction, because of the size of the action potential because they are not different sizes. As we have seen, the depolarization and repolarization of an action potential are dependent on two types of channels (the + + + voltage-gated Na channel and the voltage-gated K channel).
Being able to transform verbal commands into a sequence of motor responses 30 gm elimite fast delivery, or to manipulate and recognize a common object and associate it with a name for that object trusted elimite 30gm. The relationship between the words that describe actions order 30gm elimite with mastercard, or the nouns that represent objects, and the cerebral location of these concepts is suggested to be localized to particular cortical areas. Certain aphasias can be characterized by a deficit of verbs or nouns, known as V impairment or N impairment, or may be classified as V–N dissociation. To describe what is happening in a photograph as part of the expressive language subtest, a patient will use active- or image-based language. The lack of one or the other of these components of language can relate to the ability to use verbs or nouns. Damage to the region at which the frontal and temporal lobes meet, including the region known as the insula, is associated with V impairment; damage to the middle and inferior temporal lobe is associated with N impairment. Judgment and Abstract Reasoning Planning and producing responses requires an ability to make sense of the world around us. Making judgments and reasoning in the abstract are necessary to produce movements as part of larger responses. Will hitting the snooze button multiple times lead to feeling more rested or result in a panic as you run late? In the mental status exam, the subtest that assesses judgment and reasoning is directed at three aspects of frontal lobe function. First, the examiner asks questions about problem solving, such as “If you see a house on fire, what would you do? The prefrontal cortex is composed of the regions of the frontal lobe that are not directly related to specific motor functions. Anterior to that are the premotor cortex, Broca’s area, and the frontal eye fields, which are all related to planning certain types of movements. Anterior to what could be described as motor association areas are the regions of the prefrontal cortex. The antecedents to planning certain movements are judging whether those movements should be made, as in the example of deciding whether to hit the snooze button. The neurological exam does not necessarily assess personality, but it can be within the realm of neurology or psychiatry. A clinical situation that suggests this link between the prefrontal cortex and personality comes from the story of Phineas Gage, the railroad worker from the mid-1800s who had a metal spike impale his prefrontal cortex. Later anecdotal evidence from his life suggests that he was able to support himself, although he had to relocate and take on a different career as a stagecoach driver. The disorders associated with this procedure included some aspects of what are now referred to as personality disorders, but also included mood disorders and psychoses. Depictions of lobotomies in popular media suggest a link between cutting the white matter of the prefrontal cortex and changes in a patient’s mood and personality, though this correlation is not well understood. As an extreme measure to deal with a debilitating condition, the corpus callosum may be sectioned to overcome intractable epilepsy. When the connections between the two cerebral hemispheres are cut, interesting effects can be observed. If a person with an intact corpus callosum is asked to put their hands in their pockets and describe what is there on the basis of what their hands feel, they might say that they have keys in their right pocket and loose change in the left. They may even be able to count the coins in their pocket and say if they can afford to buy a candy bar from the vending machine. If a person with a sectioned corpus callosum is given the same instructions, they will do something quite peculiar. They will not even move their left hand, much less report that there is loose change in the left pocket. The reason for this is that the language functions of the cerebral cortex are localized to the left hemisphere in 95 percent of the population. Additionally, the left hemisphere is connected to the right side of the body through the corticospinal tract and the ascending tracts of the spinal cord. Motor commands from the precentral gyrus control the opposite side of the body, whereas sensory information processed by the postcentral gyrus is received from the opposite side of the body. For a verbal command to initiate movement of the right arm and hand, the left side of the brain needs to be connected by the corpus callosum. Language is processed in the left side of the brain and directly influences the left brain and right arm motor functions, but is sent to influence the right brain and left arm motor functions through the corpus callosum. Likewise, the left-handed sensory perception of what is in the left pocket travels across the corpus callosum from the right brain, so no verbal report on those contents would be possible if the hand happened to be in the pocket. Unlike normal people, this patient can perform two independent tasks at the same time because the lines of communication between the right and left sides of his brain have been removed. Whereas a person with an intact corpus callosum cannot overcome the dominance of one hemisphere over the other, this patient can. If the left cerebral hemisphere is dominant in the majority of people, why would right-handedness be most common? The Mental Status Exam The cerebrum, particularly the cerebral cortex, is the location of important cognitive functions that are the focus of the mental status exam. The regionalization of the cortex, initially described on the basis of anatomical evidence of cytoarchitecture, reveals the distribution of functionally distinct areas. Cortical regions can be described as primary sensory or motor areas, association areas, or multimodal integration areas. The functions attributed to these regions include attention, memory, language, speech, sensation, judgment, and abstract reasoning. The mental status exam addresses these cognitive abilities through a series of subtests designed to elicit particular behaviors ascribed to these functions. Losses of language and speech functions, known as aphasias, are associated with damage to the important integration areas in the left hemisphere known as Broca’s or Wernicke’s areas, as well as the connections in the white matter between them. The subtests related to these functions depend on multimodal integration, as well as language-dependent processing.