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141. Entonox: Ward administration of

consciousness ( ) Entonox should also be used with caution in patients with poor nutritional status ( ). Examples of this include: Patients with poor intake or on a diet low in animal products e.g. vegans. Patients with malabsorption syndromes, particularly those with ileal resections. Patients requiring synthetic diets (e.g. phenylketonuria, maple syrup urine disease) Patients on a diet for which special vitamin and mineral supplements are prescribed for deficiency states (more than standard vitamins

2014 Publication 1593

142. Cleaning: perioperative environment cleaning

based practice. Please use with caution. The purpose of this document is to provide guidance about the control of MRSA at Great Ormond Street Hospital (GOSH). Please note that this is a GOSH clinical guideline and may vary from other external hospital MRSA policies or guidelines. The purpose of this guideline is to provide guidance on the collection of microbiology and virology specimen at Great Ormond Street Hospital (GOSH). Parenteral nutrition (PN) is the administration of nutrition directly (...) into the bloodstream. It is the method of providing nutrition to children who have intestinal failure. Five per cent glucose solution is no longer commercially available. This guideline explains how a solution can be made up on the ward by adding dextrose monohydrate (eg Nutrivit glucose powder) to a 90ml bottle of sterile water. The purpose of this guideline is to provide guidance about intravenous and subcutaneous immunoglobulin infusions at Great Ormond Street Hospital (GOSH). Epidermolysis bullosa (EB

2014 Publication 1593

143. Chest drain management

with caution. The purpose of this document is to provide guidance about the control of MRSA at Great Ormond Street Hospital (GOSH). Please note that this is a GOSH clinical guideline and may vary from other external hospital MRSA policies or guidelines. The purpose of this guideline is to provide guidance on the collection of microbiology and virology specimen at Great Ormond Street Hospital (GOSH). Parenteral nutrition (PN) is the administration of nutrition directly into the bloodstream. It is the method (...) of providing nutrition to children who have intestinal failure. Five per cent glucose solution is no longer commercially available. This guideline explains how a solution can be made up on the ward by adding dextrose monohydrate (eg Nutrivit glucose powder) to a 90ml bottle of sterile water. The purpose of this guideline is to provide guidance about intravenous and subcutaneous immunoglobulin infusions at Great Ormond Street Hospital (GOSH). Epidermolysis bullosa (EB) is a genetically determined skin

2014 Publication 1593

144. Central venous access devices (long term)

based practice. Please use with caution. The purpose of this document is to provide guidance about the control of MRSA at Great Ormond Street Hospital (GOSH). Please note that this is a GOSH clinical guideline and may vary from other external hospital MRSA policies or guidelines. The purpose of this guideline is to provide guidance on the collection of microbiology and virology specimen at Great Ormond Street Hospital (GOSH). Parenteral nutrition (PN) is the administration of nutrition directly (...) into the bloodstream. It is the method of providing nutrition to children who have intestinal failure. Five per cent glucose solution is no longer commercially available. This guideline explains how a solution can be made up on the ward by adding dextrose monohydrate (eg Nutrivit glucose powder) to a 90ml bottle of sterile water. The purpose of this guideline is to provide guidance about intravenous and subcutaneous immunoglobulin infusions at Great Ormond Street Hospital (GOSH). Epidermolysis bullosa (EB

2014 Publication 1593

145. Central venous access (temporary) for extracorporeal therapies

recent evidence based practice. Please use with caution. The purpose of this document is to provide guidance about the control of MRSA at Great Ormond Street Hospital (GOSH). Please note that this is a GOSH clinical guideline and may vary from other external hospital MRSA policies or guidelines. The purpose of this guideline is to provide guidance on the collection of microbiology and virology specimen at Great Ormond Street Hospital (GOSH). Parenteral nutrition (PN) is the administration (...) of nutrition directly into the bloodstream. It is the method of providing nutrition to children who have intestinal failure. Five per cent glucose solution is no longer commercially available. This guideline explains how a solution can be made up on the ward by adding dextrose monohydrate (eg Nutrivit glucose powder) to a 90ml bottle of sterile water. The purpose of this guideline is to provide guidance about intravenous and subcutaneous immunoglobulin infusions at Great Ormond Street Hospital (GOSH

2015 Publication 1593

146. Breast milk: expressed breast milk fortification

of factors including the presence of active enzymes that enhance the maturation of the underdeveloped gut, anti-infective properties which protect the newborn from infection and earlier tolerance of full enteral feeding ( ). Despite the benefits of breast milk, the nutrient levels in breast milk may not fully meet the increased nutritional needs of the preterm infant, particularly energy, protein, sodium, calcium, phosphorus and some vitamins ( ). Preterm infants who have accumulated deficits in calcium (...) restricted, eg those with cardiac or renal anomalies. Infants who are failing to thrive due to increased requirements or losses, eg in malaborptive states. When fortification is required, an aseptic technique must be used when handling the EBM ( )( ). Methods of increasing the nutritional intake of the preterm infant The first step to improve nutritional intake should be to slowly increase the volume of EBM given ( ). Well preterm infants >1500g may tolerate up to 220ml/kg ( ) although an iron supplement

2014 Publication 1593

147. Breast milk: expressing and handling

acute and chronic diseases . The World Health Organisation (WHO) now recommends exclusive breastfeeding for the first six months following a thorough review of scientific studies on the health, growth and development benefits of breastfeeding ). These guidelines have been developed to ensure that breast milk can be used for each baby safely and easily, giving both excellent nutrition and encouragement to the mother. All health care professionals should promote, protect and support breastfeeding (...) storage at home and how dads can help. The above documents and other useful information can be found on the neonatal section of GOSH web. Further information can be obtained from the Neonatal Nurse Advisor on ext. 6355. Background Breast milk is recommended as the optimal source of nutrition for infants. Several large studies and reviews have demonstrated that breastfeeding can confer a range of significant health benefits for both child and mother. Unfortunately, because of their infant’s prematurity

2014 Publication 1593

148. Blood sampling from central venous access devices (CVADs)

recent evidence based practice. Please use with caution. The purpose of this document is to provide guidance about the control of MRSA at Great Ormond Street Hospital (GOSH). Please note that this is a GOSH clinical guideline and may vary from other external hospital MRSA policies or guidelines. The purpose of this guideline is to provide guidance on the collection of microbiology and virology specimen at Great Ormond Street Hospital (GOSH). Parenteral nutrition (PN) is the administration (...) of nutrition directly into the bloodstream. It is the method of providing nutrition to children who have intestinal failure. Five per cent glucose solution is no longer commercially available. This guideline explains how a solution can be made up on the ward by adding dextrose monohydrate (eg Nutrivit glucose powder) to a 90ml bottle of sterile water. The purpose of this guideline is to provide guidance about intravenous and subcutaneous immunoglobulin infusions at Great Ormond Street Hospital (GOSH

2014 Publication 1593

149. Breast feeding: Guidance for staff assisting the mother

breasts do not become overly engorged. Aim to discontinue expressing within 2-3 days ( ). Much practical and psychological support will be required ( ). Encourage the mother to wear a firm, supportive brassiere ( ). Encourage the mother to take adequate analgesia ( ). Suppression with hormones is no longer recommended. Rationale Rationale 1: Breast milk is the optimum form of nutrition for babies unless this is medically contraindicated. Rationale 2: Mothers who have a sick baby, may lack knowledge

2009 Publication 1593

150. Arterial lines

with caution. The purpose of this document is to provide guidance about the control of MRSA at Great Ormond Street Hospital (GOSH). Please note that this is a GOSH clinical guideline and may vary from other external hospital MRSA policies or guidelines. The purpose of this guideline is to provide guidance on the collection of microbiology and virology specimen at Great Ormond Street Hospital (GOSH). Parenteral nutrition (PN) is the administration of nutrition directly into the bloodstream. It is the method (...) of providing nutrition to children who have intestinal failure. Five per cent glucose solution is no longer commercially available. This guideline explains how a solution can be made up on the ward by adding dextrose monohydrate (eg Nutrivit glucose powder) to a 90ml bottle of sterile water. The purpose of this guideline is to provide guidance about intravenous and subcutaneous immunoglobulin infusions at Great Ormond Street Hospital (GOSH). Epidermolysis bullosa (EB) is a genetically determined skin

2014 Publication 1593

151. Blood glucose monitoring

limits in accordance with the clinical management plan . Blood glucose monitoring is necessary for children: Receiving intravenous or subcutaneous insulin . Receiving medication that can alter blood glucose levels, e.g. octreotide, diazoxide Receiving intravenous glucose solutions, this includes parenteral nutrition Nil by mouth for 4 hours without intravenous fluids Nil by mouth and receiving only intravenous fluids for more than 12 hours Commencing parenteral nutrition and during 'wind down (...) ' of cyclical parenteral nutrition until stable ) With some endocrine and metabolic conditions, e.g. congenital hyperinsulinism and glycogen storage disease With blood glucose levels outside of normal parameters 4-7mmol/L or parameters as specified by local policy and medical instruction specific to child‘s condition Post-operatively as per local guidelines, i.e. procedure specific Presenting with seizures and/or unexplained loss of consciousness Commencing steroid therapy Following a ketogenic diet

2014 Publication 1593

152. Analgesia: patient controlled and nurse controlled

based practice. Please use with caution. The purpose of this document is to provide guidance about the control of MRSA at Great Ormond Street Hospital (GOSH). Please note that this is a GOSH clinical guideline and may vary from other external hospital MRSA policies or guidelines. The purpose of this guideline is to provide guidance on the collection of microbiology and virology specimen at Great Ormond Street Hospital (GOSH). Parenteral nutrition (PN) is the administration of nutrition directly (...) into the bloodstream. It is the method of providing nutrition to children who have intestinal failure. Five per cent glucose solution is no longer commercially available. This guideline explains how a solution can be made up on the ward by adding dextrose monohydrate (eg Nutrivit glucose powder) to a 90ml bottle of sterile water. The purpose of this guideline is to provide guidance about intravenous and subcutaneous immunoglobulin infusions at Great Ormond Street Hospital (GOSH). Epidermolysis bullosa (EB

2015 Publication 1593

153. Tracheostomy: care and management review

. Please use with caution. The purpose of this document is to provide guidance about the control of MRSA at Great Ormond Street Hospital (GOSH). Please note that this is a GOSH clinical guideline and may vary from other external hospital MRSA policies or guidelines. The purpose of this guideline is to provide guidance on the collection of microbiology and virology specimen at Great Ormond Street Hospital (GOSH). Parenteral nutrition (PN) is the administration of nutrition directly into the bloodstream (...) . It is the method of providing nutrition to children who have intestinal failure. Five per cent glucose solution is no longer commercially available. This guideline explains how a solution can be made up on the ward by adding dextrose monohydrate (eg Nutrivit glucose powder) to a 90ml bottle of sterile water. The purpose of this guideline is to provide guidance about intravenous and subcutaneous immunoglobulin infusions at Great Ormond Street Hospital (GOSH). Epidermolysis bullosa (EB) is a genetically

2012 Publication 1593

154. Infant feeding: weaning

boluses or overnight feeding) and offer foods at other times ( ). Liaise with your ward dietitian if feed volumes are reduced as intake of food increases ( ). Rationale Rationale 1: Breast milk and formula milk meet the nutritional requirements of most healthy babies for the first six months of life (W ). Rationale 2: Sick infants have different nutritional requirements to healthy babies. The dietitian will ensure the diet is nutritionally adequate and that appropriate solids are offered. Rationale 3 (...) : To ensure nutritional adequacy and that appropriate solids are offered. Rationale 4: The degree of prematurity will determine the appropriate age for introduction of solids. Rationale 5: To ensure the baby is comfortable and the stomach is not compressed. Rationale 6: The shallow bowl of a weaning spoon allows the baby to more easily take food from it. A metal spoon may harm the baby’s mouth. Rationale 7: To allow the baby to practice how to move a bolus of food around and to experience flavours

2014 Publication 1593

155. Infant feeding: formula

. No other foods, fluids, drugs should be stored in the milk refrigerator . Feed volumes required Fluid requirement from about one week of age to six months of age for a term baby, receiving all of its nutrition from a feed, is about 150ml/kg. Each baby will have its own individual requirements and so it is best to let them feed on demand . Babies should be weighed weekly or more frequently if indicated and their weight plotted on the appropriate centile chart . ( ). Extra fluid may be needed if the ward (...) breastfeeding Rationale 3: To ensure nutritional adequacy. Rationale 4: To prevent potential contamination if feeds were to be prepared in the ward environment. To comply with infection control guidance. Rationale 5: Whey-based infant formulas have a profile closer to that of breast milk. Rationale 6: Term formulas do not meet the increased nutritional requirements of premature babies. The levels of some nutrients in preterm formulas are too high for term infants. Rationale 7: To comply with patient choice

2014 Publication 1593

156. Head circumference: measuring a child

. Please use with caution. The purpose of this document is to provide guidance about the control of MRSA at Great Ormond Street Hospital (GOSH). Please note that this is a GOSH clinical guideline and may vary from other external hospital MRSA policies or guidelines. The purpose of this guideline is to provide guidance on the collection of microbiology and virology specimen at Great Ormond Street Hospital (GOSH). Parenteral nutrition (PN) is the administration of nutrition directly into the bloodstream (...) . It is the method of providing nutrition to children who have intestinal failure. Five per cent glucose solution is no longer commercially available. This guideline explains how a solution can be made up on the ward by adding dextrose monohydrate (eg Nutrivit glucose powder) to a 90ml bottle of sterile water. The purpose of this guideline is to provide guidance about intravenous and subcutaneous immunoglobulin infusions at Great Ormond Street Hospital (GOSH). Epidermolysis bullosa (EB) is a genetically

2014 Publication 1593

157. Weight: measuring a child/young person

Weight: measuring a child/young person Weight: measuring a child/young person | Great Ormond Street Hospital Google Tag Manager Navigation Search Search You are here Weight: measuring a child/young person Weight: measuring a child/young person ). It provides a sensitive guide to children and young people's: health development nutritional status response to treatment . It is also used for the accurate calculation of drug doses, intravenous and oral fluid replacement and oral parenteral feeds (...) care/parent held record recorded in the Patient Assessment Form (PAF) /Outpatient Assessment Form (OAF) recorded on the Nutrition Screening Record recorded on the Electronic patient record including electronic prescribing system recorded on the electronic growth chart within EDM All paper documentation should be recorded with the date, time and the name of the measurer along with a signature and job role. The electronic growth chart will document the date and time the measurement was made

2014 Publication 1593

159. Patients Hospitalized with Heart Failure: Risk Assessment, Management, and Clinical Trajectory

the evidence-based approaches to HF therapy and management enumerated in the 2013 ACCF/AHA GuidelinefortheManagementofHeartFailureandthe 2016 and 2017 ACC/AHA/HFSA focused updates (15,25,26). 3. These algorithms assume that a broad multidisci- plinary approach is ideal, with input anticipated from experienced physician and nurse specialists, as well as other disciplines such as pharmacy, social work, psy- chiatry, physical therapy, and nutrition. 4. Therapeutic decisions should be governed by clinical (...) bypass surgery. Exercise program/cardiac rehabilitation. Behavioral Weight Loss Interventions to Prevent Obesity-Related Morbidity and Mortality in Adults: US Preventive Services Task Force Recommendation Statement Malnutrition Assess for protein calorie malnutrition. Referral to dietician. Guidelines for the Provision and Assessment of Nutrition Support Therapy in the Adult Critically Ill Patient Frailty, deconditioning Assess for frailty, consider physical therapy and/or referral for rehabilitation

2019 American College of Cardiology

160. Screening and Management of the Hyperandrogenic Adolescent

alongaspectrumthatmayevolveovertimeandcanpresent differently among different ethnicities. Treatment of acne and hirsutism should not be withheld during the ongoing longitudinal evaluation for possible PCOS. In addition, although obesity and insulin resistance are not diagnostic criteriaforPCOS,theyoftenco-existinthispopulationand warrant early counseling on healthy weight, nutrition, and exercise and evaluations to exclude diabetes (7). Evaluation of the Hyperandrogenic Adolescent The initial evaluation should focus on identifying clinical

2019 American College of Obstetricians and Gynecologists

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