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D. Topork, M.B.A., M.D.

Associate Professor, University of the Virgin Islands

Specifically: Remnants of cops, or other refuse resulting from the working of cotton, wool, hemp, and the like, used for wiping machinery, absorbing oil in the axle boxes of railway cars, etc. Note: Waste is voluntary, as by pulling down buildings; or permissive, as by suffering them to fall for want of necessary repairs. Full of waste; destructive to property; ruinous; as; wasteful practices or negligence; wasteful expenses. Expending, or tending to expend, property, or that which is valuable, in a needless or useless manner; lavish; prodigal; as, a wasteful person; a wasteful disposition. The simnel bread and wastel cakes, which were only used at the tables of the highest nobility. One who, or that which, wastes; one who squanders; one who consumes or expends extravagantly; a spendthrift; a prodigal. An imperfection in the wick of a candle, causing it to waste; -called also a thief. Being unable to wield the intellectual arms of reason, they are fain websters 1913 gutenberg(2009). Defn: An overfall, or weir, for the escape, or overflow, of superfluous water from a canal, reservoir, pond, or the like. Defn: Causing waste; also, undergoing waste; diminishing; as, a wasting disease; a wasting fortune. The act of watching; forbearance of sleep; vigil; wakeful, vigilant, or constantly observant attention; close observation; guard; preservative or preventive vigilance; formerly, a watching or guarding by night. Note: Watch was formerly distinguished from ward, the former signifying a watching or guarding by night, and the latter a watching, guarding, or protecting by day Hence, they were not unfrequently used together, especially in the phrase to keep watch and ward, to denote continuous and uninterrupted vigilance or protection, or both watching and guarding. This distinction is now rarely recognized, watch being used to signify a watching or guarding both by night and by day, and ward, which is now rarely used, having simply the meaning of guard, or protection, without reference to time. Ward, guard, or custodia, is chiefly applied to the daytime, in order to apprehend rioters, and robbers on the highway. One who watches, or those who watch; a watchman, or a body of watchmen; a sentry; a guard. The post or office of a watchman; also, the place where a watchman is posted, or where a guard is kept. The period of the night during which a person does duty as a sentinel, or guard; the time from the placing of a sentinel till his relief; hence, a division of the night. Or whistle from the lodge, or village cock Count the night watches to his feathery dames. A small timepiece, or chronometer, to be carried about the person, the machinery of which is moved by a spring. Note: Watches are often distinguished by the kind of escapement used, as an anchor watch, a lever watch, a chronometer watch, etc. To be attentive or vigilant; to give heed; to be on the lookout; to keep guard; to act as sentinel. To remain awake with any one as nurse or attendant; to attend on the sick during the night; as, to watch with a man in a fever. To give heed to; to observe the actions or motions of, for any purpose; to keep in view; not to lose from sight and observation; as, to watch the progress of a bill in the legislature. Defn: A dog kept to watch and guard premises or property, and to give websters 1913 gutenberg(2009). Thu Feb 11 12:10:05 2016 15013 Defn: One who watches; one who sits up or continues; a diligent observer; specifically, one who attends upon the sick during the night. A place where persons under temporary arrest by the police of a city are kept; a police station; a lockup. Defn: A tower in which a sentinel is placed to watch for enemies, the approach of danger, or the like. A word given to sentinels, and to such as have occasion to visit the guards, used as a signal by which a friend is known from an enemy, or a person who has a right to pass the watch from one who has not; a countersign; a password. The fluid which descends from the clouds in rain, and which forms rivers, lakes, seas, etc. Note: Pure water consists of hydrogen and oxygen, H2O, and is a colorless, odorless, tasteless, transparent liquid, which is very slightly compressible. It is the most important natural solvent, and is frequently impregnated with foreign matter which is mostly removed by distillation; hence, rain water is nearly pure.

When the blood pressure cuff is inflated the fingers twitch when he has a grand mal seizure. The doctor could be charged with malpractice, which is failing to perform, or performing an act that causes harm to the client. Negligence is failing to perform care for the client; a tort is a wrongful act committed on the client or their belongings; and assault is a violent physical or verbal attack. The other tasks can be performed by the nursing assistant; therefore, A, B, and C are incorrect. About 30% of all newborns have a rash on the face and forehead that dissipates in approximately one month. The nurse who is pregnant should not be assigned to the client with a radium implant. The other nurses are not at risk when caring for this client, so A, C, and D are incorrect. The Joint Commission on Accreditation of Hospitals will probably be interested in the problems in answers A and C. The failure of the nursing assistant to care for the client with hepatitis might result in termination, but is not of interest to the Joint Commission. The next action after discussing the problem with the nurse is to document the incident by filing a formal reprimand. If the behavior continues or if harm has resulted to the client, the nurse may be terminated and reported to the Board of Nursing, but these are not the first actions requested in the stem. A tort is a wrongful act to the client or his belongings and is not indicated in this instance. The client at highest risk for complications is the client with multiple sclerosis who is being treated with cortisone via the central line. The pregnant client and the client with a broken arm are the best choices for placing in the same room. The clients in answers A, C, and D need to be placed in separate rooms due to the serious natures of their injuries. Before instilling the eardrops, the nurse should consider the age of the child because the ear should be pulled down and out to best deliver the drops in the ear canal. Answers B, C, and D are not considerations when instilling eardrops in a small child. Answers A, B, and D are incorrect because white grape juice, a grilled cheese sandwich, and ice cream do not pose a risk of aspiration for a child. Lantus insulin cannot be mixed with other insulins, but can be taken by the client taking regular insulin. A, C, and D are not correct methods of administering Lantus insulin with regular insulin. A child with epiglottis has the possibility of complete obstruction of the airway. The client with hyperthyroidism will often exhibit tachycardia, increased appetite, and weight loss; therefore, answers A, B, and D are incorrect. Answers A, B, and C all contain gluten, while answer D gives the only choice of foods that does not contain gluten. Before notifying the physician or assessing the pulse, oxygen should be applied to increase the oxygen saturation, so answers A and D are incorrect. An amniotomy is an artificial rupture of membranes and normal amniotic fluid is straw-colored and odorless. There is no data to indicate the need to move the client to the delivery room at this time. There is no need to prepare for a Caesarean section or to place the client in Genu Pectoral position (knee-chest), so answers A and C are incorrect. Answer D is incorrect because there is no need for an ultrasound based on the finding.

Thekeytocorrect diagnosis is a thorough history, a skilled physical examination and judicious choiceofinvestigations. Diagnoses that require specific treatment to avoid further damage or danger are primarily displaced or unstable fractures (including slipped upper femoral epiphysis),abusiveinjury(asapresentingfeatureorincidentalfinding),boneor joint infection, and neoplastic processes, principally bone tumours and leukaemia. Examination the approach to musculoskeletal examination in the child is discussed in Chapter25. If hip pathology is suspected internal rotation of hip (assessed with the hip flexed to 90 degrees) is important to assess as a subtle difference in range of motionwithpainmaybetheonlyindicationofahipjointeffusion. Thengentlyattempttofoldthekneeoverthecontralaterallegwithout the child lifting the buttock off the couch. A more detailed discussion of investigations useful in the assessment of musculoskeletalpathologyisincludedinChapter25. Clinicaldecisionmakinginachildwithalimp Thechildwhoseexaminationfindingssuggestanisolatedirritablehipislikely to have one of the pathologies outlined in Table 25. A decision-making algorithm for managing acute irritable hip is illustrated in. Spinal, abdominal and pelvic pathology can present as a limp and must be considered priortothisnarrowedfocus. Theinfantortoddler,becauseoftheirincreasedrisk for invasive bacterial illness, also represents a special circumstance and the ill childunder2yearswithanabnormalacutemusculoskeletalassessmentisbest admittedforcombinedpaediatricandorthopaedicassessmentandinvestigation. An ultrasound assessment should confirm the suspicion of a hip effusion as suggested by examination but does not differentiate between transudate and exudate. The five most important variables to give a predictedprobabilityofsepticarthritisinagivenchildwithanacutelyirritable hipareshowninBox25. History Theonsetoflower-limbpainisgenerallygradualandinitiallymaybelocalised to hip, knee, groin or thigh with a limp or unwillingness to weight bear. The child may be mildly unwell with or without a history of recent non-specific upperrespiratorytractillness. Range of movement at the hip joint is usually mildly diminished, with discomfortattheend-pointsoftherange. Although haematogenousbacterialspreadisthecommonestcauseofsepticarthritis,direct inoculation through penetrating injuries or surgery is known to occur. Direct spread from adjacent bone infection may also occur resulting in osteomyelitis, particularly in joints where the metaphysis is intracapsular as in the hip and shoulder. Phagocytic and neutrophil responses to the bacteria result in proteolytic enzyme release and cytokine production; with synovial abscess formationandcartilagenecrosis. Infants and children under 3 years of age are at particular risk of septic arthritis, comprising one-third and one-half, respectively, of a large paediatric series. Other commonly infected joints include the ankle and shoulder;however,anysynovialjointinthebodycouldbeaffected. In osteomyelitis, bacteria enter the vascular metaphyseal bone initially then typically extend to the sub-periosteal space forming an abscess. Thisisaninflammatoryprocessofunknown origin,whichdemonstratesculture-negativebonyinflammationwithhistological evidence of necrosis and chronic inflammatory cell infiltrates. Infantsmaypresentwithnonspecific symptoms, such as poor feeding, vomiting, lethargy or fever. Relevantpasthistoryincludestrauma,past history of recurrent staphylococcal infection, such as boils, and immunisation status in respect to Haemophilus influenzae and Pneumococcus. Consider Salmonella osteomyelitis as a potential pathogen in patients with sickle cell disease. Childrenwithapainful hipwillusuallymaintainthejointinslight(20degrees)flexion,abductionand external rotation (in a position of least intracapsular pressure).

Diseases

• Ectodermal dysplasia hypohidrotic autosomal dominant
• Young Mc keever Squier syndrome
• O Doherty syndrome
• Laplane Fontaine Lagardere syndrome
• Arachnodactyly
• Toriello Higgins Miller syndrome