NNI Nursing Preread Module

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This pre-read module is intended as a guide for nurses taking part in the NNI National Nurses’ Quiz 2014. This module covers various aspects of nursing practices mainly the medical errors in hospital setting and the role of a nurse in preventing these errors. It also contains information about nutrition across different stages of life categorized into maternal, paediatric and adult nutrition. The focus of this module is to provide a summary of the topics that will be a part of the quiz competition.A woman’s body undergoes several physiologic changes during pregnancy and nutrition during pregnancy is very vital for the woman, which result in increased plasma volume and red blood cells and a decreased concentration of circulating nutrient-binding proteins and micronutrients. Under-nutrition can aggravate these physiologic changes leading to deficiency states such as anaemia, which can be life-threatening for both the mother and the new-born. In developing countries, maternal under-nutrition affects a large proportion of women, but has not received adequate attention. Maternal nutrition and under-nutrition is an important determinant of poor maternal, new-born, and child health outcomes such as intrauterine growth restriction, preterm birth, and maternal and infant morbidity and mortality.Good nutrition is vital for the growth and development that occur during the first year of an infant’s life. Consumption of appropriate quantities and types of foods provides adequate amount of essential nutrients. Several factors influence the energy or caloric requirements of an infant. They are body size and composition, metabolic rate (the energy the body expends at rest), physical activity, size at birth, age, sex, genetic factors, energy intake, medical conditions, ambient temperature and growth rate. The birth-weight of healthy infants doubles by 6 months of age, and triples by 12 months of age.Nutrition during lactation is very important and breastfeeding is the most ideal and safest form of nourishment for an infant. Breast milk is the best source of nutrients for young infants. Lactation progresses through three stages Colostrum, transitional milk, and mature milk. Colostrum is the first fluid secreted by the mother’s breasts postpartum. It is yellowish in colour with a high protein and mineral content, low fat and lactose concentrations and provides 67 kcal/dL according to the needs of the new-born during the first week of life. Colostrum is rich in immunologic components (secretory IgA, lactoferrin and leukocytes) and developmental factors (epidermal growth factor). Concentrations of sodium, chloride, and magnesium are higher and the concentrations of calcium and potassium are lower in colostrum than in the milk produced later. Colostrum facilitates the growth of Lactobacillus bifidus in the gastrointestinal tract of the new-born and the elimination of meconium. The transitional phase of lactation lasts from the seventh day or the tenth day, up to 2 weeks postpartum. The composition of colostrum changes during this stage. The concentration of immunoglobulins and proteins decreases and the levels of lactose, fat and energy content also increase to maintain the characteristics of mature milk. Mature breast milk is a homogenous mixture containing three fractions: Emulsion (fat droplets), suspension (casein micelles) and solution (water-soluble components). Maternal milk contains 88% of water with an osmolarity similar to that of plasma. Hence, exclusive breastfeeding on demand, without supplementation with water, is crucial to keep the nursing infant well hydrated.