How To Do Newborn Physical Examination?

A complete physical examination is an important part of newborn care within the first 12 hours of life. Each body system is carefully examined for signs of health and normal function. The physician also looks for any signs of illness or birth defects. Physical examination of a newborn often includes assessment or examination of the following:

A. Vital Signs (normal readings):

• Axillary temperature - 96°F to 99°F or 35.6°C to 37.2°C 
• Pulse - 120 - 160 bpm, normally irregular 
• Respiration - 30 - 60 per minute, irregular, abdominal 
• Blood Pressure - 60 - 90mmHg (systolic) , 40 - 90 mmHg (diastolic) 

B. Measurements:

• Length - 18 - 22 in. or 45 - 55 cm., average - 20 in. 
• Head circumference - 13 - 14 in. or 33 - 35 cm 
• Chest circumference - 12 - 13 in. or 30 - 33 cm 
• Weight - average is 7 pounds or or 3.2 kilogram 

C. Skin

• The skin is usually reddish, although the fingers and toes may have a bluish tinge because of poor blood circulation during the first few hours.
• Presence of vernix caeseosa (is the waxy or cheese-like white substance found coating the skin of human babies.)
• Some cracking and peeling of skin
• Presence of Milia (tiny cysts and appear as whitish pinhead-sized spots mainly on and around the nose which usually disappear within a few weeks.
• Occasionally, the skin has several hard lumps (subcutaneous fat necrosis) due pressure from bones destroyed some fatty tissue. Most common on the head, cheek, and neck, particularly if forceps were used during delivery. May break through to the skin surface, releasing a clear yellow fluid, but they usually heal fairly quickly.

D. Head

• Presence of moulding (shaping of the head from passage through the birth canal)
• Sutures are palpable with small separation
• Presence of anterior fontanelle (diamond shaped, soft and flat and has 2-4 cm in size) and posterior fontanelle (triangular shape and has 0.5 - 1 cm in size)
• Caput succedaneum presents as a scalp swelling that extends across the midline and over suture lines and is associated with head moulding. It does not usually cause complications and usually resolves over the first few days.
• Hair are silky and soft

E. Face

• Symmetric in appearance and movement
• parts are proportional and appropriately placed

     1.  Ears

• Well formed and complete
• Startle response to loud noises
• Upper ear must be about same level with the outer canthus of the eye

     2.  Eyes

• Symmetric and clear
• Scant or absence of tears
• Pupils equal and react to light
• Follow objects across midline
• May have subconjunctiva haemorrhage
• Edema of eyelids from pressure during birth

     3.  Nose

• Both nostril open to air flow
• May have slight flattening from pressure during birth

     4.  Mouth

• Mouth, gums, and tongue are pink
• Lips and palate intact
• Presence of sucking, rooting, swallowing and gag reflexes

     5.  Neck and Clavicles

• Short neck turns head easily from side to side
• Presence of clavicles (bones across the upper chest)

     6.  Chest

• Cylindric.  Xyphoid process may be prominent
• Symmetric
• Nipples present and located properly
• May have engorgement with white discharge

     7.  Abdomen

• Usually distended
• Check for masses and hernias
• Umbilical cord clumped securely.  Cord must have 2 arteries and 1 vein    

     8.  Genital
          
      Female

• Labia  are prominent because of exposure to the mother's hormones, and they remain swollen for the first few weeks
• Small amount of vaginal discharge white mucous in color
• Urethra is open and vagina present 

      Male

• Testes should be present in the scrotum
• Rogue on scrotum
• Urethra open at the tip of penis

     9.  Extremities (both upper and lower)

• Equal and bilateral movement of extremities
• Correct number and formation of fingers and toes
• Good muscle tone and flexion
• Legs equal in length
• Normal position of feet

     10.  Back

• No opening observed or felt in the vertebral column to exclude spina bifida  (is a developmental congenital disorder caused by the incomplete closing of the embryonic neural tube)
• Anus patent
• Sphincter tightly closed

     11. Reflexes

• Grasp reflex
• Press finger against base of fingers or toes
• Fingers curl tightly and toes curl forward
• Plantar creases - these creases on the soles of the feet range from absent to covering the entire foot, depending on the maturity.

• Sucking reflex - when an object is placed in their mouth, newborns begin sucking immediately

• Rooting reflex - when either side of their mouth is touched, newborns turn their head toward that side. This reflex enables newborns to find the nipples.

• Moro Reflex - when newborns are startled, their arms and legs swing out and forward in a slow movement with fingers outstretched. This disappears in 6 months.

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24 Ways To Loose Weight Without Dieting (Part III)

Here is the last part on how to loose weight without deiting.

16: Chew Strong Mint Gum
Chew sugarless gum with a strong flavor when you're at risk for a snack attack. Making dinner after work, at a party, watching TV, or surfing the Internet are a few dangerous scenarios for mindless snacking. Gum with a big flavor punch overpowers other foods so they don't taste good.

17: Shrink Your Dishes

Chose a 10" lunch plate instead of a 12" dinner plate to automatically eat less. Cornell's Brian Wansink, PhD, found in test after test that people serve more and eat more food with larger dishes. Shrink your plate or bowl to cut out 100-200 calories a day – and 10-20 pounds in a year. In Wansink's tests, no one felt hungry or even noticed when tricks of the eye shaved 200 calories off their daily intake.

18 : Get Food Portions Right

The top habit of slim people is to stick with modest food portions at every meal, five days a week or more. "Always slim" people do it and successful losers do it, too, according to a Consumer Reports survey. After measuring portions a few times, it can become automatic. Make it easier with small "snack" packs and by keeping serving dishes off the table at meal time.

19: Try the 80-20 Rule

Americans are conditioned to keep eating until they're stuffed, but residents of Okinawa eat until they're 80% full. or named it as hara hachi bu. Try to adopt this healthy habit by consuming out 20% less food, according to researcher Brian Wansink, PhD, where his studies show most people don't miss it.

20: Choose for the Red Sauce

The tomato-based sauces tend to have fewer calories and much less fat than cream-based sauces. But remember, portion size still counts. A serving of pasta is one cup or roughly the size of a tennis ball.

21: Less Meat is Better

Eating vegetarian meals more often is a slimming habit, according to WebMD's "recipe doctor," Elaine Magee, MPH, RD. Vegetarians weigh up to 20% less than meat eaters. While there are several reasons for this, legumes play an important role. Bean burgers, lentil soup, and other tasty legume-based foods are simply packed with fiber. Most Americans get only half of this important nutrient, which fills you up with fewer calories.

22: Burn 100 Calories More

Lose 10 pounds in a year without dieting by burning an extra 100 calories every day. Try one of these activities:

• Pull weeds or plant flowers  - 20 minutes.
• Mow the lawn - 20 minutes.
• Clean house - 30 minutes.
• Jog - 10 minutes.
• Walk 1 mile - 20 minutes 

23: Celebrate

When you've kicked the soda habit or made through the day without overeating, pat yourself and say we made closer to a slimming lifestyle. Phone a friend, get a pedicure, buy new clothes -- or on occasion, indulge in a small slice of cheesecake.

24: Manage Stress without Food

Many people eat in response to stress. Unfortunately, food does not help you cope with stress; it simply adds calories to your daily total. Find more effective alternatives: exercise, take a bath, call a friend, surf the internet. Just steer clear of the kitchen!

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How Does Haemodialysis Works?

Hemodialysis is a type of dialysis that uses a machine with an artificial filter to remove wastes and extra fluids from the blood. This treatment also helps control the chemical balance in your body and helps control blood pressure. Each treatment takes about 4 hours and is done 3 times each week.

A dialysis machine pumps small amounts of blood out of the body and through a filter called an artificial kidney or dialyzer. This kidney filters extra fluid and wastes from the blood. The blood is then pumped back into your body. Medicine will be given to you to prevent your blood from clotting. Fluid, called dialysate, is added to the dialysis machine to: 

1. Help filter out extra fluid and wastes that have built up
2. Add chemicals that your body uses The dialysate is a mixture of water and chemicals that are present in your blood. This fluid can be adjusted, based on your lab values, to give you the best filtering with fewer side effects.

For your safety, the machine has pumps, sensors, monitors and alarms to let the staff know if there is any problem.                  

Access Site

For this treatment, there needs to be a site where the blood is taken out of the body and then returned to the blood stream. This is called an access. After the access is made and healed, 2 needles connected to tubing are inserted into the access. One needle draws a small volume of blood out and pumps it through to the dialysis machine and filter. After the blood is filtered, it is return to the body through the other needle. 

There are three main types of access sites:

1. Fistula – With minor surgery, an artery is joined to a vein under the skin. This is most often done in an arm. This increases the amount of blood that flows through the vein, and makes it bigger. This is the best access because it has fewer complications and lasts longer.
2. Graft – With minor surgery a soft plastic tube is used to join the artery and vein under the skin.
3. Catheter – There are two kinds of catheters, temporary and permanent. The temporary catheter is used for 1 to 2 weeks. This catheter is used until a more permanent access is placed. A permanent catheter is placed in the neck vein and tunneled under the skin. It is good for about a year. The catheter has a risk for infection and is used only until a fistula or graft can be placed. Both the fistula and graft need 2 to 6 weeks to heal and mature before they are able to be used.

Side Effects of Hemodialysis

During treatment:

• Feel tired and sleepy
• Feel dizzy
• Be cold
• Have muscle cramps
• Have nausea

Complication

• Hypotension
• Painful muscle cramps
• dialysis diequillibrium
• chest pain
• dysrythmias
• air embolism (through the line)
• haemorrhage (due to heparin)

Let the staff know how you are feeling so that they can help you be more comfortable.

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The Secret To Surviving Nursing School

Always remember these! 

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What Are The Nursing Care Given To Haemodialysis Patients

When your kidneys do not work well, dialysis is needed to remove extra fluid and waste products such as creatinine and urea, as well as free water from the blood in your body.  It can be done either by haemodialysis or peritoneal dialysis, where the former is the most common choice among patients.

Hemodialysis is a type of dialysis that uses a machine with an artificial filter to remove wastes and extra fluids from the blood. This treatment also helps control the chemical balance in your body and helps control blood pressure. Each treatment takes about 4 hours and is done 3 times each week. 

The need for dialysis may be acute (when there is high and increasing level of serum potassium, fluid overload-impending pulmonary edema, increasing acidosis, pericarditis and severe confusion) or chronic (e.g., End Stage Renal Failure, presence of uremic sign and symptoms affecting all body systems, hyperkalemia, fluid overload not responsive to diuretics and fluid restriction, and a general lack of well-being).

Nursing Care

Pre dialysis care

• assess vital sign as a baseline information to help evaluate the effects of haemodialysis
• weigh and record patient's weight
• assess vascular access site for palpable pulsation or vibration and for signs of inflammation.  Absence of pulsation/vibration should be reported to doctors and dialysis can no longer be done in the assessed access site.
• no procedure should be done on the extremities with vascular access site to avoid damage of blood vessels leading to the failure of the arteriovenous fistula.

Post dialysis care

• assess and document vital signs, weight and vascular access site condition
• rapid fluid and solute removal during dialysis may lead to hypotension, cardiopulmonary changes and weight loss
• assess client general condition for dialysis disequillibrium
• rapid changes in BUN (Blood Urea Nitrogen), pH and electrolyte level during dialysis may lead to cerebral edema and increase intracranial pressure
• assess for bleeding at the access site
• heparinization during dialysis increase the risk of bleeding
• provide psychological support; listen actively, address concerns and explain about the dialysis

Haemodialysis can be an outpatient or inpatient therapy.

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Prenatal Pesticide Exposure Linked With Lower IQ

Babies exposed to pesticides before birth may have significantly lower intelligence scores by age 7 than children who were not exposed, three separate studies published on Thursday said.

Results from the studies — two in New York and one in an agricultural community in California — suggest prenatal exposure to pesticides can have a lasting effect on intelligence.

In one study, a team at the University of California Berkeley found that every tenfold increase in prenatal exposure to organophosphate pesticides corresponded with a 5.5 point drop in overall IQ scores in children by age 7.

“That difference could mean, on average, more kids being shifted into the lower end of the spectrum of learning, and more kids needing special services in school,” Berkeley’s Brenda Eskenazi, who led one of the three studies published online in Environmental Health Perspectives, said in a statement.

The two other studies — one at Mount Sinai Medical Center and the other at Columbia University — also examined prenatal exposure to pesticides and IQ in children at age 7.

The teams at Berkeley and Mount Sinai sampled pesticide residues in maternal urine, while the team at Columbia tested umbilical cord blood levels of chlorpyrifos, part of a class of pesticides known as organophosphates that are known to be toxic to brain cells.

Until it was banned for indoor residential use by the U.S. Environmental Protection Agency in 2001, chlorpyrifos was one of the most widely used insecticides for residential pest control.

In the Columbia study, researchers sampled 265 New York City minority children born before the ban. The higher levels of chlorpyrifos in the babies’ umbilical cord blood were linked with lower performance on two different IQ tests.

Children who were in the highest 25 percent of exposure levels scored 2.7 points lower on IQ tests than children whose exposures were in the lowest quarter of the study.

The UC Berkeley study involved 329 children whose mothers enrolled when they were pregnant.

Urine samples were taken twice during pregnancy from the mothers and after birth from the children at regular intervals between ages 6 months and 5 years.

The team said while prenatal exposure to pesticides were significantly linked with childhood IQ, pesticide exposure after birth was not, suggesting exposure during fetal brain development was a more critical period than childhood exposure.

Children in the UC Berkeley study were exposed to pesticides in 1999 through 2000. Since the 2001 ban, use of organophosphates in the United States has fallen by more than 50 percent, but agricultural use of chlorpyrifos is still permitted.

“It is vitally important that we continue to monitor the levels of exposure in potentially vulnerable populations, especially in pregnant women in agricultural communities, as their infants may continue to be at risk,” Dr. Robin Whyatt of Columbia said in a statement.

(Source: Reuters, April 17th, 2011)

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Tips on How To Survive As A Student Nurse

My first day as a student nurse was frightening.  I can fell the ball rolling down my tummy and wanting to go to bathroom every now and then.  There were so many things questions in my mind. Will i make friends or will they like an older classmate.  Can i cope up with the lessons being out of education for over 10 years?  Can i really put into practice what i will learn in the class?  The worst is can i keep my promise to my husband that i can manage my time as a student, a wife and a mother!  For over a year now, i would say YES. In fact i am 1 of the deans list in the class and i have conquered all my fears during clinical posting time.  Though you fell scared on your first days on new hospital setting but definitely you be able to cope up once you are familiar with the new environment and the people around.

If you’re feeling nervous, let me reassure you. You are about to start the most amazing adventure. The next few years will be the most rewarding of your life.

Being a student nurse is a privilege and a wonderful experience. Yes it can be hard, yes you may struggle, but every moment is worth it. As you learn, you will acquire valuable memories that will stay with you throughout your career.  You will make friends who will stay with you for the rest of your life. Hold on to those special people who encourage and support you.

So what’s the most important thing to do as you embrace this new stage of your life? Enjoy it! All the best to guys!


A. STUDIES

• Don’t put too much pressure on yourself, but try your hardest and be proud of your achievements.
• Listen, understand and relate the lesson.  You can score even for twisted and tricky question.
• Ask if you have any doubts. 
• Learn to laugh at yourself. You will make mistakes, but that is how you learn.
• Manage your time for your studies, extra curricular activities, houseworks, exercise and others carefully.  Nursing needs ample time to study.
• Practice procedures many times and if you are not sure of the steps and proper ways to do it, ask your tutor, lecturer, or Clinical Instructor.  Remember practice makes perfect!

B. CLINICAL POSTING

• Be ready for your clinical posting.  Read and refresh your new and old notes.  Clinical Instructors (CI) loves to ask question every technical words you say and make sure you know the rationale.
• Be confident in every procedures you do with your CI.  This builds trust with the patient.
• Never try and do something if you are unclear about what you’ve been asked to do. It is always better to ask even 10 times if needed to fully understand rather make mistakes.
• Learn to laugh at yourself. Everyone make mistakes but learn from it.
• Keep a diary and/or write reflective accounts of your experiences. This may seem like a chore but when you read it, you’ll realise just how far you’ve come. It’s also a good way of venting emotions and putting things in perspective.
• Don’t refer to patients by their condition or bed number rather learn their names! That and a kind word can work wonders.
• Don't get disappointed when you are address as "the student" instead of your name.
• Be ready for criticism.  Don't be discouraged no matter how well you think you are doing.  Take it positively.
• Get used to assessment and appraisal.  It is part of the training.  Remember every CI has their own assessment and some has prejudices, don't be discouraged and accept it with good grace.
• Respect healthcare assistants. They know the wards inside and out. If you’re looking for something, they will know where to find things. Form good relationships with them and they will support you.
• Don’t be afraid to cry. I wouldn’t recommend you do it on the ward, but it is perfectly OK to cry. We all have awful days as student nurses and it’s important to deal with them. And then it’s time to move on - tomorrow will bring new challenges and new people.

DO WHAT YOU HAVE LEARN and WRITE WHAT YOU HAVE DONE!!!

This is the favorite saying our head of the nursing school will always remind us...

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24 Ways To Loose Weight Without Dieting (Part II)

Here is the second part of the 24 ways to loose weight without dieting.

11: Limit Alcohol

When an occasion includes alcohol, follow the first drink with a non-alcoholic, low-calorie beverage like sparkling water instead of moving directly to another cocktail, beer, or glass of wine. Alcohol has more calories per gram (7) than carbohydrates (4) or protein (4). It can also loosen your resolve, leading you to mindlessly inhale chips, nuts, and other foods you'd normally limit.

12: Go for Green Tea

Drinking green tea may also be a good weight loss strategy. Some studies suggest that it can rev up the body's calorie-burning engine temporarily, possibly through the action of phytochemicals called catechins. At the very least, you'll get a refreshing drink without tons of calories.

13: Go Yoga - The State of Mind

Women who do yoga tend to weigh less than others, according to a study in the Journal of the American Dietetic Association. What is the connection? The yoga regulars reported a more "mindful" approach to eating. For example, they tend to notice the large portions in restaurants but eat only enough to feel full. Researchers think the calm self-awareness developed through yoga may help people resist overeating.

14: Prefer Home Cook 

Eat home-cooked meals at least five days a week to live like a thin person. A Consumer Reports survey found this was a top habit of "successful losers." Sound daunting? Cooking may be easier than you think. Short cut foods can make for quick meals, such as pre-chopped lean beef for fajitas, washed lettuce, pre-cut veggies, canned beans, cooked chicken strips, or grilled deli salmon.

15: Catch the "Eating Pause"

Most people have a natural "eating pause," when they drop the fork for a couple of minutes. Watch for this moment and don't take another bite. Clear your plate and enjoy the conversation. This is the quiet signal that you're full, but not stuffed. Most people miss it.

to be continued...Part III

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24 Ways To Loose Weight Without Dieting (Part I)

Do you want to loose weight but having problems with dieting? Try these ways and see whether you can cope it.

1: Time Your Meals

Set a timer for 20 minutes and reinvent yourself as a slow eater. This is one of the top habits for slimming down without a complicated diet plan. Savour each bite and make it last until the bell chimes. Paced meals offer great pleasure from smaller portions and trigger the body's fullness hormones. Wolfing your food down in a hurry blocks those signals and causes overeating.

2: Sleep More, Weigh Less

Sleeping an extra hour a night could help a person drop 14 pounds in a year, according to a University of Michigan researcher who ran the numbers for a 2,500 calorie per day intake. His scenario shows that when sleep replaces idle activities – and the usual mindless snacking – you can effortlessly cut calories by 6%. Results would vary for each person, but sleep may help in another way, too. There's evidence that getting too little sleep revs up your appetite, making you uncommonly hungry.

3: Serve More, Eat More Veggies. 

Serve three vegetables with dinner tonight, instead of just one, and you'll eat more without really trying. Greater variety tricks people into eating more food – and eating more fruits and vegetables is a great way to lose weight. The high fibre and water content fills you up with fewer calories. Cook them without added fat. And season with lemon juice and herbs rather than drowning their goodness in high-fat sauces or dressings.

4: When Soup's On, Weight Comes Off

Add a broth-based soup to your day and you'll fill up on fewer calories. Think minestrone, tortilla soup, or Chinese won-ton. Soup's especially handy at the beginning of a meal because it slows your eating and curbs your appetite. Start with a low-sodium broth or canned soup, add fresh or frozen vegetables and simmer. Beware of creamy soups, which can be high in fat and calories.

5: Go for Whole Grains

Whole grains such as brown rice, barley, oats, buckwheat, and whole wheat also belong in your stealthy weight loss strategy. They help fill you up with fewer calories and may improve your cholesterol profile, too. Whole grains are now in many products including waffles, pizza crust, English muffins, pasta, and soft "white" whole-wheat bread.

6: Eyeball Your Skinny Clothes

Hang an old favourite dress, skirt, or a smokin' pair of jeans where you'll see them every day. This keeps

 your eyes on the prize. Choose an item that's just a little too snug, so you reach this reward in a relatively short time. Then pull out last year's cocktail dress for your next small, attainable goal.

7: Skip the Bacon

Pass on those two strips of bacon at breakfast or in your sandwich at lunch time. This simple move saves about 100 calories, which can add up to a 10 pound weight loss over a year. Other sandwich fixings can replace the flavour with fewer calories. Think about tomato slices, banana peppers, roasted red bell peppers, grainy mustard, or a light spread of herbed goat cheese.

8: Build a Better Slice of Pizza

Choose vegetable toppings for pizza instead of meat and you'll shave 100 calories from your meal. Other skinny pizza tricks: go light on the cheese or use reduced-fat cheese and choose a thin, bread-like crust made with just a touch of olive oil.

9: Sip Smart: Cut Back on Sugar

Replace one sugary drink like regular soda with water or a zero-calorie seltzer and you'll avoid 10 teaspoons of sugar. Add lemon, mint or frozen strawberries for flavour and fun.

The liquid sugar in soda appears to bypass the body's normal fullness cues. One study compared an extra 450 calories per day from jelly beans vs. soda. The candy eaters unconsciously ate fewer calories overall, but not so the soda drinkers. They gained 2.5 pounds in four weeks.

10: Sip Smart: Use a Tall, Thin Glass

Use a tall, skinny glass instead of a short, wide tumbler to cut liquid calories — and your weight — without dieting. You'll drink 25-30% less juice, soda, wine, or any other beverage.

How can this work? Brian Wansink, PhD, says visual cues can trick us into consuming more or less. His tests at Cornell University found all kinds of people poured more into a short, wide glass — even experienced bartenders.

(More tips on Part II - next posting...)

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Learn The 9 Best Diet Tips

Are you looking for the best diet tips online? Well, here the 9 simple but best diet tips i have ever found.  Apply it and see for yourself.

1:  Drink plenty of water or other calorie-free beverages.

Before you tear into that bag of potato chips, drink a glass of water first. People sometimes confuse thirst with hunger, so you can end up eating extra calories when an ice-cold glass of water is really all you needed. If plain water doesn't cut it, try drinking flavoured sparkling water or brewing a cup of fruit-infused herbal tea.

2:  Be choosy about night time snacks.

Mindless eating occurs most frequently after dinner, when you finally sit down and relax. Snacking in front of the TV is one of the easiest ways to throw your diet off course. Either close down the kitchen after a certain hour, or allow yourself a low-calorie snack, like a 100-calorie pack of cookies or a half-cup scoop of low-fat ice cream.

3: Enjoy your favourite foods.

Instead of cutting out your favourite foods altogether, be a slim shopper. Buy one fresh bakery cookie instead of a box, or a small portion of candy from the bulk bins instead of a whole bag. You can still enjoy your favourite foods - the key is moderation.

4: Eat several mini-meals during the day.

If you eat fewer calories than you burn, you'll lose weight. But when you're hungry all the time, eating fewer calories can be a challenge. "Studies show people who eat 4-5 meals or snacks per day are better able to control their appetite and weight," says obesity researcher Rebecca Reeves, DrPH, RD. She recommends dividing your daily calories into smaller meals or snacks and enjoying most of them earlier in the day - dinner should be the last time you eat.

5: Eat protein at every meal.

Protein is the ultimate fill-me-up food - it's more satisfying than carbs or fats and keeps you feeling full for longer. It also helps preserve muscle mass and encourages fat burning. So be sure to incorporate healthy proteins like lean meat, yogurt, cheese, nuts, or beans into your meals and snacks.

6: Spice it up.

Add spices or chiles to your food for a flavor boost that can help you feel satisfied. "Food that is loaded with flavour will stimulate your taste buds and be more satisfying, so you won't eat as much," says American Dietetic Association spokeswoman Malena Perdomo, RD. When you need something sweet, suck on a red-hot fireball candy. It's sweet, spicy, and low in calories.

7: Stock your kitchen with healthy convenience foods.

Having ready-to-eat snacks and meals-in-minutes on hand sets you up for success. You'll be less likely to hit the drive-through or call in a pizza order if you can throw together a healthy meal in five or 10 minutes. Here are some essentials to keep on hand: frozen vegetables, whole-grain pasta, reduced-fat cheese, canned tomatoes, canned beans, pre-cooked grilled chicken breast, whole grain tortillas or pitas, and bags of salad greens.

8: Order children's portions at restaurants.

Ordering a child-size entree is a great way to cut calories and keep your portions reasonable. This has become such a popular trend that most servers won't bat an eye when you order off the kids' menu. Another trick is to use smaller plates. This helps the portions look like more, and if your mind is satisfied, your stomach likely will be, too.

9: Swap a cup of pasta for a cup of vegetables.

Simply by eating less pasta or bread and more veggies, you could lose a dress or pants size in a year. "You can save from 100-200 calories if you reduce the portion of starch on your plate and increase the amount of vegetables," says Cynthia Sass, RD, a spokeswoman for the American Dietetic Association.

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Nursing Care Plan for Acute Lymphocytic Leukemia (ALL)

NCP for Acute Lymphocytic Leukemia

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Nursing Care Plan for Pleural Effusion

A sample of nursing care plan for pleural effusion with actual and potential problems.

Ncp for Pleural Effusion

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Case Study on Acute Lymphocytic Leukemia

Here is another case study on Acute Lymphocytic or Lymphoblastic Leukemia.

Case Study on Acute Lymphocytic/Lymphoblastic Leukemia

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