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nursingscience · 2 years ago

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GOLDEN RULES FOR NURSES

NURSES

Golden Points to Remember

➥ Antiemetic drugs prevent vomiting.

➥ Intraosseous injections are given into the bone marrow.

➥ Intrathecal injections are given into the spinal cavity.

➥ Intramuscular injections should be given on 90° angle.

➥ Subcutaneous injections should be given on 45° angle.

➥ Intradermal injections should be given on 15° angle.

➥ Blood group ‘AB’ is known as universal recipient and blood group ‘O is known as universal donor.

➥ Mercury is used in thermometer because mercury is very sensitive to little change in temperature.

➥ For giving enema, left lateral position should be given.

➥ Air cushion is used to prevent bed sores.

➥ Hey’s test is performed for identify bile salts in urine

➥ Smith’s test is performed to found out presence of bile pigments in urine.

➥ Components of Total parenteral nutrition (TPN) are carbohydrates (glucose), amino acids, lipids,vitamins, minerals, and electrolytes.

➥ Insulin may be added to TPN to offset the high concentration of glucose and heparin may be added to limit the formation of a fibrous clot at the tip of the catheter.

➥ The bones in the forearm act as a natural splint by providing support to an I.V. access site.

➥ Don’t select an I.V. site on a paralyzed or traumatized arm.

➥ The basilica vein is normally used for a peripherally inserted central catheter (PICC) line.

➥ Because the insertion of a PICC line is below the level of the heart, an air embolism isn’t an expected occurrence.

➥ If a client has a high temperature, notify the physician before administering any blood product.

➥ No solution or product other than normal saline should be added to blood or blood product.

➥ Maslow’s hierarchy of needs must be met in the following order: physiologic (oxygen, food, water,sex, rest, and comfort), safety and security, love and belonging, self-esteem and recognition, and self- actualization.

➥ To avoid staining the teeth, the client should take a liquid iron preparation through a straw.

➥ Fluid oscillation in the tubing of a chest drainage system indicates that the system is working properly.

➥ The type of assessment that includes data related to a client’s biological, cultural, spiritual and social need is called Comprehensive Assessment.

➥ The Vital Signs are: 1. Temperature, 2. Pulse, 3.Respiration, 4. Blood pressure, and 5. Pain.

➥ Heat loss due to contact with circulating air movement is known as Convection.

➥ The range of marking in glass/clinical thermometer is 95-110° F and 35-43.3°C.

➥ Normal Rectal temperature is 99.6° F (37°C) (1°F ) higher than oral temperature).

➥ Rectal temperature is the most reliable.

➥ Relapsing fever: Fever episodes are separated by intervals of normal temperature for days or weeks.

➥ Rigor: Sudden rise in body temperature with shivering as seen in malaria.

➥ Increased depth of breathing with normal respiratory rate is called Hyperpnea.

➥ Cheyne-Stokes Respiration is characterized by altered period of Tachypnea and Apnea.

➥ Pulse deficit refers to the difference between apical pulse and radial pulse.

➥ A Blood Pressure Cuff that is too large will give falsely low reading of BP.

➥ Beneficence: Doing good for clients and providing benefit balanced against risk.

➥ Isotonic solutions allow free movement of water across the membrane without changing concentration of solutes on either side. E.g. 0.9% NaCl.

➥ Hypertonic solution: Fluids with solutes more concentrated than in cells, e.g. 5% dextrose.

🛑 Explanation

1. Antiemetic drugs prevent vomiting.

Antiemetic drugs are medications used to prevent or treat nausea and vomiting. They work by targeting different receptors in the body, including those in the gastrointestinal tract and the central nervous system.

There are several types of antiemetic drugs available, including:

1. Serotonin antagonists: These drugs block the action of serotonin, a neurotransmitter involved in nausea and vomiting. Examples include ondansetron, granisetron, and dolasetron.

2. Dopamine antagonists: These drugs block the action of dopamine, a neurotransmitter involved in nausea and vomiting. Examples include metoclopramide and prochlorperazine.

3. Histamine antagonists: These drugs block the action of histamine, a neurotransmitter involved in nausea and vomiting. Examples include dimenhydrinate and meclizine.

4. Cannabinoids: These drugs work by activating cannabinoid receptors in the body, which can help to reduce nausea and vomiting. Examples include dronabinol and nabilone.

Other types of antiemetic drugs include benzodiazepines, which can help to reduce anxiety and nausea, and corticosteroids, which can help to reduce inflammation and swelling that can contribute to nausea and vomiting.

Antiemetic drugs may be prescribed for a variety of conditions, including chemotherapy-induced nausea and vomiting, postoperative nausea and vomiting, and motion sickness, among others. It is important to note that antiemetic drugs may have side effects, and should only be taken as directed by a healthcare professional.

GOLDEN POINTS FOR NURSES

2. Intraosseous injections are given into the bone marrow.

Intraosseous injections are given directly into the bone marrow, typically of the long bones such as the femur, tibia, and humerus.

This route of administration is used when intravenous access is not feasible or when a more rapid onset of action is needed, such as in emergency situations.

Intraosseous injections are commonly used in pediatric patients, as well as in adult patients in emergency and critical care settings.

The technique involves using a specialized needle to penetrate the bone and access the marrow cavity, where medications or fluids can be injected directly into the bloodstream.

GOLDEN POINTS FOR NURSES

3. Intrathecal injections are given into the spinal cavity.

Intrathecal injections are given directly into the spinal cavity, specifically into the subarachnoid space surrounding the spinal cord.

This route of administration is used to deliver medications or other substances directly to the central nervous system, bypassing the blood-brain barrier. Intrathecal injections may be used to treat conditions such as chronic pain, spasticity, and certain types of cancer, among others.

The technique involves using a specialized needle to puncture the spinal canal and access the subarachnoid space, where medications or other substances can be injected. Because of the risks associated with this procedure, including infection, bleeding, and damage to the spinal cord or nerves, it is typically performed under strict sterile conditions by trained medical professionals.

Golden rules for NURSES

4. Intramuscular injections should be given on 90° angle.

The angle at which an intramuscular injection should be given can vary depending on the size of the needle and the location of the injection site. In general, a 90-degree angle is appropriate for most adult patients receiving intramuscular injections.

However, for patients who have less subcutaneous tissue or who are receiving injections in areas with less muscle mass, such as the deltoid muscle in the upper arm, a 45-degree angle may be more appropriate. It is important to follow proper injection technique and to consult with a healthcare provider if you have any questions or concerns about administering an intramuscular injection.

Golden rules for NURSES

5. Subcutaneous injections should be given on 45° angle.

The angle at which a subcutaneous injection should be given can vary depending on the size of the needle and the location of the injection site. In general, a 45-degree angle is appropriate for most adult patients receiving subcutaneous injections.

However, for patients who have less subcutaneous tissue or who are receiving injections in areas with less fat, such as the abdomen, a 90-degree angle may be more appropriate. It is important to follow proper injection technique and to consult with a healthcare provider if you have any questions or concerns about administering a subcutaneous injection.

Golden rules for NURSES

6. Intradermal injections should be given on 15° angle.

Yes, that's correct. Intradermal injections are administered at a shallow angle, typically between 5 and 15 degrees, into the dermis layer of the skin.

The angle used for an intradermal injection is much shallower than for an intramuscular or subcutaneous injection, as the goal is to inject the medication just under the surface of the skin.

This type of injection is commonly used for skin testing, such as for tuberculosis or allergies, and is typically given on the inner forearm or upper back. It is important to follow proper injection technique and to consult with a healthcare provider if you have any questions or concerns about administering an intradermal injection.

Golden rules for NURSES

7. Blood group ‘AB’ is known as universal recipient and blood group ‘O is known as universal donor.

Yes, that's correct. Blood group AB is known as the universal recipient because individuals with this blood type can receive blood from any other blood type without experiencing an adverse immune reaction. This is because they have both A and B antigens on the surface of their red blood cells, and therefore do not produce antibodies against either antigen.

On the other hand, blood group O is known as the universal donor because individuals with this blood type can donate blood to individuals with any other blood type without causing an adverse immune reaction. This is because they do not have A or B antigens on the surface of their red blood cells, and therefore do not produce antibodies against these antigens. However, individuals with blood group O can only receive blood from other individuals with blood group O, as their immune system will recognize the A and B antigens as foreign and produce antibodies against them.

Golden rules for NURSES

8. Mercury is used in thermometer because mercury is very sensitive to little change in temperature.

Yes, that is correct. Mercury is often used in thermometers because it is a liquid metal that has a high coefficient of thermal expansion, which means that it expands and contracts in response to changes in temperature. This makes it very sensitive to even small changes in temperature and allows for accurate temperature readings.

In addition, mercury has a low freezing point and a high boiling point, which means that it remains in a liquid state over a wide range of temperatures. This allows it to be used in both low-temperature and high-temperature applications.

However, it is important to note that mercury is a toxic substance and can be harmful if ingested or inhaled. For this reason, many countries have banned the use of mercury in thermometers and other consumer products, and alternative substances such as alcohol or digital thermometers are often used instead.

Golden rules for NURSES

9. For giving enema, left lateral position should be given.

Yes, the left lateral position is commonly used for administering an enema. This position helps to promote the flow of the enema solution into the rectum and prevents it from flowing back out.

To assume the left lateral position for an enema, the patient should lie on their left side with their left leg straight and their right knee bent slightly. They should bring their right knee up towards their chest to further open the rectal area. This position helps to straighten out the rectum and makes it easier to insert the enema tip.

It is important to follow proper enema administration technique and to use sterile equipment to minimize the risk of infection or injury. A healthcare provider should be consulted if you have any questions or concerns about administering an enema.

Golden rules for NURSES

10. Air cushion is used to prevent bed sores.

Air cushions can be used as part of a preventative strategy to help reduce the risk of bed sores, also known as pressure ulcers. Pressure ulcers can occur when there is prolonged pressure on a particular area of the skin, often caused by immobility or being in a seated or lying position for an extended period of time.

Air cushions are designed to distribute pressure evenly over the surface of the cushion, which can help reduce pressure on any particular area of the body. This can help to prevent the development of pressure ulcers and also provide greater comfort for the person sitting or lying on the cushion.

However, it is important to note that air cushions are just one component of a comprehensive pressure ulcer prevention plan. Other strategies may include repositioning the patient regularly, maintaining good skin hygiene, and providing adequate nutrition and hydration. It is important to work with a healthcare provider to develop an individualized care plan for preventing pressure ulcers in each patient.

Golden rules for NURSES

11. Hey’s test is performed for identify bile salts in urine

Hey's test is a laboratory test used to detect the presence of urobilinogen in urine, not bile salts. Urobilinogen is a colorless substance that is produced in the liver during the breakdown of bilirubin, a yellowish substance that is formed when old red blood cells are broken down.

Hey's test involves adding a chemical reagent to a urine sample, which causes any urobilinogen present to oxidize and turn pink or red in color. The intensity of the color change is used to determine the concentration of urobilinogen in the urine.

While Hey's test is not used specifically to identify bile salts in urine, elevated levels of urobilinogen in the urine can be an indication of liver disease or other medical conditions affecting the liver or biliary system, which can lead to the accumulation of bile salts in the urine. It is important to consult with a healthcare provider for proper diagnosis and treatment of any medical condition.

Golden rules for NURSES

12. Smith’s test is performed to found out presence of bile pigments in urine.

No, Smith's test is not used to detect the presence of bile pigments in urine. Smith's test is a laboratory test used to detect the presence of protein in urine.

Bile pigments, such as bilirubin and urobilinogen, may be present in urine in certain medical conditions affecting the liver or biliary system. However, there are other laboratory tests that are more commonly used to detect these substances in urine, such as the bilirubin test or the urobilinogen test.

It is important to consult with a healthcare provider for proper diagnosis and treatment of any medical condition that may be affecting the urinary system or other organ systems in the body.

Golden rules for NURSES

13. Components of Total parenteral nutrition (TPN) are carbohydrates (glucose), amino acids, lipids,vitamins, minerals, and electrolytes.

Yes, that is correct. Total parenteral nutrition (TPN) is a form of nutrition therapy that delivers all of the necessary nutrients, including carbohydrates (glucose), amino acids, lipids, vitamins, minerals, and electrolytes, directly into the bloodstream through a vein. TPN is typically administered when a patient is unable to obtain adequate nutrition through the gastrointestinal tract, such as in cases of severe malabsorption, intestinal obstruction, or other medical conditions.

The specific components and concentrations of TPN are tailored to the individual patient's needs based on factors such as age, weight, medical condition, and laboratory values. TPN is typically administered in a hospital setting and requires close monitoring by a healthcare provider to ensure proper dosing and to monitor for any potential complications or side effects.

Golden rules for NURSES

14. The bones in the forearm act as a natural splint by providing support to an I.V. access site.

Yes, that is correct. The bones in the forearm, specifically the radius and ulna, can act as a natural splint by providing support and stability to an IV access site. When an IV catheter is inserted into a vein in the arm, it can be secured in place using a dressing or tape to prevent movement or dislodgement. However, the bones in the forearm can also provide additional support and stability to the IV catheter, which can help to prevent accidental dislodgement or complications such as infiltration or extravasation.

It is important to ensure that the IV catheter is properly placed and secured, and to monitor the IV site for signs of complications such as swelling, redness, pain, or leakage. If any of these signs are present, it is important to notify a healthcare provider immediately.

Golden rules for NURSES

15. Don’t select an I.V. site on a paralyzed or traumatized arm.

Yes, that is correct. When selecting an IV site, it is important to avoid areas that are paralyzed or traumatized. A paralyzed limb may have reduced blood flow and sensation, which can increase the risk of complications such as infiltration or extravasation. Additionally, a traumatized limb may have damaged blood vessels or tissues, which can also increase the risk of complications.

When selecting an IV site, healthcare providers typically look for a site that has good blood flow, easy access, and minimal risk of complications. The most common sites for IV access are the veins in the arms, but other sites such as the hands or feet may be used if necessary. Factors such as the patient's medical condition, age, and overall health may also be taken into consideration when selecting an IV site.

It is important to properly assess the patient's veins and select the most appropriate site for IV access, while also considering the patient's comfort and safety. Proper insertion and maintenance of the IV catheter, as well as monitoring for signs of complications, can help to ensure optimal outcomes for the patient.

Golden rules for NURSES

16. Don’t select an I.V. site on a paralyzed or traumatized arm.

It is important to avoid selecting an intravenous (IV) site on a paralyzed or traumatized arm. There are several reasons for this:

Risk of further injury: If the arm is already traumatized or paralyzed, there is a risk of further injury or damage to the arm if an IV is inserted in that area. This can result in nerve damage, muscle damage, or other complications.

Difficulty monitoring: If the arm is paralyzed, it may be difficult to monitor for signs of infection or other complications at the IV site. This can lead to delayed diagnosis and treatment of any problems that may arise.

Reduced blood flow: A paralyzed or traumatized arm may have reduced blood flow, which can affect the delivery of fluids and medications through the IV. This can result in poor IV access or incomplete delivery of medication.

In general, it is important to choose a site for IV insertion that is healthy, well-vascularized, and free from any injuries or abnormalities. If a patient's arm is paralyzed or traumatized, it is best to select a different site for the IV. This can help ensure that the IV is placed safely and effectively, without causing any further harm to the patient.

Golden rules for NURSES

17. The basilica vein is normally used for a peripherally inserted central catheter (PICC) line.

The basilic vein is one of the veins that can be used for a peripherally inserted central catheter (PICC) line. A PICC line is a long, thin tube that is inserted through a peripheral vein (usually in the arm) and passed through to the larger veins near the heart. This type of catheter is often used for patients who require long-term intravenous (IV) access for medications, fluids, or other treatments.

The basilic vein is located on the medial (inner) side of the upper arm, and it runs from the elbow to the axilla (armpit). It is one of the larger veins in the arm, making it a good candidate for a PICC line insertion. Other veins that can be used for a PICC line include the cephalic vein and the brachial vein.

When a PICC line is inserted, the healthcare provider will use ultrasound guidance to locate the basilic vein and insert the catheter through the skin and into the vein. The catheter is then advanced through the vein and into the larger veins near the heart. Once the catheter is in place, it can be used for the administration of medications, fluids, or other treatments.

It is important to note that while the basilic vein is a common choice for a PICC line insertion, the healthcare provider will consider several factors when choosing the best vein for each patient. These factors may include the patient's medical history, the size and condition of the veins, and the specific needs of the patient's treatment plan.

Golden rules for NURSES

18. Because the insertion of a PICC line is below the level of the heart, an air embolism isn’t an expected occurrence.

While it is true that the insertion of a peripherally inserted central catheter (PICC) line is typically done below the level of the heart, an air embolism can still occur during the insertion process or while the catheter is in place.

An air embolism occurs when air bubbles enter the bloodstream and block the flow of blood to vital organs. While air embolisms are rare, they can be life-threatening if not promptly recognized and treated.

During the insertion of a PICC line, there is a risk of air entering the catheter or the bloodstream. Healthcare providers take precautions to minimize this risk by carefully priming and flushing the catheter and using specialized techniques to insert and position the catheter.

However, even with these precautions, it is still possible for air to enter the bloodstream. This can happen if the catheter becomes disconnected or if the patient experiences a sudden change in position that allows air to enter the catheter.

To minimize the risk of air embolism, healthcare providers carefully monitor patients during and after PICC line insertion. They may use ultrasound or other imaging techniques to confirm proper catheter placement and check for any signs of air in the bloodstream.

If an air embolism is suspected, immediate treatment is required. This may include stopping the infusion, administering supplemental oxygen, and positioning the patient in a way that prevents the air from traveling to the heart or lungs. In severe cases, more advanced treatments may be necessary, such as hyperbaric oxygen therapy or surgery.

Golden rules for NURSES

19. If a client has a high temperature, notify the physician before administering any blood product.

If a client has a high temperature, it is important to notify the physician before administering any blood product. This is because a high temperature can be a sign of infection or another underlying condition that may be exacerbated by the administration of blood products.

Blood products are typically used to treat a variety of conditions, including anemia, bleeding disorders, and immune system disorders. While these products can be life-saving, they also carry certain risks, such as infection, allergic reactions, and transfusion reactions.

One of the key steps in ensuring the safe administration of blood products is to carefully screen patients for any underlying conditions or risk factors that may increase their risk of complications. This includes monitoring for signs of infection, such as a high temperature, before administering any blood products.

If a client has a high temperature, the physician may want to delay or modify the administration of blood products until the underlying cause of the fever can be identified and treated. This may involve further testing or evaluation to determine if the client has an infection or other condition that could increase their risk of complications from the blood product.

By notifying the physician of any signs of infection or other concerns before administering blood products, healthcare providers can help ensure the safe and effective use of these important treatments.

Golden rules for NURSES

20. No solution or product other than normal saline should be added to blood or blood product.

It is generally recommended that no solution or product other than normal saline should be added to blood or blood products. This is because the addition of other substances can increase the risk of adverse reactions and other complications.

Normal saline, also known as 0.9% sodium chloride, is a sterile solution of salt and water that is used to replace lost fluids and restore electrolyte balance in the body. It is often used as a diluent for blood and blood products because it is compatible with these substances and does not increase the risk of adverse reactions or complications.

Adding other solutions or products to blood or blood products can alter their composition and increase the risk of adverse reactions, such as transfusion reactions, allergic reactions, or infections. For example, adding medications or other substances to blood products can increase the risk of medication errors and other complications.

In some cases, healthcare providers may need to add a medication or other substance to blood or blood products to meet the specific needs of the patient's treatment plan. When this is necessary, it is important to carefully follow established protocols and guidelines to minimize the risk of adverse reactions or other complications.

Overall, the addition of any solution or product to blood or blood products should only be done under the direction of a healthcare provider with appropriate training and expertise in transfusion medicine.

Golden rules for NURSES

21. Maslow’s hierarchy of needs must be met in the following order: physiologic (oxygen, food, water,sex, rest, and comfort), safety and security, love and belonging, self-esteem and recognition, and self- actualization.

Maslow's hierarchy of needs is a theory that suggests that human needs can be organized into a hierarchy, with lower-level needs taking priority over higher-level needs. According to Maslow's theory, the hierarchy of needs must be met in a specific order, with lower-level needs needing to be met before higher-level needs can be addressed.

The hierarchy of needs includes the following levels, in order from lowest to highest:

Physiological needs: These are the most basic needs, including the need for oxygen, food, water, shelter, sleep, and other bodily needs.

Safety needs: Once physiological needs are met, individuals have a need for safety and security, including physical safety, financial security, and stability.

Love and belonging needs: After safety needs are met, individuals have a need for love, affection, and a sense of belonging, including relationships with family, friends, and community.

Esteem needs: Once the need for love and belonging is met, individuals have a need for self-esteem and recognition from others, including achievement, status, and respect.

Self-actualization needs: Once all of the other needs are met, individuals have a need for self-actualization, including personal growth, self-fulfillment, and realizing their full potential.

In order to meet higher-level needs, lower-level needs must first be met. For example, an individual who is hungry and thirsty will not be able to focus on safety needs until their basic physiological needs are met. Similarly, an individual who is struggling to find a sense of belonging may have difficulty focusing on self-esteem needs until they feel a sense of connection with others.

By understanding Maslow's hierarchy of needs, healthcare providers can better understand the needs and priorities of their patients and develop treatment plans that address their most pressing needs first. This can help promote better outcomes and improve patient satisfaction.

Golden rules for NURSES

22. To avoid staining the teeth, the client should take a liquid iron preparation through a straw.

To avoid staining the teeth, it is recommended that the client take a liquid iron preparation through a straw. Iron supplements can cause staining of the teeth, which can be unsightly and difficult to remove. By using a straw to take the supplement, the liquid can bypass the teeth and reduce the risk of staining.

In addition to using a straw, there are other strategies that can help minimize the risk of staining from iron supplements. For example, the client can rinse their mouth with water after taking the supplement to help remove any residual liquid from the teeth. They may also want to avoid brushing their teeth immediately after taking the supplement, as this can actually spread the iron around and increase the risk of staining.

If the client does experience staining from the iron supplement, there are several options for addressing the issue. One approach is to switch to a different form of iron supplement, such as a tablet or capsule, which may be less likely to cause staining. Alternatively, the client may be able to use a whitening toothpaste or receive professional teeth whitening treatment to help remove the stains.

Overall, while liquid iron preparations can be an effective treatment for iron deficiency, they can also cause staining of the teeth. By using a straw and taking other steps to minimize the risk of staining, clients can help ensure that they receive the benefits of iron supplementation without experiencing unwanted side effects.

Golden rules for NURSES

23. Fluid oscillation in the tubing of a chest drainage system indicates that the system is working properly.

Fluid oscillation in the tubing of a chest drainage system does not necessarily indicate that the system is working properly. In fact, fluid oscillation can be an indication of a problem with the system that requires attention from healthcare providers.

A chest drainage system is typically used to remove excess air or fluid from the pleural space in the chest. The system consists of a drainage tube, a collection chamber, and a series of tubing that connects the drainage tube to the collection chamber. The tubing is often clear, allowing healthcare providers to observe the movement of fluid and air through the system.

Fluid oscillation refers to the movement of fluid back and forth in the tubing of the chest drainage system. While some oscillation is normal and can indicate that the system is functioning properly, excessive oscillation can be a sign of a problem. For example, if there is a blockage in the tubing or collection chamber, fluid may be unable to flow freely and can cause increased oscillation. Similarly, if the drainage tube is not properly inserted into the pleural space, air may be drawn into the tubing and cause oscillation.

If a healthcare provider observes excessive fluid oscillation in a chest drainage system, they may need to take steps to address the underlying issue. This may involve adjusting the placement of the drainage tube, clearing any blockages in the tubing or collection chamber, or replacing a malfunctioning component of the system.

Overall, while some fluid oscillation in the tubing of a chest drainage system can be normal, excessive oscillation can be a sign of a problem that requires attention from healthcare providers.

Golden rules for NURSES

24. The type of assessment that includes data related to a client’s biological, cultural, spiritual and social need is called Comprehensive Assessment.

The type of assessment that includes data related to a client's biological, cultural, spiritual, and social needs is indeed called a comprehensive assessment.

A comprehensive assessment is a holistic approach to assessing a client's health status that takes into account various aspects of their life, including their physical health, cultural background, spiritual beliefs, and social environment. By gathering information on these different factors, healthcare providers can gain a more complete understanding of the client's health status and develop a care plan that addresses all of their needs.

In a comprehensive assessment, healthcare providers may gather data through a variety of methods, including interviews, physical exams, laboratory tests, and observation of the client's behavior and interactions with others. They may also use standardized assessment tools to gather information on specific aspects of the client's health, such as their mental health status or their risk for falls.

Overall, a comprehensive assessment is an important tool for healthcare providers in understanding their clients' needs and developing an effective care plan that addresses all aspects of their health and well-being.

Golden rules for NURSES

25. The Vital Signs are: 1. Temperature, 2. Pulse, 3.Respiration, 4. Blood pressure, and 5. Pain.

The vital signs are indeed a set of important measurements that healthcare providers use to assess a client's overall health status. The five vital signs are:

Temperature: The measurement of the body's core temperature. Normal body temperature ranges from 97.7°F to 99.5°F (36.5°C to 37.5°C).

Pulse: The measurement of the heart rate, or the number of times the heart beats per minute. A normal pulse rate for adults is between 60 to 100 beats per minute.

Respiration: The measurement of the breathing rate, or the number of breaths taken per minute. A normal respiration rate for adults is between 12 to 20 breaths per minute.

Blood pressure: The measurement of the force of blood against the walls of the arteries as the heart pumps blood throughout the body. Blood pressure is expressed in two numbers, with the systolic pressure (the top number) indicating the pressure when the heart beats, and the diastolic pressure (the bottom number) indicating the pressure when the heart is at rest. A normal blood pressure reading for adults is typically around 120/80 mmHg.

Pain: The subjective experience of discomfort or distress. Pain is assessed using various scales, such as the numeric rating scale (NRS) or visual analog scale (VAS).

Overall, the vital signs are important indicators of a client's overall health status, and healthcare providers regularly assess these measurements to monitor changes in the client's condition and develop an effective care plan.

Golden rules for NURSES

26. Heat loss due to contact with circulating air movement is known as Convection.

Yes, that is correct. Convection is the transfer of heat from a surface to a fluid (e.g. air or water) that is moving. When air moves over a surface, it carries away heat, causing the surface to cool.

This is why we feel cooler when there is a breeze or wind blowing, even if the air temperature is the same.

Convection is an important factor to consider when designing heating and cooling systems, as well as in understanding the behavior of the atmosphere and oceans.

Golden rules for NURSES

27. The range of marking in glass/clinical thermometer is 95-110° F and 35-43.3°C.

Glass or clinical thermometers typically have a range of markings from 95-110°F (Fahrenheit) and 35-43.3°C (Celsius), which is the normal range of human body temperature.

The thermometer works by using a liquid, usually mercury, that expands or contracts as it is heated or cooled.

The length of the liquid column inside the thermometer changes depending on the temperature, and this is what is used to determine the temperature reading.

It is important to use the thermometer correctly and to read the markings accurately to get an accurate measurement of body temperature.

Golden rules for NURSES

28. Normal Rectal temperature is 99.6° F (37°C) (1°F ) higher than oral temperature)

The normal rectal temperature is generally considered to be about 1°F (0.6°C) higher than the normal oral temperature, which is typically around 98.6°F (37°C).

This is because the rectum is a more accurate indicator of core body temperature, as it is located closer to the internal organs and is not affected by external factors such as food or drink.

However, rectal temperature measurement is generally reserved for medical purposes and is not recommended for routine temperature checks at home.

Oral temperature measurement is a more convenient and less invasive method that can provide a good approximation of core body temperature.

Golden rules for NURSES

29. Rectal temperature is the most reliable

Rectal temperature is generally considered to be the most reliable method of measuring body temperature because it provides a more accurate reflection of core body temperature.

This is because the rectum is located in the central part of the body, close to the internal organs which generate heat, and is not affected by external factors such as food or drink.

However, rectal temperature measurement may not be suitable for all individuals, especially for those who are uncomfortable with the procedure, those who have certain medical conditions, or those who have undergone rectal surgery.

Oral temperature measurement is a convenient and non-invasive alternative that can provide a good approximation of core body temperature for most people.

Other methods of temperature measurement include axillary (underarm) measurement, ear measurement, and forehead measurement, which may be suitable for certain populations or situations.

Golden rules for NURSES

30. Relapsing fever: Fever episodes are separated by intervals of normal temperature for days or weeks

Relapsing fever is a type of fever caused by certain bacterial infections, such as Borrelia species.

The fever episodes in relapsing fever are characterized by sudden onset of high fever, chills, headache, muscle aches, and other flu-like symptoms.

These episodes typically last for several days to a week or more, and are then followed by a period of normal temperature, which can last for days or weeks.

During the periods of normal temperature, the patient may feel completely well and may not have any symptoms.

However, the fever episodes can recur, often with different symptoms or severity, leading to a relapsing pattern of illness.

Treatment for relapsing fever typically involves antibiotics, such as doxycycline or penicillin, and may require several courses of treatment to fully eradicate the bacteria.

Golden rules for NURSES

31. Rigor: Sudden rise in body temperature with shivering as seen in malaria.

Rigor is a medical term used to describe a sudden onset of fever with chills and shivering. In the context of malaria, rigor is a common symptom that occurs during the febrile (fever) episodes, which are a hallmark of the disease.

Malaria is a parasitic infection caused by Plasmodium species, which are transmitted to humans by the bite of infected mosquitoes.

The febrile episodes in malaria are typically cyclical, with sudden onset of high fever, rigor, and other flu-like symptoms such as headache, muscle aches, and fatigue.

The fever may last for several hours to a few days, and is then followed by a period of normal or subnormal temperature.

The cyclical nature of the fever episodes is a key diagnostic feature of malaria, and helps to distinguish it from other febrile illnesses.

Treatment for malaria typically involves antimalarial medications, such as chloroquine, artemisinin-based combination therapy (ACT), or other drugs depending on the species of Plasmodium involved and the location of the infection.

Golden rules for NURSES

32. Increased depth of breathing with normal respiratory rate is called Hyperpnea.

Hyperpnea is an increase in the depth and intensity of breathing, without an increase in the respiratory rate.

It is often seen during exercise or other physical activity, as the body needs more oxygen to meet the increased demand.

It can also occur in response to certain medical conditions, such as metabolic acidosis or congestive heart failure.

Golden rules for NURSES

33. Cheyne-Stokes Respiration is characterized by altered period of Tachypnea and Apnea.

Cheyne-Stokes respiration is a type of abnormal breathing pattern that is characterized by a cycle of alternating periods of tachypnea (rapid breathing) and apnea (temporary cessation of breathing).

The cycle typically lasts between 30 seconds to 2 minutes, and can be seen in patients with various medical conditions, such as heart failure, stroke, and traumatic brain injury.

It is caused by an abnormality in the respiratory centers in the brain, which affects the regulation of breathing.

Golden rules for NURSES

34. Pulse deficit refers to the difference between apical pulse and radial pulse.

Pulse deficit is a condition where there is a difference between the apical pulse (the heartbeat heard through a stethoscope over the apex of the heart) and the radial pulse (the pulse felt at the wrist).

It occurs when some of the heartbeats are not transmitted to the peripheral arteries, leading to a discrepancy between the apical and radial pulse rates.

Pulse deficit can be caused by various medical conditions, such as atrial fibrillation, premature ventricular contractions, and heart block. It is often an indication of an underlying heart problem and should be evaluated by a healthcare provider.

Golden rules for NURSES

35. A Blood Pressure Cuff that is too large will give a falsely low reading of BP.

No, that is not correct.

A blood pressure cuff that is too large will actually give falsely high readings of blood pressure.

This is because the cuff will not be able to adequately compress the artery, leading to an overestimation of the blood pressure.

Conversely, a cuff that is too small will give falsely low readings of blood pressure, as it will compress the artery too much, leading to an underestimation of the blood pressure.

It is important to use the appropriate size of blood pressure cuff for accurate readings of blood pressure.

Golden rules for NURSES

36. Beneficence: Doing good for clients and providing benefits balanced against risk.

Beneficence is one of the four main ethical principles in healthcare, which refers to the obligation of healthcare providers to do good and to promote the well-being of their clients.

This principle requires that healthcare providers act in the best interests of their clients and provide care that maximizes benefits and minimizes risks.

Beneficence also requires that healthcare providers make decisions that are based on the best available evidence and that they continually seek to improve the quality of care that they provide.

Balancing the benefits of treatment against the risks is an important aspect of beneficence, as healthcare providers must weigh the potential benefits of a particular treatment against the potential risks and side effects in order to make informed decisions about the best course of action for their clients.

Golden rules for NURSES

37. Isotonic solutions allow free movement of water across the membrane without changing concentration of solutes on either side. E.g. 0.9% NaCl.

An isotonic solution is a solution that has the same concentration of solutes as the fluid inside the cells of the body.

When an isotonic solution is administered, water moves freely across the cell membrane in both directions, without changing the concentration of solutes on either side of the membrane.

This is because the concentration of solutes in the isotonic solution is equal to the concentration of solutes inside the cells, so there is no gradient to drive the movement of water in one direction or the other.

One example of an isotonic solution is 0.9% NaCl (normal saline), which is commonly used for intravenous fluid administration to replace lost fluids and electrolytes in the body.

Golden rules for NURSES

38. Hypertonic solution: Fluids with solutes more concentrated than in cells, e.g. 5% dextrose.

No, that is not entirely correct.

A hypertonic solution is a solution that has a higher concentration of solutes than the fluid inside the cells of the body. When a hypertonic solution is administered, water moves out of the cells and into the extracellular fluid, causing the cells to shrink.

This is because the concentration of solutes in the hypertonic solution is greater than the concentration of solutes inside the cells, creating a gradient that drives the movement of water out of the cells.

An example of a hypertonic solution is 3% saline, which is used to treat hyponatremia (low sodium levels). 5% dextrose is actually an isotonic solution, because dextrose (a form of glucose) is rapidly metabolized by the body, leaving only water and a small amount of electrolytes in the solution. When 5% dextrose is administered, it initially acts as an isotonic solution, but once the dextrose is metabolized, the remaining fluid becomes hypotonic (lower concentration of solutes than inside the cells).

It is important to note that the effects of hypertonic and hypotonic solutions on the body depend on the concentration of the solutes in the solution, as well as the rate and volume of administration. Administration of hypertonic or hypotonic solutions must be carefully monitored to avoid adverse effects on the body.

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purplesurveys · 5 years ago

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633

If you had a parrot, what would be the first word you would teach it? I’d probably teach it something polite because I’ve noticed all parrot owners almost always teach their birds bad words lmao and it’s not that funny anymore. I wouldn’t be opposed to teaching them some lame slang too, like ‘it’s lit’ haha.

What food have you eaten the most lately? Instant noodles because my mom finally gave in to our requests and started buying packs of our favorite brand again. Some context: it was almost all we ever ate as kids, so she stopped buying it for a while (and rightfully so) because of all the unhealthy stuff that’s in it.

Where you ever a Pokemon fan? I was a huge fan from the ages of 8-10. It started when my cousin got Pokemon games on his Gameboy Advance, and then it spilled over to us watching the anime every night and eventually, I collected the cards and pogs as well. We also bought one of two volumes of the Pokemon Omnibus books that they released.

How would you describe the taste of water? It’s just tasteless to me, but then it tastes so refreshing. I know water isn’t good enough if there’s a certain taste that comes along with it, because it’s supposed to just be tasteless and crisp.

Do you think books are going out of fashion? Not at all. All my friends are into reading, and they never grew out of their bookworminess. Which is honestly great, because I wouldn’t want them to end up like me, who was a big bibliophile as a kid but eventually stopped reading.

One thing you miss about being a kid: Being able to make friends with anybody, whether it be a day-long bond or a friendship for the long run. I know it’s not applicable to all kids, but I’d say I was one of those who was able to blend in at birthday parties or daytrips to water resorts and all that stuff.

What is the best product made from milk? Meh, I’m not the best person to ask about this given that I’m lactose intolerant lololol, but I doooooo love mozzarella and ricotta cheese.

How would you feel if your husband didn’t want to wear a wedding ring? I’d be pretty puzzled if my future spouse wouldn’t want to wear theirs. I’d understand if they removed it for work, but I’d raise eyebrows if they didn’t want to wear it, period.

Do you say Autumn or Fall? My Southeast Asian ass can’t relate to either.

What is your biggest “what if”? I don’t have any, because I make it a point to avoid thinking about them. I’ve heard so many of my friends mull over their what ifs and how miserable they are about them, so I know better than to dwell on mine.

What is the worst movie you have ever seen? I had a go-to answer for this many years ago, but I forgot the name of the movie by now and I’m honestly glad that’s the case. But other than that, one of the all-time worsts is the Jack & Jill movie with Adam Sandler, and a recent bad one (for me) would be Knives Out. Of course, I never liked whodunits and I generally dislike dialogue-y and fast-paced movies, so I’m pretty biased in citing that.

Have you ever spelled your own name wrong? I don’t think so. Mine was the less popular spelling of Robin, so I definitely remembered to spell it properly because everyone else was already misspelling it.

What do you want your wedding song to be? I’ve never given much thought about this. Sparks by Coldplay was one of our og songs, but the most that it is right now is just a mere option.

What is your favorite fairytale? I never liked fairytales.

True/False : If it’s meant to be, it will be. Not always. You have to work for it sometimes, too.

What electronic of yours dies the quickest? My phone, but that’s just because I had to pick and because, to be fair, I use it too much :(((( But I’m okay with the battery lives of all my gadgets.

Do you think we learn some useless things in school? Math and English have been pretty useless to me, but a lot of my other lessons, such as history, economics, physics, etc. still come in handy these days.

Do you feel like your life would be better without a certain person in it? Not really. I’m okay with the people I have now, family and friends alike. I tune out who I choose to tune out, and that’s enough for me.

Who has influenced your music taste the most? Athenna was a huge influence, which I feel bittersweet about now because I had to cut her out of my life a few years ago. She introduced me to Banks, Walk the Moon, and Twnety One Pilots, among other amazing artists. Gab has also been pretty influential – she’s made me a fan of alt-J, BP Valenzuela, Hozier, and a bigger fan of Coldplay.

What did you get your mom for Mother’s Day? We don’t really get her stuff. We greet her and have quality time together.

You go to the restroom and you see a huge spider, what do you do? Try to swat it out of the way.

what’s something you want but will probably never get? A PhD, because I’m too lazy to earn one haha.

Do you like reading scary books? I did enjoy reading my cousin’s Goosebumps as a kid, but I’m not into reading in general these days.

Is there a game your addicted to you? Currently, Luigi’s Mansion 3. <– Yooooo, my sister is OBSESSED with this game and watches playthroughs of it all day. She’s eyeing it as one of the next few games that we’re buying for the Switch.

Do you get embarrassed when your stomach growls in class? No. If anything that lets the teacher or prof know that I’m bored and/or hungry. Plus it’s an easy way to make the class laugh, and that’s always a good thing haha.

Do crying people make you uncomfortable? If it’s happy tears than yeah hahaha. If they’re sad tears I’m usually willing to be a shoulder to cry on. Would you ever marry someone your parents didn’t approve of? It’d be hard, but in the end it’s my relationship and they’d have no say.

Whats one thing you’re completely terrible at? Knitting. Origami. Any art stuff.

what is the nearest thing to you that is red? I’m very close to the wifi thingy that we have up on the rooftop and there’s a small red light coming from it.

what kind of camera do you own? I just use the one in my phone.

Do you look older or younger than your actual age? Younger. I’ve memorized the look of shock on people’s faces whenever I tell them I’m a senior in college.

Do you think tattoos are hot? No, but I don’t mind some tattoos.

What’s the worst thing about being a teenager? The confusion, all the hormones making you cranky all day, the pressure of which course to take for college especially when you’re nowhere near ready to make a choice.

What’s the best thing about being a teenager? It’s a period of experimenting, making strong friendships, and making mistakes and learning from them.

When did you last play Monopoly? I’ve never played Monopoly because I’ve never understood how it works.

Who do you trust with your secrets? My two best friends.

As a child what celebrity did you look up to? Probably Vanessa Hudgens back in her High School Musical days? Idk, she seemed like a good role model at the time.

Do you love food more than you love people? I probably do, haha.

True or False: you this read wrong Yup.

What do you usually do on a Sunday? My family goes to 9 AM mass, then we head out for lunch, go malling for a bit, take my sister back to her dorm in Manila, then we spend the rest of the evening at home.

Have you ever met anyone with the same Birthday as you? Yes.

Do you think underwater pictures look cool? I’ve never liked underwater photos ever since I saw that photo of that vacationing scuba diving couple with the dead girl in the background.

What is the most ridiculous law you ever heard about? Nothing comes to mind right now.

Zelda or Mario? Zelda (or Link, if you’re talking about the dude) story-wise, Mario for playability haha.

#survey #surveys

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ganeshwalagaurav · 4 years ago

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Home blood pressure monitoring and BP control-1

In a healthy person, blood pressure rises and falls throughout the day. But pressure higher than normal for a long time can damage health and cause health problems. In India, hypertension is poorly controlled and many hypertensive patients are living with a disability or affected with cardiovascular disease.

Current data suggest that efforts are needed to support self-monitoring in hypertensive patients because it plays important role in the management of hypertension along with medical therapy.

Why self-monitoring at home is needed?

Hypertension for a longer period can damage the heart, kidney, and brain. Patients with high blood pressure are at higher risk of complications like heart attack, heart failure, stroke, kidney failure, and many others. Hence to avoid these complications regular BP monitoring is very important. Some of the hypertensive patients check their blood pressure by visiting doctors. But, it is not always possible for patients to visit doctors and check-up their blood pressure. Hence, most often we advise patients to self-monitoring of their BP levels.

How self-monitoring can be done at home?

Firstly, understand the correct way to take a blood pressure reading. It can be done by using home blood pressure monitoring (HBPM) devices, typically known as sphygmomanometers. It records blood pressure across different points in a time outside of a clinical or community setting, mainly at home.

A blood pressure reading involves two numbers as 120/80 mmHg for a normal healthy person:

(1) The top number 120 indicates systolic blood pressure; it is the pressure in the blood vessels when the heart beats.

(2) The bottom number 80 represents diastolic pressure; it is the pressure in the blood vessels when the heart rests between the beats.

The blood pressure level for a hypertensive person is 140/90 mmHg. If a person has greater BP than this, then he/she might be at risk of developing heart diseases. Blood pressure varies during the day: it is highest after waking for short time and lowest at night. Therefore, when comparing results, it is important to compare readings that were taken at the same time of day.

Benefits of self-monitoring

Self-monitoring helps a person to measure BP at different times throughout the day and over a longer period. It also assists a doctor to get a more complete picture of a person’s blood pressure readings at different times. It can better predict cardiovascular morbidity and mortality rather than single, routine blood pressure measures that occur during a clinical visit. Let me brief some more benefits of home blood pressure monitoring.

Avoiding false diagnosis

Ø Research involving 24-hour ambulatory blood pressure monitoring indicates that most people experience two peaks in their blood pressure each day, typically between 6 and 8 AM and later between 5 and 8 PM.

Ø Blood pressure is typically elevated by 30 to 50 mmHg during these peak periods.

Ø Some patients with early hypertension may only experience higher blood pressure during one of the peak periods.

Ø Because these peak periods fall outside of normal schedules of doctor’s appointment times, could go without a diagnosis.

Ø Thus, self-testing provides the opportunity to measure BP during these peak periods and helps the doctor identify early-onset hypertension.

Identifying white coat hypertension

Ø Some of the individuals experience higher BP, when in a medical setting due to the stress of being in the doctor’s clinic or hospital.

Ø Self-testing is an effective way to rule out such type of situational high blood pressure known as “white coat hypertension”.

Ø At-home testing helps to identify the situational elevation in BP, and also helps to track daily blood pressure readings.

Monitoring treatment outcomes

Many individuals experience various symptoms when dealing with hypertension. Regular monitoring at home practically helps to create a baseline for such symptoms and provides valuable information regarding treatment outcomes which help doctors in drug and dosage adjustment.

Observing complications and emergency treatment

Home-based monitoring can also help in detecting complications and delivering needed emergency treatment. Individuals with hypertension may suffer from different complications, including diabetes, heart disease, hyperlipidemia, kidney disease, hyperthyroidism, etc. If the hypertensive patient is present with such other complications, then strict BP control is required. For example, If a person has general hypertension, then needs to regulate blood pressure at 140/90mmHg; however, if the hypertensive person also has diabetes or kidney disease, then needs to control at 130/80mmHg levels.

#heart disease treatment in pune #Best Cardiologist in Pune #Heart Clinic in Pune #Heart Specialist In Pune #Angioplasty Surgery In Pune

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thejamaicanweeb · 5 years ago

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Mitosis - Soul Division Lesson 1-1: Orientation Daze

Hello Friends! Here is the prologue to this fan fiction!

https://tinyurl.com/obey-me-mitosis-prologue

And here is the link to the previous part!

https://tinyurl.com/mitosis-fic1-1

And finally, thank you so much for continuing to read! It means a lot =3

Jan 6th 2020, Sunday

Like after the meeting with the Dean, all the planning and packing and saying goodbye everything felt so freaking surreal but at least I can finally identify how else I feel. That’s right folks, I’m pissed as fuck.

I mean, I was terrified. Like on the verge of collapsing terrified, but I’m also pissed. And tired. Hella tired. Today has been long. Longer than any day I've ever gone through, and man, I have been through some days before, can I tell yuh? The last thing I remember was trying my best to keep my crying quiet as Mummy and Daddy drove us to the airport. I must’ve really looked like a wreck cause Matthew held my hand the whole time and he isn’t a touchy-feely person in the slightest. Like at all. There he goes, being the mature one when he’s supposed to be my baby brother. After a while, I had stopped crying and began looking around at everything and everyone and everywhere. An entire year. It will be an entire year. What if I forget about my likkle island, ee? [ee: huh] I wanted to remember as much as I could.

Then I woke up in Hell.

No, yup. I’m not kidding. I woke up in Hell. Heck. The Bad Place...or the “Devildom” which is what these people are calling it.

I didn’t get to say “goodbye” or “I love you”.

Suffice to say, my initial feeling when I woke up was not a happy one.

I woke up with a jolt, with that same heart-pounding, adrenaline-fueled awakening you get when you have a nightmare about falling. My hands flew up to my face, knocking my glasses off. To add insult to injury, my uncoordinated ass poked myself in the eye. FML.

"OW! What the ever-living frick-" I grumbled, squinting around with my other eye to find them. Thankfully, they hadn't gotten far. I bent over, rubbed them with the corner of my T-shirt and put them back on.

Nothing could have prepared me for what I was about to see when the world snapped back into focus.

The word "room" seemed inadequate to describe the gargantuan space I was in. Huge vaulted stone ceilings arched high above me, reminding me of all the pictures of cathedrals (I know, 'llow me nuh [leave me be]). The sheer scale of it made me feel tiny. I glanced at one of the tall narrow windows and did a double-take, blinking hard.

Nope, I'm not crazy. That is definitely the night sky. Am I dreaming?

Did I reach already? Did I fall asleep without telling mom and dad I reached? Oh crap.

I knew that I needed to call and let them know that I was ok, but stringing my thoughts into commands that were coherent enough for my limbs to carry out was proving to be quite a challenge. My head was pounding, the pain behind my eyes warning me I was teetering on the edge of a migraine. Reflexively, I reached for my medicine bag. If I get to the Panadol quickly enough, I might be able to fend it off before it gets any worse. No way I'm about to spend my first day in this unknown country throwing up in a dark room.

Aaaand I couldn’t find my bag.

The idea that my inhalers, allergy meds, BP meds, my *phone*, my *passport* weren't close by made my stomach churn and knot up with anxiety. My already fast breathing got worse. Not exactly what someone wants when you're trying to avoid an attack. I took my glasses off and closed my eyes, willing my surroundings to return to normal. Alas, when I cracked one eyelid open to peak, there was no difference. I groaned and shut them back again.

Focus Sinai. Breathe. Now, what's the last thing you can remember?

I wracked my brains but I couldn't remember anything beyond driving on Palisadoes Strip to the airport. Don't remember saying goodbye, checking onto the flight; nothing like that. The only seemingly logical conclusion was that I was dreaming. I nodded off during car rides all the time, and Lord knows I've had way more bizarre dreams than this.

So I figured all I have to do is wake up. Simple, right?

I have never been more wrong in my entire life.

I put my glasses back on and took another look around; more details of my surroundings coming to my attention. I was on a wooden chair that was ornately carved and sturdy. Judging by the (lack of) feeling in my butt, I was probably sitting in it for a long while. I slowly tried to stand up, but my legs weren't having it.

"Woah! Crap!" I had to grab onto the chair handles to keep from falling over as my knees buckled and the pins and needles feeling prickled at the soles of my feet.

As I waited for my legs to work like they used to before (I'm sorry, I had to) I got the biggest shock so far at the time. I was too busy looking up and around me that I missed what was going on right in front of my nose.

In front of me were 8 wooden chairs, larger and grander than the one I was using for support. The way they were set up kinda reminded me of a courtroom. One was on a dais that was higher than the other seven, which were side by side in a row. Above each of the seven chairs were tapestries with different creatures.Yeah, I know beautiful; but the goddamn tapestries weren't the problem. It was the five strangers that were staring straight at me.

The anxiety twisted into genuine fear. Every news report I have ever seen heard or read about sex trafficking and abduction and murder came to mind with an irritatingly high level of clarity. I slowly shifted to stand behind my chair, my pulse rushing hard and fast enough to drown out everything other than my now frantic thoughts. The ground beneath my feet began to feel like it was shifting. You know damn well yo' girl held into that damn chair for dear life 'cause droppin' down jus' suh in front of a bag a people mi deeven know? No sah. [fainting in front of strangers? Hell no.]

In hindsight, now that things have settled down it's not like I coulda done much if dem did try fi do me sumn stillz. My one, deggeh deggeh self against five men. All worse it turns out they weren't what they appeared to be? Anyway, I digress.

[There wasn’t anything I could really do if they tried to attack me. Me, on my own against these guys?]

The man sitting on the highest chair stood up and began to walk down from the platform towards me. My heart sank when he drew closer. He was huge. Not just height-wise, but he was built with enough solid muscle that even the conservative bright red military jacket.... coat.... thing.... he wore couldn't hide it. I wouldn't have been surprised if he could pick me up with one hand and I'm not the lightest person. I involuntarily took a step back, causing the chair legs to scrape across the stone slabs.

Ok, I think that I can get good enough leverage to lift and swing this is this guy tries anything... afterwards...well I'll work that out when I come to it.

He stopped a few feet from me. I could see his face clearly now. His auburn hair lay on his forehead with his left sweeping bangs nearly covering his bright, golden-brown eyes. His nails were painted black, but what stood out the most was the gentle smile on his face. His arms were open in the universally known "I mean you no harm" gesture. I let go of the back of the chair.

Now I know, I know. I'm naïve, stupid, overly trusting. Whatever. You're probably right; but for whatever reason, at that moment I had a gut feeling that this guy wasn't going to hurt me. I mean, he could have when I was unconscious, right? Fuck, maybe he could even tell me what the heck was going on here.

"Welcome to the Devildom, Sinai"

Aaaaand there goes my little bubble of trust ‘cause how on earth does he know my name? Did he jack my ish? I shivered and started to look around again, keeping an eye out for possible escape routes this time.

No such luck. See here's the problem. There is no "flight" option for me under the best of circumstances. Yo' girl is *not* a runner. I can kick, I can punch but I cannot run. The closest set of doors were these towering heavy-looking dark stained wooden ones that I wasn't even sure I could budge; let alone throw open and run through them. Plus, I'm pretty sure that this guy would be able to catch me without even needing to run.

My lack of response and the look on my face was clearly a dead giveaway to the guy that I was T-Minus 10 seconds from completely and utterly losing my shit. He crossed his arms, his eyebrows drawn together in what seemed like genuine concern.

"Feeling a bit shocked, are we?"

No shit Sherlock! I had to literally bite my tongue to stop myself from expressing *that* particular sentient aloud. And while we're at it, WTF is a 'Devildom'?

"As a human, it will probably take a little while for you to adjust to things here in the Devildom.”

Pop quiz guys! What do you think the phrase "As a human" implies here?

That's right! This guy was something other than a human being!

I was fully waiting (And hoping. And praying) for a hidden camera crew to appear, laugh at me and send me along my merry way. Just something, anything that made more sense than what was happening right now.

"The Devildom?" I heard myself parrot back at him, hating how high pitched and false my voice sounded. I swear that it jumps up a whole octave when I'm stressed.

The man... can I even still call him that after that whole human comment? Anyway, he smiled and nodded at me encouragingly.

"Yes, exactly the Devildom. I can see you catch on quickly. Excellent"

"I wouldn't exactly call that 'catching on' Imma be real with you chief," I muttered softly enough for him to miss.

"My name is Diavolo."

Finally, a name. Why not lead with that fam? I nodded and gave him a brief, tight-lipped smile only for his next statement to bring me to a screeching halt mentally, physically, shit, even spiritually.

"I'm the ruler of all the demons and all here know of me"

The note of authority and pride were so clear, I believed him with no doubt.

A wave of nausea that had nothing to do with my impending crushed me like a tsunami.

Now I will not lie, it's been a good while since I've been to church. I grew up Anglican and may have forgotten a lot of stuff, but I was pretty damn certain that the general idea was to end up high above in the clouds, not underground or wherever. My hands started trembling and my palms were sweating. The buzzing in my ears made everything else seem fuzzy. I needed to listen to these warning signs. I needed to get out of there and fast, otherwise I would be a crying, hyperventilating ball of absolute panic. Lord knows how long. I kept screaming at myself to calm down, but I could. Not. Get. A. Grip.

Did I die? Am I dead?

Is my family dead? Where are they?

Was that the last time I've seen Mummy and Daddy and Mattie again?

Oh, God. Oh my God. Lawd 'ave mercy. Is whe mi do? What did I do?

Shadows appeared at the edges of my vision like little blobs of ink. My heart was making my chest ache, it was going so fast. Much too fast, it can't sustain this. I would die. I knew it. If I hadn't died, I certainly was going to then. Or maybe that's what Hell... the Devildom is. Dying over and over again.

I didn't even feel myself being lead through a pair of glass doors onto a balcony until the cool breeze caused my skin to come to life with goose pimples. Diavolo had led me outside. For a terrifying moment my frenzied, irrational lizard brain swore that he was going to push me over the edge, but no. He had just put an open palm on my back to steady me. He bent down to get closer to my level.

"Sinai, I know this must be scary and a terrible shock and I offer my sincerest apologies for that," he said quietly, his eyes earnest. I nodded jerkily, a puppet with an anxious puppeteer. "Breathe. I'm not going to hurt you."

He straightened back up and gestured to the view below speaking out loud, making it seem like he had simply intended to show me the different parts of the campus. For that I was grateful. I closed my eyes and took some deep breaths. I focused on the feeling of the balcony railing I was gripping on to. I focused on the warmth of the hand pressed to my back. I focused on the cool night air of the foreign land with a combination of smells that woke me up and bewitched me at the same time. I opened my eyes so I could truly take in the sprawling kingdom... Devildom in front of me. Windows of buildings glowed every hue imaginable. A castle with huge spires towered over the immediate town and mountains silhouetted by the moon towered over that. As afraid as I was, I had to admit that the sight was breathtaking. I was calm enough to sit down and list things I was fairly certain of.

Ok so here we go

1. I'm not dead. (...at least not right now. Ugh, stop being dramatic)

2. I'm not dreaming either

3. I don't seem to be in any immediate danger

It took me a moment to realize that Diavolo had stopped talking.

"Do you have any questions, Sinai?"

Fifty thousand and one of them. But the one I wanted to be answered most urgently was overridden by a query so bizarre yet important if I really was in a foreign land.

“Was I decontaminated before you bought me to this place?”

Diavolo frowned and glanced at the others sitting in the chairs. Everyone looked baffled. Not a good sign.

“... No… why would that be necessary?” the prince’s voice was slow and calm, but the concern on his face refused to be hidden.

I stepped back, away from him and the others. I didn’t even have on my mask, Mummy had had me wearing one from the get-go since I was part of the “at-risk” population.

“There’s a virus that’s going around. Like spreading everywhere, fast. I don’t wanna bring it here. I mean, I don’t have it, but just to be safe…”

I trailed off since I had started stumbling over my own words too much to be making much sense. The room was silent before they started laughing. Now I was confused. Diavolo (much to my eternal shame) ruffled my hair.

“Hey!” my voice cracked and came out as a squeak. I felt my face warming up. Fight me, damnit! The Prince chortled, completely unbothered.

“Sinai, I’m touched by your concerned but rest assured, it would take a very severe illness to be a serious threat to us.”

"Ok, just making sure,” I mumbled, “So then... why am I here?" At that moment, some movement from the chairs behind Diavolo caught my attention.

"I will explain everything to you."

The goosebumps were back, not because of fear this time. To be honest, I'm still not sure why they came back, but come back they did. This man's voice was deeper, more aloof. His fair skin was a stark contrast to his ebony hair, and he was within inches of Diavolo's height. When I made eye contact, I inhaled sharply. Black bleeding into burgundy, which then shifted to a bloody crimson. I glanced away, but I still felt like I was being scanned or X-rayed. It was bizarre.

Apparently that man was Lucifer. The Lucifer.

Well, shit. Lord, help me.

Oh well. At least I'd finally be learning what's happening.

ψ(._. )> S T A G E C H A N G E ψ(._. )>

The top half of the door of the RAD bookshop was ajar. It looked forlorn without the demon who normally ran it leaning over the counter. Down the aisles, deep into the recesses of the store, the glow of a laptop caused the merchandise to cast warped shadows on the walls. Two demons scrutinized the screen, the bars representing the popularity contest results reflected in their eyes.

“Huh,” the taller of the two ran a hand through his already messy white hair, “Ya actually managed to pull it off,”

“Told you I got this,” His friend’s bright grin stood out against his rich deep brown complexion His grin shifted into a smug smirk as he leaned back in his chair with his hands behind his head.

Mammon shrugged, shaking his head.

“I just thought it would take a while, ya know?”

“You really think I’d set up an online ballot and not leave a back door for myself?” Mephistopheles snorted, closing the windows. Mammon smirked and gave the shorter demon a high five.

“See, this is why I keep ya around Phis! He crowed as he dropped into the chair beside Mephistopheles, causing it to roll back with his momentum.

“Yeah, it has nothin’ to do with the fact that I work somewhere full of merchandise. Put that watch down, you bastard,” Mephistopheles retorted, the laughter in his voice taking the sting out of his words.

“Can’t get anythin’ past you,” The Avatar of Greed put the yellow-gold timepiece he had been fiddling with back on its shelf. “The flat top works for ya by the way,”

“Oh I know,” The demon was using his front camera to survey his jade-green style “and I was talking about the one from a week ago,”

Mammon froze for a moment, then whirled around.

“What the- how did ya even- did you get cameras installed or somethin’?” he spluttered.

“I didn’t” Mephistopheles admitted, taking a swing from his sports drink “but I do keep track of my stock and something wasn’t adding up…”

Mammon’s mouth was half open in protest, but a good comeback escaped him. He settled for throwing the other demon a look of wide-eyed reproach

“Hey, no fair, you played dirty,” he grumbled.

“Yeah yeah, come get your DDD, it’s ringing,” Mephistopheles said as he scooted backwards, Mammon’s DDD in hand. Mammon snatched it from him as he went past.

“Better answer quick It’s Lucifer” he warned, stopping himself and starting to roll back from where he came from. He cringed, sympathetic, as he saw the blood drain from his friend’s face.

“Good luck,” he said, getting up and sauntering to the storefront.

Mammon hurriedly cleared his throat before sliding the phone icon to the side.

“Yoooo,” he said, his leg jittering up and down.

“Yo, waah g’waan?”

Mammon recoiled and squinted at the phone. No, he didn’t misread the caller ID. The voice certainly wasn’t Lucifer, though. It was friendly with an easy-going accent he was sure he had heard somewhere before, but he couldn’t place it. The fact that the speaker was female was the biggest give away. But it didn’t sound like any of the witches either. His expression darkened as he concluded that he was being duped. He wasn’t amused.

“Are ya foolin’ around? Who the hell are ya?” he demanded.

“Woah, calm yourself an’ watch the attitude, fam” the voice shot back. He heard her sigh, and she spoke again, “Sorry. I’m Sinai?”

Well, that was a name he hadn’t heard in a few millennia…….

“What, you mean like the mountain?”

She snickered “Nah, well I-yes, but actually no… I’m a human, not a geographical feature”

“Ah gotcha,” Mammon replied, nodding before he fully processed what he heard. “Wait what? A human? Why didn’t ya start with that? Had me getting chills over here,” he griped.

He finally let the tension leave his body and he leaned against the wall. His brow unknitted slightly as she laughed softly again.

“Yeah, my bad. Any-”

“So,” he said, cutting her off as he inspected his nails, “what business does a human got with THE Mammon?”

“Oh ‘The Mammon’ huh?” she asked sardonically “Lol aite then. Well, congrats, you’re in charge of me for the next year.”

Mammon snorted as he peeled himself off the wall and began to wander around the store aimlessly

“Human, I don't know who you think you are, but ya got the wrong demon,” A warning note crept into his voice. In the back of his mind he toyed with the idea of just hanging up, but he had to admit he was a bit curious about how this human even knew his number.

“Who are you anyway and whaddya mean by “be in charge of you”?

He met Mephistopheles’ eyes. The stockier demon looked about as baffled as Mammon felt. They both shrugged and Mephistopheles took his computer back to the front with him. He turned his attention back to the phone; the human was saying something else.

“Bruh, why yuh sound more lost than I do? Do I have the wrong number?” she was getting exasperated.

“AAH!” Mammon clapped a hand to his forehead as it finally clicked, “Oh yeah, I remember you’re the other human.”

“Well yeah, who else would I be?”

“Who knows? Anyway, g’luck with that whole babysitter thing. See ya~”

He was about to end the call when he heard other voices in the background from her end of the call. The human said something to someone else before her voice got clearer again.

“Yo, Lucifer wants you,”

Mammon rolled his eyes and let go of the notebook he was absent mindedly flipping through. Not even two minutes into their first conversation and this chick was already shaping up to be a real pain in the ass. Plus, it seemed she was taking him as a joke.

“Pfft whatever,” he said, dismissively, “Ya think that THE Mammon would listen to ya just ‘cause you’re tryin’ to scare me with that name?”

A deep, familiar voice answered instead, making his hair stand on end and sweat start to bead on his forehead.

“You’ve got 10 seconds,” Lucifer’s voice made his stomach sink, “9...8…”

“YESSIR!”

Mammon vaulted over the bottom half of the door, leaving a chuckling Mephistopheles in his wake. He was fuming.

“Get me in trouble with Lucifer right off the bat huh?” he muttered darkly “Just ya wait, human, by the time I’m through with ya you’ll be beggin’ Diavolo to send ya back home.”

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Latest news: Iran launches missile attacks on US bases Criminal proceedings launched by Ukraine Pictured | Three Britons among 176 dead Iran plane crash, in pictures Iran is facing mounting pressure to explain the destruction of a civilian airliner near Tehran hours after Iranian forces launched missile strikes against US forces. Three Britons were among 176 people killed when an Ukrainian International Airlines Boeing 737 plunged into a nosedive and exploded shortly after take-off from Tehran’s Imam Ayatollah Khomeini International Airport on Wednesday morning. Iran dismissed speculation that the aircraft had been downed by a missile but said it would not hand over the black boxes from the aircraft to Boeing, in an unusual move likely prompted by high tensions with the United States. Earlier Ukraine withdrew an initial statement attributing the crash to engine failure and ruling out a terror attack, sparking an international scramble to investigate the crash. The crash came three and a half hours after Iran fired a barrage of ballistic missiles at US bases in Iraq in what it said was revenge for the assassination of general Qassim Soleimani. Iran’s military said it had fired 22 missiles at Iraqi bases housing US troops in Erbil and Ain al-Asad. No US or Iraqi troops were killed in the half-hour bombardment. Leaders in both Tehran and Washington played down the prospect of further armed conflict between the adversaries. In a televised address Donald Trump claimed that Iran "appeared to be standing down" and said he would impose further economic sanctions, but did not mention further military action. Although Iran’s Supreme Leader, Ayatollah Ali Khamenei, termed the strikes a “slap in the face” for America and vowed to continue a campaign to oust US forces from the region, the Iranian foreign minister, said the strikes "concluded" Iran's military response to the assassination of Soleimani. The Ukrainian International Airlines Boeing 737-800 bound for Kyiv took off shortly after 6 AM Tehran’s Imam Khomeini International Airport early on Wednesday morning. Plane crash in pictures Footage filmed by a local man showed the aircraft trailing fire before it dived into the ground and exploded in a large fireball shortly after 6am local time. Din Mohammad Qassemi, a local villager watching the TV said he heard an almighty explosion. Assuming he was under attack from the Americans, he dived below ground into his basement. “All the houses started to shake. There was fire everywhere,” said Mr Qassemi. “At first I thought (the Americans) have hit here with missiles and went in the basement as a shelter.” Dead bodies, fragments of aircraft, and the victims personal belongings were discovered at the crash site near the village of Fedosiye, about 10 miles from the airport. The victims included 83 Iranians and 63 Canadians, according to a flight manifest released by UIA. Ten Swedes, four Afghans, three Germans, and eleven Ukrainians including the nine crew members were also killed. Flags were lowered to half mast in Ottawa and Justin Trudeau, the Canadian prime minister, issued a statement promising to work with allies to ensure a full investigation. Canada does not have an embassy in Tehran. The three British passport holders on board the flight included Saeed Tahmasebi, a chartered Engineer with Laing O’Rourke who was completing a PhD at Imperial College. No survivors reported as Ukrainian passenger jet crashes in Iran He was returning with his wife Niloofar Ebrahim, a fellow Iranian studying Psychology in London, from their wedding in Tehran. Sam Zokaei, 42, an engineer who worked for the BP Exploration Operating Company and lived in Richmond, had been on holiday and had been visiting relatives. Mohammed Reza Kadkhoda-Zadeh, a forty year old father of one from Brighton, had been in Iran to visit family over the Christmas break. Iranian media said both flight recorders had been found, but the investigation into the crash is likely to be complicated by the stand off between the United State and Iran. Ali Abedzadeh, the head of the Iranian civil aviation authority, said the government would not hand over the black boxes to Boeing, a US company, and that it was unclear which country would be asked to analyse them. Iran may have the ability to extract data from black boxes but would have to call on the expertise of one of a handful of countries, including the US, France, and Britain, if they are badly damaged. Western intelligence agencies quoted by Reuters said they shared Iran's initial assessment that the aircraft had not been hit by a missile. Iranian officials said the pilot lost control of the aircraft after a fire struck fire one of its engines. "The rumors about the plane are completely false and no military or political expert has confirmed it," said Gen. Abolfazl Shekarchi, a spokesman for the Iranian armed forces, But aviation experts last night queried whether the plane could have been destroyed by simple engine failure and friends and family of the three British victims demanded an investigation into the circumstances of the crash. David Learmount, Consulting Editor at FlightGlobal, told the Telegraph that the failure of the crew to send out a Mayday signal suggested they faced “a sudden and violent” event that forced them to fight for control of the aircraft. Qassim Soleimani drone strike | Read more “Even a catastrophic engine failure would be highly unlikely to have such a dramatic effect on control of the aircraft. A 737 is capable of flying safely on just one of its two engines,” he said. Ukraine’s embassy in Tehran initially posted but then deleted a statement attributing the crash to engine failure. Later Oleksiy Honcharuk, the Ukrainian prime minister, refused to rule out the possibility that it had been shot down at a briefing in Kyiv. Volodymyr Zelenskiy, the president of Ukraine, said he had dispatched a team of experts including ministry of defence and civil aviation personnel to Iran to investigate the crash and repatriate the remains of the Ukrainians killed. "Our priority is to establish the truth and those responsible for this terrible catastrophe," he said. Boeing said: "We are in contact with our airline customer and stand by them in this difficult time. We are ready to assist in any way needed," the manufacturer said in a statement.” UIA said that the 737-800 that was destroyed was one of its “best” and had undergone maintenance just two days earlier. It said that it could not believe that an error by the experienced crew could have caused the crash. Justin Trudeau, the Canadian prime minister, said his government would “continue to work closely with its international partners to ensure that this crash is thoroughly investigated and Canadians’ questions are answered.” Mr Pompeo said the United States would offer Ukraine full support to complete the investigation. Boris Johnson last night called Mr Trudeau to express his condolences for the loss of Canadian lives. A Downing Street spokesman said the UK was "working closely with the Ukrainian authorities and the Iranian authorities" over the crash but that there was “no indication” that it had been hit by a missile. The loss of an airliner during a period of international conflict raises bitter memories for both Ukraine and Iran. In 2014 a Russian missile shot down a Malaysian airlines flight over eastern Ukraine, killing 298 people. In 1988 an American warship shot down an Iranian passenger jet, killing 290 people. The shootdown of Iran Air 655 is still bitterly felt in Iran. Earlier this week Hassan Rouhani, the president of Iran, said Donald Trump should “remember the number 290.” 6:04PM Crash one of worst losses of life for Canadians in an aviation disaster At least 63 Canadians were killed in the crash, but Canadian Foreign Minister Francois-Philippe Champagne said the number of deceased Canadians could change as more information becomes available, including details on dual citizens. The crash is one of the worst losses of life for Canadians in an aviation disaster. Many passengers on board were international students as the Tehran to Toronto route via Kyiv is considered affordable. Payman Paseyan, a member of the Iranian-Canadian community in Edmonton, Alberta, said about 27 people from Edmonton, including international students and a family of four that he knew, were on the flight. Two professors from the University of Alberta, Pedram Mousavibafrooei and Mojgan Daneshmand, and their daughters died. Ukrainian plane crash victims Mr Paseyan said most of victims were visiting family in Iran over the holidays. He said many were dual citizens and international students. "One of the reasons why you take that flight is you wouldn't want to take a flight that has a connection in the United States because international students can't do that," he said. The University of Guelph in Canada said two PhD students, as well as the partner of one of the students, were among the 176 who died. Ghanimat Azhdari was a student in the department of geography and Milad Ghasemi was a student in marketing. Azhdari's partner, Hamed Alibeiki, also died. Western University said four of their students died. Three were current graduate students and one was an incoming graduate student. They did not name the students. Canada is urging Canadians to avoid non-essential travel to Iran due to the volatile security situation. 5:24PM Dominic Raab offers condolences after 'tragic loss of life' Foreign Secretary Dominic Raab offered his condolences to those affected by the crash. He said on Twitter: "I would like to express the UK's deepest condolences to all the families of the victims of the UIA crash in Iran today. "This is a tragic loss of life for all countries affected. Foreign Office staff are assisting the families of British victims at this difficult time." I would like to express the UK's deepest condolences to all the families of the victims of the UIA crash in Iran today. This is a tragic loss of life for all countries affected. @foreignoffice staff are assisting the families of British victims at this difficult time— Dominic Raab (@DominicRaab) January 8, 2020 Meanwhile, a Downing Street spokesman said the UK was "working closely with the Ukrainian authorities and the Iranian authorities" over the crash. The spokesman said there was "no indication" the plane was brought down by a missile, after the Ukrainian authorities refused to rule out the prospect. 5:10PM Crew's inability to transmit emergency call before crash confuses aviation experts Aviation expert David Learmount has said the crew's failure – or inability - to communicate has confused aviation experts, "because the implication is that whatever happened was sudden and violent, forcing the crew immediately to fight for control". The crew of the Boeing 737-800 did not have the capacity to transmit an emergency call before it descended out of control to impact on the edge of the city. Mr Learmount said: "Even a catastrophic engine failure – a possibility originally mooted by the Ukrainian authorities but then withdrawn – would be highly unlikely to have such a dramatic effect on control of the aircraft. A 737 is capable of flying safely on just one of its two engines. "Video released online soon after the accident shows what looks like an aircraft engulfed in flames descending unsteady, parts separating from it as it plunged. "This video has not yet been authenticated, but if it does indeed show the Ukrainian 737 in its fatal descent, it explains why the Ukrainian authorities, asked whether the aircraft might have been brought down by a missile, have refused to rule it out." 4:50PM Secretary of State Mike Pompeo calls for 'complete cooperation' in investigations into crash Mike Pompeo, the US Secretary of State, has called for "complete cooperation" in any investigation into the cause of the crash. He said in a statement: "The U.S. Department of State extends our deepest condolences to the families and friends of the 176 passengers and crew killed in the tragic crash of Ukraine International Airlines flight PS 752. "The United States will continue to follow this incident closely and stands prepared to offer Ukraine all possible assistance. The United States calls for complete cooperation with any investigation into the cause of the crash." 4:43PM Trump: Britain and others must withdraw from Iran deal President Trump did not comment directly on the Tehran plane crash, focusing instead on the 22 missiles fired at US forces in Iraq on Wednesday night. Flanked by senior administration officials, Mr Trump doubled down on his decision to assassinate Iranian general Qassim Soleimani, saying the attack sent "a powerful message to potential terrorists". Mr Trump called on Britain and other European countries to withdraw from the Iran deal, as the US has already done. He added that more sanctions are set to hit Iran, but that he does not want to use military force against Iran unless necessary. Trump said he would ask Nato to get "much more involved" in the Middle East peace process. You can read more on our missile attack live blog here. 4:28PM President Trump speaks publicly for first time following crash The President has begun his press conference and is joined by Vice President Mike Pence and Secretary of State Mike Pompeo. 4:22PM Ukraine to send team of experts to Iran to 'establish the truth' President Trump is currently 20 minutes behind schedule to make his televised address. Meanwhile, Ukraine's president Volodymyr Zelenskyy has said the country will send a team of experts to Iran in order to "establish the truth" surrounding the catastrophe. Ukraine will send security officials, experts and rescuers to assist in the investigation and recovery of the bodies of Ukrainian nationals from the wreckage of flight PS752. In a statement on the presidential website, Mr Zelenskyy said: "Our priority is to establish the truth and those responsible for this terrible catastrophe." 3:56PM President Trump to make imminent statement on Iran crisis President Donald Trump will address escalating tension with Iran in a press conference at 11am EST (4pm GMT). It it thought that Mr Trump will comment on the Tehran plane crash. Watch the President's address at the top of this article. 3:42PM Canada's questions will be answered, says Justin Trudeau Justin Trudeau, Canada's Prime Minister, has said that his nation's questions will be answered after it was confirmed 63 citizens had been killed in the plane crash. BREAKING: Prime Minister Justin Trudeau issues statement on the plane crash that killed 63 Canadians. cdnpolipic.twitter.com/RpqpXEztlb— Michel Boyer (@BoyerMichel) January 8, 2020 His Minister of Foreign Affairs François-Philippe Champagne also paid tribute. Tragic news regarding Ukraine International Airlines Flight 752. Our hearts are with the loved ones of the victims, including many Canadians. I have been in touch with the government of Ukraine. We will continue to keep Canadians informed as the situation evolves. PS752— François-Philippe Champagne (FPC) �� (@FP_Champagne) January 8, 2020 3:35PM 'Not a chance of crew error,' airline says In an updated statement, Ukraine International Airlines (UIA) said: "According to our records, the aircraft ascended as high as 2,400 metres. "Given the crew's experience, error probability is minimal. We do not even consider such a chance." 3:17PM Tributes to 'lovely man with lovely smile' Staff at a pet store have paid tribute to Mohammed Reza Kadkhoda-Zadeh, who ran a neighbouring dry cleaners and was one of the three Britons killed in a plane crash in Iran. Staff at Hassocks Pet Centre, West Sussex, paid tribute to "a lovely man [with] a lovely smile". Mohammad Zadeh Store owner Stephen Edgington, 68, said: "Reza was a lovely guy. He was good looking, sociable. "Before he left we were chatting and he said 'do you realise I have been here so many years?'." Mr Edgington, who works at the store with his wife Nola, said they were told what had happened on Wednesday morning by Mr Kadkhoda-Zadeh's staff. 3:00PM Reservoir engineer one of three Britons killed BP has confirmed one of those killed in the Tehran plane crash as reservoir engineer Sam Zokaei, who has worked at the oil company for more than 14 years. Mr Zokaei, from Twickenham, London, was on holiday from working at BP's site at Sunbury-on-Thames in Middlesex. Sam Zokaei The company said in a statement: "With the deepest regret, we can confirm that one of our colleagues at BP, Sam Zokaei, was a passenger on the Ukrainian International Airlines plane that crashed in Iran this morning, reportedly with no survivors. "We are shocked and deeply saddened by this tragic loss of our friend and colleague, and all of our thoughts are with his family and friends." 2:57PM Briton killed was 'brilliant engineer with bright future' Saeed Tahmasebi Khademasadi was one of the three Britons killed. A spokesman for Imperial College London, where Engineer he was a post-graduate researcher, said: "We are deeply saddened at this tragic news. "Saeed Tahmasebi Khademasadi was a brilliant engineer with a bright future. Saeed Tahmasebi "His contributions to systems engineering earned respect from everyone who dealt with him and will benefit society for years to come. "He was a warm, humble and generous colleague, and close friend to many in our community. "Our thoughts and sincere condolences are with Saeed's family, friends and colleagues, as well as all those affected by this tragedy." 1:29PM British Airways, Virgin Atlantic and Qantas among slew of airlines avoiding Middle East airspace British Airways rerouted flight 134 from Mumbai to Heathrow mid-way through the flight, to avoid crossing Iraqi airspace. The plane flew in a circle and was then diverted to the Greek capital Athens for refuelling. The move has left a number of Indian passport holders stuck in the terminal as they do not possess the right visa to leave the airport. A number of commercial airlines have rerouted flights to avoid possible danger amid escalating tensions between the United States and Iran. Airspace above Iran and Iraq at 11:00 UTC time Live map: https://t.co/PbnsBqTxDUpic.twitter.com/TxjqYKZ69r— Flightradar24 (@flightradar24) January 8, 2020 Virgin Atlantic said they were "closely monitoring the situation" and were not flying over Iranian airspace. Due to changes in flight routing, their trips to and from Mumbai might now take longer than expected. Australian carrier Qantas said it was altering its London to Perth, Australia routes to avoid Iran and Iraq airspace until further notice. Malaysia Airlines and Singapore Airlines have also rerouted planes to avoid Iranian airspace. The US Federal Aviation Administration has barred American pilots and carriers from flying in areas of Iraqi, Iranian and some Persian Gulf airspace. 1:23PM Iran plane crash analysis: What happened mid-air and who has the black box? Our Industry Editor Alan Tovey has this piece of analysis on the doomed flight. In it, he looks at what happened during the last seconds of the Ukrainian International Airlines flight from Tehran to Kyiv, the reaction and what happens now. Read it in full here. 1:06PM Three Britons killed in Tehran plane crash named The three Britons killed in a plane crash in Tehran have been unofficially identified as Mohammad Reza Kadkhoda Zadeh, 40, Saeed Tahmasebi Khademsadi, 35, and Sam Zokaei, also 35. Read Chief Reporter Robert Mendick's piece on the victims here. 12:41PM At a glance: The Boeing 737-800 The first thing to note about the crash of Ukraine International Airlines flight PS752 is that the aircraft was a Boeing 737-800, a different model to the 737 Max, the type which was grounded last year after two crashes in five months, reports Industry Editor Alan Tovey. The 737-800 - part of Boeing’s 737 Next Generation (NG) family - does not have the “MCAS” control system fitted to the Max, and which is blamed for the two crashes. A modernised version of the 737 classic model dating from the 1960s, 737 NGs are one of the most popular airliners ever. More than 7,000 737 NGs, of which about 5,000 are the 800 model, are in service and the aircraft has a very good safety record. Prior to PS752, there had been nine accidents involving the aircraft type which have resulted in fatalities. A Ukraine International Airlines Boeing 737-800 airplane taxis in front of the tower Credit: REX One was the result of a mid-air collision, and all but one of the rest have been attributed to either weather problems, pilot error, maintenance issues or a combination of these factors. The final incident saw an engine failure which sent debris into the cabin, causing the aircraft to decompress. A passenger was partially sucked from the aircraft and later died from her injuries. Overall, the 737 NG has a fatal crash rate of 0.06 fatalities per million flights according to data from Airsafe, making it one of the safest aircraft in service. However, the 737 NG has not been without problems. In September Boeing ordered all 737 NGs with more than 30,000 flights to be checked after cracks were discovered in the “pickle fork” of a jet undergoing maintenance. This component is one of the main attachment points for the wing and fuselage and should have a life of about 90,000 flights. Boeing said that about 5pc of the affected aircraft needed repairs. 12:23PM Boris Johnson calls for de-escalation of Middle East crisis Boris Johnson said he opposed any further escalation of violence and told MPs: "As far as we can tell there were no casualties last night sustained by the US and no British personnel were injured in the attacks. "We are doing everything we can to protect UK interests in the region, with HMS Defender and HMS Montrose operating in an enhanced state of readiness to protect shipping in the Gulf." Mr Johnson said General Soleimani had the "blood of British troops on his hands". Answering a question from Labour leader Jeremy Corbyn about the legality of the drone strike that killed the Iranian general, the PM said the US had the right to defend its bases. "Clearly the strict issue of legality is not for the UK to determine since it was not our operation," said the PM. "But I think most reasonable people would accept that the United States has the right to protect its bases and its personnel." The PM said Gen Soleimani had supplied "improvised explosive devices to terrorists, which I'm afraid killed and maimed British troops". He added: "That man had the blood of British troops on his hands." Follow the first Prime Minister's Questions of the decade here. 11:18AM Ukrainian Prime Minister refuses to rule out plane was hit by missile Asked at a briefing in Kyiv if the plane could have been downed by a missile, Ukraine's Prime Minister Oleksiy Honcharuk cautioned against speculation until the results of an investigation were known. The timing of the crash has led to speculation it could have been linked to the offensive that saw rockets from Iran striking US targets overnight, hitting two Iraqi airbases where American and coalition forces are based. No survivors reported as Ukrainian passenger jet crashes in Iran The Iraqi military said it recorded a half hour bombardment between 1.45am and 2.15am local time (10.45am - 11.15am GMT). The Ukraine Airlines 737 crashed at 6.15am local time in Tehran (2.45am GMT), at more than three hours after the last Iranian ballistic missile barrage ended. 11:16AM Recap: What happened in the air seconds before crash? Qassem Biniaz, a spokesman for Iran's Road and Transportation Ministry, said it appeared a fire struck one of its engines. The pilot of the aircraft then lost control of the plane, sending it crashing into the ground, Biniaz said, according to the state-run IRNA news agency. Hassan Razaeifar, the head of air crash investigation committee, said it appeared the pilot couldn't communicate with air-traffic controllers in Tehran in the last moments of the flight. He did not elaborate. Authorities later said they found the plane's so-called "black boxes," which record cockpit conversations and instrument data. "The only thing that the pilot managed to do was steer the plane towards a soccer field near here instead of a residential area back there," witness Aref Geravand said. "It crashed near the field and in a water canal." 10:54AM Iran refuses to hand over black box from Ukrainian plane Iran's aviation authority said it would not hand over to Americans the recovered black boxes of a Boeing 737 that crashed Wednesday, killing all 176 passengers and crew. "We will not give the black boxes to the manufacturer (Boeing) and the Americans," Iran Civil Aviation Organisation head Ali Abedzadeh said, quoted by Mehr news agency. 10:39AM Met Police 'extremely alert' to impact of wider Middle East crisis Police in the UK are monitoring the wider crisis in Iran and are "extremely alert" to any effect it may have on home soil, the country's most senior officer has said. Metropolitan Police Commissioner Dame Cressida Dick told LBC that head of UK counter-terror policing Neil Basu has been in discussions with the security agencies and government bodies about the crisis. She told host Nick Ferrari: "It's a very worrying time clearly and we have lots of people of Iranian and Iraqi heritage and the surrounding areas in London, so there's lots for us to think about, lots for us to be alert to. "What I can say is so far in London we have had no issues directly associated with this, there was one quite small protest. "But of course we're extremely alert to what this could possibly lead to, but it's a very complex situation. At the moment there's absolutely no impact on London." Met Police Commissioner Cressida Dick is live in the LBC studio, answering questions from listeners. Watch it live. https://t.co/wnxGmCvjCs— LBC (@LBC) January 8, 2020 Dame Cressida, herself a former chief of counter-terrorism policing, said the force is "very adept" at measuring possible domestic threats linked to international events. "Being the international city that we are, with the multiplicity of communities and also the threats that we have had to face over the years which change and morph all the time, we are very, very adept at seeing what's happening around the world, reaching out into communities and looking at the possible threats and risks that might come," she said. "That's what we're doing on a day by day basis, and in response to this." The UK's terror threat level remains at substantial, meaning an attack is likely. 10:04AM Foreign Office 'deeply saddened' by loss of life in Iran plane crash The Foreign Office has issued a statement on the Iran plane crash. BREAKING | Foreign Office "deeply saddened" by Iran plane crash and "urgently seeking confirmation about how many British nationals were on board". Full statement here: pic.twitter.com/Q4Curn1yGg— Gareth Davies (@GD10) January 8, 2020 10:01AM Chinese airline becomes latest to avoid Iran China Southern - a Chinese airline - has cancelled an Urumqi to Tehran flight which was scheduled to depart on Wednesday. 9:35AM Map of where the plane came down Flight data from the airport showed a Ukrainian 737-800 flown by Ukraine International Airlines took off on Wednesday morning, then stopped sending data about eight minutes later, according to tracking website FlightRadar24. Here is a look at where the plane came down in relation to the the airport and its scheduled destination - Kyiv. AFP map and details of the path of Ukrainian International Airlines flight PS-752 which crashed shortly after takeoff from Tehran @AFPgraphicspic.twitter.com/D72x9iVhpk— AFP news agency (@AFP) January 8, 2020 It also tracks the plane's altitude up to the moment it disappeared from the radar. 9:20AM Ukraine withdraws statement ruling out terror or rocket attack Having initially said the plane crash was due to engine failure and not foul play, there is now a new statement on the Ukrainian embassy website. It reads: "A commission is working to clarify the causes of the plane crash. Any statements regarding the causes of the accident prior to the findings of the commission are not official." The earlier line ruling out terrorism or a rocket attack as possible causes have been removed. 9:17AM Russia warns against 'rushed theories' on crash Russia has offered its condolences and warned against "rushed theories" about the cause of the crash, Theo Merz reports. Senator Konstantin Kosachev, the head of the Russian Federation Council Foreign Affairs Committee, wrote on Facebook: "A terrible crash of a Ukrainian airliner in Tehran. It looks like no one survived. Was it a technical malfunction? A mistake of the crew? A terror attack? Only an investigation will show and one must refrain from any rushed theories." He said the Russian embassy was working to clarify if there were any of its citizens on board. "I would like to offer sincere condolences to all the families and loved ones of the deceased, whatever their nationality. We share the Ukrainian people's grief." MP Leonid Slutskiy said on his Telegram messaging channel: "The reasons of the crash are yet to be assessed. The tragedy must not be used for political purposes - sinking to the level of groundless accusations against Tehran or anti-Iranian rhetoric." 9:00AM Ukrainian President instructs prosecutors to open criminal proceedings Volodymyr Zelensky, Ukraine's president, said his government was working to understand the causes of the crash. Ukrainian President Volodymyr Zelensky Credit: Sergei Chuzavkov/AFP He has cut short a trip to Oman and returning to Kyiv and instructed Ukraine's prosecutors to open criminal proceedings over the crash. Mr Zelenskyy, in a statement on the president's website, said he had ordered the Prosecutor General of Ukraine to open criminal proceedings over the UIA plane crash in Tehran. He said: "An investigation commission should be set up of representatives of the civil and aviation agencies responsible for civil aviation. We have to work out all the possible versions. "Regardless of the conclusions regarding the causes of the Iranian catastrophe, the airworthiness of the entire civilian fleet will be tested. "I keep all measures on personal control. I very much ask everyone to refrain from speculation and putting forward untested versions of the disaster before the official announcements." 8:40AM Russia suspends flights over Iran and Iraq As the tension in the Middle East heightens, Moscow has called off any flights that use the airspace over Iran and Iraq. A telegram from the Russia's Federal Air Transport Agency said: "In connection with the information on the existing risks to the security of international flights of civil aircraft before the subsequent notification, the Federal Air Transport Agency recommends not using the airspace over the territories of Iran, Iraq, the Persian and Oman gulfs for flights of civil aircraft of the Russian Federation, including transit flights." Air France has also suspended flights over the region. 8:38AM 'Nothing wrong with plane', says Ukrainian airline Ukrainian International Airlines(UIA) has appeared to bite back at claims its plane came down because of engine failure. The airline said there was "nothing wrong" with its plane. A Boeing 737-3E7 from Ukraine International Airlines lands in 2017 Credit: Jack Guez/AFP It is understood the plane that crashed just outside the Iranian capital last passed a planned technical service just two days ago on Jan 6. President of UIA Yevgeny Dykhne told a press briefing: "The aircraft was in good condition... We guarantee the serviceability of our aircraft and the high qualification of our crews" 8:23AM Kyiv confirms British citizens were on board flight The Ukrainian Minister for Foreign Affairs of Ukraine Vadym Prystaiko has revealed the nationalities of those on board. He said Kyiv is aware of the "following information on the countries of origin of those killed in the crash". Наразі нам відома наступна інфо��мація щодо країн походження загиблих в катастрофі PS752: Іран - 82; Канада - 63; Україна - 2 + 9(екіпаж); Швеція - 10; Афганістан - 4; ФРН - 3; Велика Британія - 3. Висловлюємо наші співчуття. Українська влада продовжує розслідування.— Vadym Prystaiko (@VPrystaiko) January 8, 2020 Iran - 82 Canada - 63 Ukraine - 2 + 9 (crew) Sweden - 10 Afghanistan - 4 Germany - 3 United Kingdom - 3 8:13AM Flights to Tehran 'suspended indefinitely' by Ukrainian airline Ukraine International Airlines has suspended flights to Tehran indefinitely, according to Reuters. 7:59AM Boeing 'aware of media reports' Boeing spokesman Gordon Johndroe said the company was aware of media reports of a plane crash in Iran and was gathering more information. 7:48AM Three British citizens on board, says local media A local media outlet in the Ukraine claims there were British citizens on board. Obozrevatel, a popular news website in the country, said there were also 71 Canadians on board, quoting sources. Ukrainian citizens - 15 Iranian citizens - 71 Canadian citizens - 73 German citizens - 4 UK citizens - 3 Swedish citizens - 8 Afghan citizens - 6 The Foreign Office was not immediately available for comment and the figures from Obozrevatel have not been confirmed. But the Ukraine Security Council said there were 11 Ukrainians on board, including nine crew, according to Reuters. 7:41AM Iran plane crash, in pictures Debris is seen from the plane crash on the outskirts of Tehran Credit: Mohammad Nasiri/AP An aerial view of the crash site Credit: Rohhollah Vadati/AFP A side panel from the aircraft in a ditch Credit: AFP 7:31AM Special flights on standby to take bodies back to Ukraine The Ukrainian President Volodymyr Zelensky has special flights are on standby to take bodies back to Kyiv. The planes will need permission from Iran. 7:28AM What we know so far Boeing 737 crashed eight minutes after taking off All 176 aboard killed, 167 passengers and nine crew Plane appeared to be on fire before it hit the ground Engine failure to blame, says Ukraine 7:27AM Video: 'Plane falls from the sky' Ali Hashem, a BBC correspondent, tweeted a video which he claimed showed the plane falling through the air while aflame before crashing into the ground and exploding. Breaking First footage of the Ukrainian airplane while on fire falling near Tehranpic.twitter.com/kGxnBb7f1q— Ali Hashem علي هاشم (@alihashem_tv) January 8, 2020 6:54AM What type of plane was it? The plane that came down this morning was a Boeing 737-800. This is similar to but not the same as the 737 Max 8 aircraft, which has been grounded since two fatal crashes in Indonesia and Ethiopia that have brought huge scrutiny to Boeing. The 737-800 uses a different software system to that of the Max 8. The Ukraine International Airlines jet that crashed this morning was believed to be less than four years old. Boeing's 737 Max 8 is grounded following fatal crashes Credit: Lindsey Wasson/Reuters The airline has not yet made a statement. 6:27AM Rescuers sift through wreckage Iranian officials and emergency crews are at the crash site in Tehran, investigating the cause of the crash earlier this morning. The plane crashed about eight minutes after taking off Credit: Nazanin Tabatabaee/WANA 6:18AM 'Impossible that anyone survived' The head of Iran's Red Crescent has said they do not expect survivors at the crash site. "Obviously it is impossible that passengers" on flight PS-752 are alive, he told Iranian state news. 6:06AM '176 people' on board Iranian state TV news are claiming that the flight had 176 people on board - 167 passengers and nine crew. 5:50AM All passengers dead - Ukraine's president Volodymyr Zelensky, Ukraine's president, has confirmed that all 170 passengers aboard the Boeing 737 in Tehran have been killed. He offered condolences to the families of the victims and said his government was working to understand the causes of the crash.

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