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Hirschsprung's and therapeutic communication

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1 Hirschsprung's and therapeutic communication on Sun Dec 04, 2011 2:27 pm

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I communicated with my patients in the most tactful and caring way possible for my approach. I use therapeutic communication with my patients at all times, but try to be extremely careful when establishing rapport in the beginning. I use open-end questions and a positive, caring approach to elicit my responses. I feel like the only problem I have with my communication techniques may be the use of the word “hun” or “sweety”. Being from the south it is incredibly hard to break the habit of referring to people with cute names such as these. I know that very seldom does anyone express that they don’t appreciate this approach, but part of being southern is not be confrontational. So, there could be people who take offense to being called names other than their own or “sir” or “maa’m”.

One encounter I had with a patient that was not kind was an elderly gentlemen who had a mistrust for the healthcare system. Upon entering the room this man expressed that he did not care to have a student nurse and was very short with myself and the other nursing staff. After several attempts to establish rapport, I eventually backed off and gave the man his space. He would say things that were inappropriate and offensive to myself and other students. When it was determined that I would continue care for this gentlemen, I became very stern and stoic in my approach to his care. This actually fostered respect from the man and he complied with my commands for the rest of my clinical experience.

12 considerations for a patient with Hirschsprung’s disease:
Assessment
1. X-ray
2. Rectal biopsy
3. Barium enema
Medical interventions and rationales
1. Initial-I.V hydration: This is to foster normal bowel function without the use of invasive treatments.
2. NG tube insertion: This is to prevent contents from entering the intestines and thus promoting bowel healing.
3. Surgery: The impaired portion of the bowel is removed and the healthy colon is then resected.
Preop surgical management
1. NPO
2. Preop teaching the procedure and expected outcomes
3. Encourage patient to express fears and anxiety related to procedure
Post-op surgical management
1. Administration of oral and IV antibiotics
2. Administer stool softeners
3. Semi Fowler’s to relieve dyspnea

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