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Nov 27-Dec 3

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1 Nov 27-Dec 3 on Sun Dec 04, 2011 4:13 pm

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The past clinical I had was a 57-year-old male who was admitted with Syncope. He had passed out last night watching TV and his wife found him like that. When I went to gaither V/S and assessment I told him what I was doing and informed him of his V/S. We talked about why he was admitted. I provided therapeutic communication and explored his feelings about what had happened. He told me his was fine, but was worried about his wife because she was very upset. He told me his wife was a nurse on telemetry and has worked for Frye for along time. He said she always thinks the worst when it comes to healthcare. I told him that was understandable because you see so much when caring for clients. An hour later, his wife arrived and was ready to take charge. His whole demeanor changed with me. He did not need or want my help. When I went in to introduce myself to his wife and provide care, she gave me a look like "great a student" she states "we are good". I told the client to ring his call light if he needed anything at all and that I was here for him. I know as healthcare providers and student nurses we have all been in this situation where they don't need or want our help. All I could do is offer care and provide periodic checks on my client. I am not sure if their was anything I could do without offending his wife. I'm sure his wife was just upset about his episode and wanted to oversee his care which is understandable.

Things to look for during Assessment in:
1. Newborn- Failure to pass meconium stool within 24-48 hr, refusal to eat, episodes of vomiting bile, and abdominal distention.
2. Infant- failure to thrive, constipation, abdominal distention, episodes of vomiting and diarrhea
3. Older child- Constipation, abdominal distention, visible peristalsis, ribbon-like stool, palpable fecal mass, and a malnourished appearance.

Medical Management Interventions and Rationales
1.I: Assess V/S, Bowel sounds, Elimination
R: Gaither Baseline and determine status
2. I: Inspect, palpate for loops of Bowel
R: Sign of Hirschsprungs Disease this happens because the bowel dilates
3.I: Assess for hydration status, skin turgor,mucous membrane,output, weight changes
R:childern with Hirschsprung's Disease can be malnourished due to bowel obstruction, vomiting, Diarrhea, and decreased appetite.

Preop
1.I: Restrict to clear liquids day before surgery and then NPO 12 hours before surgery.
R: To prevent aspiration and vomiting
2. I: Provide rectal irrigation 3-4 times prior to surgery.
R: To evacuate the bowel
3. I:Measure abdominal girth with a paper tape measure at the level of the umbilicus at the widest part of the abdomen
R: to assess for abdominal distention

Postop
1.I: Auscultate bowel sounds,lung sounds, and assess V/S post op
R: to assess for complications or change in status to provide the earliest intervention if needed
2.I: Institute incremental feedings beginning with a solution of clear liquids/glucose/electrolytes and assess for readinessto progress back to breast milk or formula.
R: Assess bowel function
3.I: Assess for change in status such as fever and explosive diarrhea
R: this could be a complication known as Entercolitis

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