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1 communication on Mon Dec 05, 2011 10:57 pm

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My patient was a 67 year old female that was admitted for a possible seizure and was then diagnosed with Lupus. She told me some of her life story which made me realize that she hasn’t had the most ideal experiences. One of her major concerns was that her husband had just left her for a younger woman and now she was at the hospital alone. She had one living child that lived an hour away. I saw that this lady was becoming more upset the more she talked. At first I kept asking her about her life because I could tell she had a lot she wanted to get off her chest. This also helped me better understand her family dynamics. Once I had heard a lot of the same stories I tried to talk to her about the good tasks she had completed in life to take her mind off of the hardship of this last year. She spoke to me about being a stay at home mom and stated that that was the best job anyone could ever ask for. I then asked her how many children she had. I should have caught onto this because she had just told me prior that she only had one child living. She answered that she had 2. This question automatically put her in a depressed mood. She started talking to me about her son’s death. It made me feel bad because I felt that if I would have been a better listener and decision maker I would have not brought it up and we would still be in an upbeat conversation. Through this year and a half I have learned that the patient’s that make the unkind comments are the ones that become your best friend at the end of the day. Sometimes they are so bitter that all they need is 15 minutes of kindness to turn their whole attitude around.
Assessment- 1 Look for Failure to pass meconium within 24 to 48 hours, refusal to eat, episodes of vomiting bile, and abdominal distention. 2 Failure to thrive, constipation, abdominal distention, episodes of vomiting and diarrhea. 3 Constipation, abdominal distention, visible peristalsis, ribbon like stool, palpable fecal mass, and malnourished appearance.
Medical Management Interventions- 1. Full thickness biopsies are done and will reveal the absences of ganglion cells. 2. Surgical incision into the pyloric sphincter that may require temporary colostomy to correct the problem. 3. Offer small frequent feedings of thickened formula to prevent aspiration
Preop Surgical Man-1. Prepare the child and family for the surgical or therapeutic procedure. 2. Maintain good hydration by administering electrolytes and fluid replacement. 3. Ensure the comfort of the child by surrounding child with happy items
Postop Surg Man-1. Institute incremental feedings beginning with a solution of clear liquid/ glucose/ electrolytes and assessing for readiness to progress back to breast milk or formula. 2. The infant may continue to vomit for 24 to 48 hours after surgery so help patient stay clean and dry. 3. Position infant with their heads slightly elevated to prevent reflux. Infants usually progress will and are discharged on the second or third postoperative day

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