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1 clinical post conference on Mon Dec 05, 2011 11:16 pm

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This week, I had a great patient on Tuesday who was friendly, cooperative, and truly an “ideal patient”. She thanked me for everything I did, and really expressed that she enjoyed having me as her student nurse that day. That made me feel like I was needed, and that feeling is great! We were able to make small talk about where I would like to work after I graduated, and she told me about herself and her profession. It is surprising how much you can learn about your patients in such a small amount of time if you just stop and listen. I always strive to communicate with my patients effectively and directly to meet their needs and ease any concerns they may have, even if it may not always be “perfect”.

During NUR 114, I had a patient who was very annoyed with my presence from the time I stepped in the room for 7AM vitals. I knew this was going to be one of those “not-so-great” days that no one hopes for. Apparently, she was frustrated that someone had lost her dentures after surgery. The whole day, all she communicated to me was how it was my fault no one had found her dentures. No matter what I said, nothing could convince her that the hospital staff was searching endlessly to find her dentures that I had nothing to do with. In order to handle this situation as appropriately as possible, I notified the primary nurse of her concerns and did everything I could to be an advocate on her behalf. I let her vent her frustrations and expressed understanding and listened to everything she had to say. I may or may not have helped, but at the end of the day the dentures were found! She reluctantly thanked me for my help.

Interventions for Hirschsprung's disease


Assessment:
1. Inspect and palpate the abdomen
2. Inspect the child’s stool for color, consistency, odor, and volume
3. Assess the child’s hydration state


Medical management and interventions/rationales
I: Routinely measure abdominal circumference
R: help detect any possible distention

I: Provide emotional support to the child and family
R: The diagnosis of Hirschsprung can cause emotional hardship for the family

I: Offer and encourage fluids frequently
R: maintain patient’s hydration



Pre OP:
1. Preoperative oral intake varies depending on the surgeon; however, intake is generally restricted to clear fluids the day before surgery
2. Rectal irrigation may be performed to evacuate the bowel prior to surgery
3. Oral antibiotics usually given 3 days before surgery, IV antibiotics given 1 hr. before

Post OP:
1. Maintain intravenous fluids and nasogastric tube
2. Monitor intake and output
3. Administer pain medication as prescribed and assess at least every hour for evidence of pain utilizing a pain scale and documenting assessment


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