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Clinical post conference Dec. 1

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1 Clinical post conference Dec. 1 on Thu Dec 01, 2011 5:36 pm

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When I am in clinical I try to be myself. I am at times a little reserved until I get a good feel of my patient’s temperament. I have never really had a situation to where I felt like I had not said the right thing. I had two patients today that were very thankful for what I did for them. I have had a patient in the past that did not want to cooperate with me because they were suffering from Alzheimer’s. My concern with this patient pertained to the fact that they had not eaten breakfast or lunch and because they were somewhat combative no one wanted to get close enough to try and feed them. I did try, and because of the combativeness I was told by my instructor due to safety reasons for myself to stop trying to feed this patient. I have to commend anyone that deals with patients with this problem. I know that the patient was not aware of how they were acting. My concern was that they needed to eat, or at least drink something to stay hydrated. I did not understand then nor now why this patient was not on some type of medication to make them calmer. I feel like had they been the staff could have handled this situation differently. I was somewhat shocked that the staff did not seem to share my concerns. It was as if everyone had the attitude of “oh well, we can only do so much.” I know I have a lot to learn and I am sure I will see more of this type situation in the future, I just hope when it does occur it can be handled differently. If I am ever faced with the situation of a patient becoming annoyed with my presence I hope that I can recognize this occurrence and deal with it by letting the patient know I am nearby and I will graciously give them “space.” As a nurse we all need to know that when people are sick they are not happy and unhappy people say and do things they normally would not do in a normal circumstance.
Hirschsprung’s Disease
Obtain nutritional history along with history of weight gain/loss.
Obtain bowel elimination history.
Measure abdominal circumference to monitor for distention.
Observe stool for amount, form, and consistency. Patient may be constipated. Chronic constipation is a symptom of this disease.
Measure weight of patient every day, at the same time, and with the same scales. Patient may be chronically malnourished from early satiety, and abdominal discomfort.
Assess for infection related to intestinal perforation. Enterocolitiis presents with fever, pain, foul smelling diarrhea, and vomiting. If not recognized early it can be fatal.
Pre-Op
Perform rectal irrigations to clean bowel prior to surgery.
Provide support to patient and patient’s family.
Restrict intake to clear liquids the day before surgery.
Post-Op
Maintain intravenous fluids and nasogastric tubing.
Administer pain medication.
Monitor for skin breakdown around colostomy.

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