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November 27-December 3

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1 November 27-December 3 on Thu Dec 01, 2011 7:39 pm

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I try to communicate with each patient differently, but with the same empathetic care. When first meeting each individual, I try to "feel" them out to see how they communicate with me and that provides me with somewhat of a guide to how they may best or prefer to express themselves to me and me to them, so that I can communicate with them in the best possible way to ensure understanding, with an open line of communication. I suppose I may not always use the quote therapeutic communication with all,because their are some people that prefer to keep things simple and to the point, while other patients' may need that extra time and attention. Some patient's prefer to not be treated like they are sick/injured, desiring a simple conversation about anything else besides their medical issues, being in the hospital, etc. Sure they want to be well taken care of, but don't wanna talk or know about it; some seem to avoid asking for things they should cause they do not like feeling "helpless." For many patients' they need to focus on the reality, or current events outside of the facility to still have that feeling of self-control and remain in good spirits. So, for those patients' I try and focus on the non-verbal cues and offer things that they may never ask for, but could use or may be interested in, so do not feel like a bother. Maybe the therapeutic communication spectrum is just as complex as our patients can be. Idea If I cannot find the right words to say, I tell the patient the truth; I cannot answer that at this time, or I'll have to get back with you. I never want to be misleading and lose their trust, they need to be able to trust the people that are caring for them.
I recall having several different incidences when caring for patients with dementia. They can be very mean and short-fused, but it's only for a moment. When dealing with these patient's initially, the offensive behavior did offend me (especially being hit). Despite, I knew in the back of my mind they couldn't control it and they were so sweet the rest of the time it wasn't possible for me to continue to take it personal, so I toughened up a bit and had a blast working with them. After I figured each individual patient out, it was nothing but the usual day with them lol!

[u]Hirschsprung's: Not prominent at birth
Assessment: History of constipation at birth-temporary relief with enema
Distention of the abdomen – progressive enlarging
Thin abdominal wall with observable peristaltic activity
Stool appears ribbon like, fluid like, or in pellet form
Failure to grow – loss of subcutaneous fat; appears malnourished; perhaps has stunted growth
Medical Management Interventions/Rationales:
Enema or colonic irrigation with physiologic saline solution: temporary relief.
Older child whose symptoms are chronic but not severe may be treated with isotonic enemas, stool softeners, and a low residue diet.
Initially, a colostomy or ileostomy is performed to decompress intestine, divert fecal stream, and rest the normal bowel.
Definitive surgery is done to remove the non-functioning bowel segment with various pull-through procedures (abdominoperineal, endorectal, or rectorectal).
Preop Surgical Management: Assist in emptying the bowel by giving repeated enemas and colonic irrigations.
If abdominal distention is not relieved by enemas, discomfort is significant, and rectal tube insertion fails to give relief, consult doctor for a nasogastric (NG) tube.
Offer pacifier for infant to suck if on parenteral fluids.
Encourage parents to hold and rock the infant.
Postop Surgical Management: Change wound dressing using sterile technique.
Prevent wound contamination from diaper.
Prevent perianal and anal excoriation by thorough cleaning and use of ointments after the infant soils (postoperative stools can number 7 to 10 per day).
In older child, encourage frequent coughing and deep breathing to maintain respiratory status.
Allow the infant to cry for a short period to prevent atelectasis.

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