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December 2nd post

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1December 2nd post Empty December 2nd post on Fri Dec 02, 2011 5:30 pm


I had two very easy to take care of patients yesterday. One was a lady who had had a partial knee replacement and was scheduled to go home. She was pleasant and engaging. The other was a 29 year old man who had crused his foot at work. He was scheduled for an operation at 0500 yesterday and was on a morphine pump. He was funny and pleasant to talk to. His wife was in the room and she and I talked quite a bit and for a while. Tuesday I had a lady who had had a BKA. She was scared and often held my hand, cried, and asked me to stay with her. For a while I just held her hand and knelt next to her. I stayed with her as long as I could and told her that I was there for her and would do anything I could for her. She and I talked quite a bit that day. You asked in this post if we had said anything unprofessional to our patients and my answer is no. You also asked if anyone had been rude to us and if so how did we handle it. Yes, someone said something and it was not her place to say it but I handled it with an open heart as I always try to do. I cannot speak for the intentions of others but I can tell you that I know what is in my own heart and there is nothing there that I am ashamed of. There is no spite and no guile in my own heart. The relationships I make with those close to me such as my husband, my children, and my friends are deep and unwavering. I feel that this is because they know me and they know where my heart is. I fully believe in karma and that whatever we put out there into the world comes back to us. We may put on a mask and pretend to be something we are not, but the universe cannot be fooled. If a person finds themselves lonely or lacking in his or her own personal life, perhaps he/she needs to take a good look at his or her own heart and intentions. I will admit, it isn't an easy thing to do. Soul searching is not for the weak spirited. When I take care of my patients in the hospital and I am alone with them, I reach out to them from my heart and the response I get is wonderful.

Considerations for Hirschsprung Disease:
Most common cause of neonatal obstruction of the colon. Complete or partial blockage may occur. The lack of ganglion cells in the affected portion of the bowel results in lack of nervous system stimulation to that sectionof the colon. The lack of motility in the colon causes a build-up of waste material that the body cannot get rid of.
A child with this disease will have a swollen abdomen and will be in considerable pain. When a child has a serious disease, it is a strain on the entire family. Most parents will need a great deal of teaching in order to know what to look for and how to handle the child at home. The family will need to be taught about the disease process and pre-op and post-op procedures. The family may go through denial, anger, bargaining, depression, and grief. They may need special counciling and to attend support groups with other parents who have had children with serious diseases. If the parents have other children they may have to make special arrangements for the care of their other children.
Assessment: A child with Hirschsprung's disease will fail to pass meconium within the first 48 hours of life. Physical findings include vomiting, abdominal obstruction, failure to pass stools, diarrhea, flatus, or explosive bowel movements. In older children, the initial symptom is constipation. Another sign of this disease is enterocolitis. Radiographic studies show evidence of a dilated loop of bowel.
Interventions and Rationales: Maintain fluid and electrolyte balance--fluid and electrolyte balance is critical for celluar regulation and immunity support. The child is placed NPO and a nasogastric tube is inserted. Pain management is another critical consideration for these patients. When we are in pain, our heart rate increases, our BP increases, and our respirations. Much of our energy is spent on dealing with the pain. Pain control is critical so our bodies can heal. Another consideration is skin integrity. If the patient is unable to control his bowel movements, especially an infant because infants cannot control bowel movements at all, his skin needs to be kept clean and dry. Fecal material can quickly break down skin.
Pre-op care: attain IV access, administer all pre-op meds, obtain written consent from parent or legal guadian, make sure parents understand the procedure, explain that a temporary colostomy may be needed, explain what a colostomy is and how to care for one, make sure parents are aware of the options, give parents time to ask questions, if you are unable to answer their questions, make sure you find someone who can before the procedure takes place. Teach parents what to expect after surgery. Take baseline vitals, know blood type in case it is needed, make sure room is prepared for return of patient after surgery. Be aware of pain meds ordered and possible sugical complications. Know all allergies.
Post-op: Take vitals signs, check placement of NG tube, check wound and dressing for drainage, rubor, edema, and calor. Do a complete assessment. Check LOC. Have pain meds ready. Have antidote for pain meds ready. Check vitals every 15 minutes for first hour, then every 30 minutes, then every hour for the first 24 hours after surgery. Check CBC count.If unusual amount of drainage is present, or if infection occurs, notify care giver. Encourage interaction of parents with child. Support family and take time to answer questions and try to put thier minds at ease. Weigh patient before and after surgery. Measure abdominal girth before and after sugery.

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