Nursing Care of Children Part 5

• PET scan= teaching: empty bladder before test • Clomidene- increases ovulation… S/E= multiple births • Pyridium is a medication for bladder infection. It will change urine orange/red/pink. • BPH TX= TURP (transurethral resection of prostate): there will be some blood loss for 4 days & burning for 7 days post-op. • Endometriosis is greater in pts who never have had children… can cause infertility. • **Bethanecol** (cholinergic drug) is given to pt w/ neurogenic bladder (urinary retention) following spinal cord injury. • Contraceptives ▪ Diaphragm- must be left in place for 6 hrs after intercourse. “ ▪ “Pill” raises the progesterone levels and tricks the body into thinking you are pregnant so no ovulation occurs. Avoid smoking ↑ your risks for DVT. • If one pill is missed- take 2 the next day • If two pills are missed-take 2 the next 2 days • If 3 are missed find another form of contraceptive (D/C & continue the next month) • STI’s ▪ Syphilis: TX= Penicillin • Primary stage (90 days) = chancre + red painless lesion • Secondary stage (6 months) = rash on palms & soles w/ flu-like symptoms. • Tertiary stage (10-30 yrs.) = neurologic & cardiac destruction. ▪ Gonorrhea: “CLAP”. • Yellow-green urethral discharge ▪ **Chlamydia: TX= Tetracycline** Most common can cause blindness in newborn. • Mild vaginal discharge or urethritis ▪ Trichomoniasis: TX= Flagyl • Frothy foul smelling vaginal discharge ▪ HPV= cervical cancer, bleeding after intercourse- suggest cancer of the cervix ▪ Candiasis: TX= Miconazole, Nystatin… can cause thrush in newborn • Yellow cheesy discharge w/ itching ▪ Musculoskeletal • Following a myelogram encourage fluids to get rid the oil based dye. • Never pull yourself up using a walker= safety • Measure 2 inches below the axilla to a point 6 inches in front of the tip of the tow & 2 inches outside the foot. • Squeezing a rubber ball helps strengthening hand muscles in preparation for using crutches. • Pts who develop paralysis to either RT or LT side should have a sign placed in their door stating “DO NOT USE the affected side for lifting”- they cant offer resistance so shoulder could be dislocated. • Degenerative joint disease: occurs mainly in those with obesity, DM, Paget’s or hemophilia. • Pt w/ halovest when placed on wheel chair needs to have legs rests lowered or will cause the wheel chair to tip backward • Following total knee replacement: nurse should place sequential compression devices. • Cane is held on the non-affective side, moving the weak leg & the cane. ▪ Move cane forward followed by the weak leg then the strong leg. ▪ When going UP the stairs step up w/ the strong extremity ▪ When going DOWN the stairs lead w/ the weak leg & the cane. • When using crutches (3 point gait= not baring weight on affected foot). The bad foot always goes with the crutches. Ex. Advance crutches & the weak foot, then advance the strong foot while balancing weight on the crutches. ▪ Stair climbing w/ crutches= *up w/ the good down w/ the bad*. Have your weight on the crutches & move the good foot up then bring up both crutches & repeat. When coming down balance weight on the good foot put the crutches down to the next step & bring the good foot down & repeat. • 4 point gate= baring weight on both feet (crutch… opposite foot… crutch) Ex. Pt w/ a left ankle injury= move the right crutch first then the left foot followed by the crutch & the right foot. Usually used on pts w/ generalized weakness • Cast care: ▪ Air dry-plaster cast ▪ Palm the wet cast- plaster cast: water can dissolve it not fiberglass cast ▪ Elevate limb: ↓ swelling & edema ▪ Neuro- sensation/motion; vascular- blanching/ temperature/swelling ▪ Skin care: pedaling the cast-plaster. Itching because of shedding which can lead to developing an ulcer if they cut their skin. They can use a blow drier in the cool setting. ▪ Smell the cast • Traction: • Skin o Buck’s- foot & leg goes to a boot. Used for ppl w/ a fracture hip until Sx. Continuous traction. (Allow weights to hang freely) ▪ Remove foam boot 3x’s/day & inspect ▪ Turn pt on nonaffected side ▪ Back care every 2 hrs to prevent sores ▪ Ask pt to dorsiflex the affected foot (assesses the peroneal nerve) ▪ Elevate the foot off the pts bed o Russell’s- fractures of the femur; vertical & horizontal pull. Do arterial & venous circulation. Restraint depends on the situation. o Bryant’s- used for children < 2 & <30 lbs. w/ hip fracture. 90° angle & you must be able to put hand under buttocks. o Head halter traction (Halo)-Cervical; intermittently applied- if pain is felt 24-48 hrs. when chewing the pins might of slipped into the temporal plate= notify physician o Pelvic used for back issues. Weights are hanging freely w/ knees bent. • Skeletal o Pins are inserted into bones. Pin site care= soap & water (saline). Cleaning the area & apply antibiotic ointment. Make the bed from top to bottom & pts use the trapeze bar. • Fractures: ▪ Simple fracture= closed fracture ▪ Compound fracture= open fracture, tetanus shot for pts w/ bone fracture that breaks the skin. ▪ Greenstick fracture only in children ▪ Commuted fracture the bone is splintered into fragments • Carpal tunnel syndrome assessment requires the nurse to perform the Phalen’s maneuver= put back of hands together & bend both wrist @ the same time, it will cause pain or tingling. • Compartment syndrome: permanent damage in 6-8 hrs. Bivalve the cast it might help. ▪ Volkmann contracture: happens w/ compartmental syndrome= fingers & wrists become contracted. EMERGENCY!!! • Fat embolism: usually on leg fractures= chest pain, dyspnea, & petechia • Hip replacement care= extension & abduction. Put a pillow between the legs when turning. High chair & toilets to prevent hip flexion. • Arthritis- systemic autoimmune disease. ▪ Rheumatoid= if left untreated can lead to bone alkalosis which is the loss of complete movement. Tx w/ ASA, NSAIDS, steroids, Antimalarials, gold (Au) weeks to months to be effective, immunosuppressant’s * Methotrexate* ▪ Osteoarthritis: place joints in their functional position ▪ Gout: usually big toe pain. It’s treated w/ allopurinol… push FLUIDS!!! Low purine diet: reduce consumption in meats, fowl (birds), fish & shell fish, lentils, dry peas & beans, nuts & oats. NO ALCOHOL!!! Eat fresh fruits & whole grains. ▪ Lupus: young African American women are at greater increase. Manifestations= butterfly rash on face, Reynaud’s, photosensitivity, hair loss, joint pain, can damage the kidneys & heart years later. Tx is the same as for rheumatoid arthritis. No Cure or prevention ▪ Lyme disease: tick bite manifests are a bull’s eyes rash. If treated quickly the disease will not progress. Tx w/ tetracycline… prevention is w/ long sleeves & pants tucked into your sock w/ light colored clothing. To remove the tick use tweezers… never burn the tick. • Rocky mountain spotted fever (dog tick) mayor symptoms: fever, rash on palms & soles of feet, HA. Tx w/ tetracycline family. • Guillain-Barre syndrome: weakness progresses from the legs upward → respiratory arrest. • Mobility of the client with hyperparathyroidism should be ↑ to avoid renal calculi. • Lumbar puncture: if HA occurs assess the site for leakage & position side lying. • Herniated nucleus pulposus= herniated disk. Puts pressure on the spinal nerve. Tx: muscle relaxants, traction, heat, PT, Sx ▪ Cervical= shoulder & arm pain • Laminectomy/discectomy- semi recumbent position) 20-30°= low fowlers)… keep the neck straight; use log rolling. Assess airway & upper extremities neuro checks- squeeze my hand etc. ▪ Lumbar= low back & leg pain • Laminectomy/discectomy- flat/ supine for the first few hours. Assess lower extremities neuro checks & bowel & bladder functioning. • Multiple sclerosis (MS): Ig bands on electrophoresis. Weakness starts in upper extremities; bowel & bladder are affected 90% (demyelination). Tx: ACTH, corticosteroids, Cytoxan & other immunosuppressant’s. ▪ Urinary retention, ↓ LOC, hypoactive DTR’s, numbness/tingling, ↓ short term memory ▪ A fluid intake of 2000 mL/day is recommended. The client should initiate the bowel program on an every-other-day basis, approx. 45 minutes after the largest meal of the day! ▪ Should try to sleep on their stomach as much as possible to ↓ the spasm of the muscle of the hips/knees as well as contractures/ ulcers • Gower’s sign= muscular dystrophy … like minor’s sign ( walks up legs w/ hands) • Milwaukee brace- worn 23 hrs /day; log rolling after sx. • PAD= pain is relieved when legs are @ rest or in a dependent position (below the heart). Extremities are cold to touch & have no hair. **pain, pallor, paresthesia, & paralysis** ▪ They cannot distinguish between sharp & dull ▪ They can have a heating pad placed on abdomen once a day to promote cause reflex vasodilation. NO hot tub soaking. ▪ No smoking, exercise even if in pain, stay inside during extreme weather changes, never use warm packs-burns • PVD= (above the heart) avoid massaging. Warm to touch, hair present, purplish. Peripheral pulses Psychiatry ▪ Pts admitted against their will still retain their right to refuse tx. ▪ Phobias involve projection & displacement ▪ MAOI’s: HTN crisis occurs w/ tyramine foods (meats, tenderizer, smoked/pickled fish, sausage, chocolate, caffeine, avocado, beer, & yogurt. o S&S= restlessness ▪ Phenothiazines: typical antipsychotics- induce (EPS) Parkinsonism & photosensitivity. ▪ CCU psychosis occurs in some clients in the critical care milieu. The ability to focus fluctuates over the course of a day ▪ Atypical antipsychotics: work on the + & - symptoms, ↓ EPS. ▪ Suicidal pts care consists of providing authority, action & participation. ▪ Benzodiazepines (Ativan, lorazepam): good for alcohol withdrawal & status epilepticus. ▪ The nurse monitors the CBC because hematological effects of this therapy include aplastic anemia, agranulocytosis, leukopenia, and thrombocytopenia= Dilantin ▪ Grapefruit juice ↑ levels of Carbamazepine (Tegretol) ▪ Neuroleptic malignant syndrome (NMS): lethal S/E of antipsychotic meds (Haloperidol). S&S ↑ temp. (102), pulse, incontinence, & muscle rigidity. ▪ Serotonin syndrome= diaphoresis, HA, agitation, & confusion → give Prozac ▪ Pts w/ severe depression should have activities w/ little concentration (drawing) ▪ Antabuse: given for alcohol deterrence; makes you sick w/ alcohol intake. o Given after alcohol detoxification to maintain abstinence. o Teaching: No alcohol in any form (mouth wash), abstain 12 hrs. before taking, no alcohol for 2 weeks after last dose ▪ S/E: HA, dry mouth, flushing ▪ A client with severe anxiety may feel abandoned and become overwhelmed if left alone. Placing the client in a quiet room is also indicated, but it is more important to stay with the client. o Anxiety attack= support & protect pt. Always assess 1st ▪ Schizophrenia: provide short frequent contacts; clarify: be specific (short phrase); provide individually packaged or canned foods o Associative looseness o Affective inappropriateness o Ambivalence: conflicting feelings (love-hate same person) o Autism: delusions- don’t attack them, express doubt, hallucinations- present reality, ideas of reference, & depersonalization. ▪ Neologism: made up words- tell them you don’t understand don’t reinstate. ▪ negative symptoms: flat affect ▪ Phobias: TX: antianxiety, desensitization, behavior modification, relaxation technique. DON’T confront or try to reason!!! o Simple phobia: object or situation o Agoraphobia: open or public places (elevators) ▪ Pts w/ OCD= rituals are performed to control unpleasant thoughts/feelings. o W/ a newly admitted pt the nurse should create a trusting nurse-client relationship o Don’t interrupt rituals but set limits; distract; assess: skin breakdown o Desensitization o Behavior modification o Help pt. express feelings in appropriate ways o Individual & group therapy. ▪ Conversion disorder: sudden loss of motor & sensory function (Voluntary nervous system)-short term= they don’t care o Primary gain: person no longer to be in the anxiety provoking situation o Secondary gain: attention ▪ Dissociative disorder: sudden or gradual loss of identity or memory usually by a traumatic event. ▪ Somatization= emotional turmoil expressed in physical signs (loss of functioning) o Rule out actual disease/ o Don’t focus on physical symptoms o AVOID being over attentive o Discourage secondary gains: benefits from being sick-special attention o Teach alternative coping mechanisms o Diversion ▪ Antisocial personality disorder: no conscience o little motivation to change o manipulative o Set limits! o Improvement= expresses sincere concern about another pt. ▪ Bipolar personality disorder: o Nursing care involves refraining from self-mutilation. ▪ Finger foods o Manic phase: flight of ideas, don’t argue, fast speech ▪ Bipolar Affective disorder mania o ↑ mood