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By: H. Kent, MD

Program Director, Texas Tech University Health Sciences Center Paul L. Foster School of Medicine

Which intervention is most important to symptoms nausea buy 50 mg dramamine visa include in a nursing care plan for a patient with atelectasis? Performed every hour symptoms 9 days after ovulation dramamine 50mg for sale, it produces deep inhalations that help open the collapsed alveoli symptoms renal failure buy dramamine with mastercard. Coughing and deep breathing (Option B) is a good intervention but rarely results in as deep an inspiratory effort as incentive spirometry; it should also be performed more fre quently than every 4 hours. Getting the patient out of bed to a chair (Option D) also helps expand the lungs and stimulate deep breathing, but it’s not as important as incentive spirometry. Used by arrangement with Wiley-Blackwell Publishing, a company of John Wiley & Sons, Inc. Nursing implications ofNursing implications of diagnostic diagnostic teststests To provide appropriate care for a patient undergoing a diagnostic test, the nurse must understand the test and its uses, prepare the patient properly (including verifying that informed consent has been obtained and explaining the procedure), and monitor the patient carefully before and after the test. Test and description Uses of test Patient preparation Nursing implications Radiologic (X-ray) tests Abdominal flat plate of abdomen or kidneys, ureters, and bladder X-ray of the abdomen or kid; Detecting abdominal; Have the patient remove; Cover the patient’s reproduc neys, ureters, and bladder masses, bowel obstructions, clothing and metal objects. Angiography X-ray of arterial blood vessels; Identifying femoral artery; Instruct the patient to fast; Check for allergies to shell using contrast media (dye) occlusion for 3 to 8 hours before the test. Bone densitometry Measures bone mineral; Diagnosing osteoporosis; Tell the patient to wear; Tell patient to remain still during density and monitoring its progression clothing that’s easily removed the test. Cardiac catheterization and coronary angiography X-ray examination of; Determining size and struc; Have the patient fast for 3; Check for allergies to shellfish or coronary vessels using ture of cardiac chambers to 8 hours before the test. Nursing implications of diagnostic tests ❍ 347 Test and description Uses of test Patient preparation Nursing implications Radiologic (X-ray) tests (continued) Chest X-ray Visualization of the; Detecting lung diseases or; Have the patient remove; Cover the patient’s reproductive lungs, heart, and bony tumors metal objects. If an allergic reaction occurs, administer a steroid or antihistamine as prescribed. Hysterosalpingography X-ray that visualizes the; Detecting tubal abnormali; Check the patient’s history; Teach the patient that she can uterine cavity, fallopian ties for recent pelvic infection and return to pretest activities gradually. Mammography X-ray examination of; Detecting benign breast; Have the patient remove; Tell the patient to remain still dur the breast’s soft tissue cysts, mastitis, or abscess clothing and jewelry from the ing the test. Nursing implications of diagnostic tests ❍ 349 Test and description Uses of test Patient preparation Nursing implications Radiologic (X-ray) tests (continued) Myelography X-ray examination of; Detecting tumors or other; Tell the patient to increase; Check for allergies to shellfish or the spinal column using obstructions of the spinal tract fluid intake the day before the iodine and for a prior reaction to dye. Venography X-ray examination of; Detecting deep vein throm; Explain the test to the; Check for allergies to shellfish or the peripheral venous bosis patient. Endoscopic tests Arthroscopy Visualization of the; Detecting torn cartilage or; Perform standard preopera; Check the incision site for infection. Cystoscopy Visualization of the ure; Detecting tumors and; If the patient will receive gen; Monitor urine output and vital signs. Sigmoidoscopy Visualization of the; Screening for polyps and; Administer two saline ene; Observe the patient for signs of rectum and sigmoid colorectal cancer mas the morning of the test. Leukocyte scan Injection of indium; Locating sources of infec; Make sure the patient’s; No special follow-up care is tagged leukocytes to tion that are difficult to detect, blood is drawn, tagged with required. Lymphoscintigraphy Following subcutane; Diagnosing lymphedema; Explain that the skin around; Don’t perform the test on a preg ous administration of a; Locating sentinal lymph the tumor site or in the distal nant patient. Magnetic and ultrasound studies Endoscopic ultrasonography Combines ultrasonogra; Evaluating or staging; Instruct the patient to fast; Make sure the patient is scheduled phy and endoscopy to lesions of the esophagus, for 6 to 8 hours before the test. Ultrasonography Visualization of under; Identifying gallstones; Explain the test to the; Tell the patient he can resume lying soft tissues and; Differentiating between patient based on the body site activity and diet as ordered. For a kidney, gall; Assessing blood flow (Dop bladder, spleen, or abdominal pler) and detecting occlusion scan, instruct the patient to or aneurysm fast for 8 to 12 hours before; Assessing heart valve move the test. Nursing implications of diagnostic tests ❍ 355 Test and description Uses of test Patient preparation Nursing implications Biopsies (continued) Other tissue biopsies Removal of organ tissue; Detecting malignant tumors; Preparation for a patient; Nursing care for the patient under for microscopic exami; Identifying pathologic cel undergoing other tissue biopsy going other tissue biopsy is similar to nation lular changes is similar to that for a liver biopsy. Electrodiagnostic tests Electrocardiography Noninvasive test that; Detecting ischemia, injury,; Tell the patient that his skin; Withhold medications, as ordered, gives a graphic repre and necrosis may be prepared with alcohol, before the stress test. Electroencephalography Noninvasive test that; Identifying seizure activity; Explain to the patient that; Withhold caffeine-containing records the electrical; Assessing and locating cere he’ll be subjected to stimuli, beverages and chocolate and refrain activity of the brain via bral lesions and injury such as lights and sounds. In the United States, it’s the second leading health problem and the cause of one of every four deaths. Various risk factors for cancer have been identified:; Tobacco is associated with cancers of the lung, mouth, tongue, upper airway, bladder, kidney, pancreas, and esophagus. During initiation, they’re exposed to factors that damage them, causing mutation of their genetic codes.


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Urinalysis for proteinuria In patients with no prenatal care treatment 197 107 blood pressure cheap 50mg dramamine, obtain Rh factor and antibody screen medications derived from plants order 50mg dramamine otc. Prevention of infective endocarditis: Guidelines from the American Heart Association: A guideline from the American Heart Association Rheumatic Fever medicine to prevent cold purchase generic dramamine on line, Endocarditis, and Kawasaki Disease Committee, Council on Cardiovascular Disease in the Young, and the Council on Clinical Cardiology, Council on Cardiovascular Surgery and Anesthesia, and the Quality of Care and Outcomes Research Interdisciplinary Working Group. Surgical therapy in the form of labyrinthectomy/posterior canal occlusion/vestibular nerve section, etc. Diagnostic, pathophysiologic, and therapeutic aspects of benign paroxysmal positional vertigo. Dizzy and confused: A step-by-step evaluation of the clinician’s favorite chief complaint. Disconnect between charted vestibular diagnoses and emergency department management decisions: A cross sectional analysis from a nationally representative sample. Assess presence of devitalized tissue, debris from foreign materials, bone or joint violation, tendon injury: Avoid digital exploration if the object is believed to be sharp. Consider surgical consultation for complex lacerations, especially involving eyes and face. Analgesia and conscious sedation: Adequate analgesia is crucial for good wound management. Avoid epinephrine in the penis, digits, toes, ears, eyelids, tip of nose, skin flaps (necrosis), and severely contaminated wounds (impairs defense). For patient comfort, inject slowly with small-gauge needle; buffer every 9 mL of 1% lidocaine with 1 mL 8. Exploration and removal of foreign body: Indications for removal of a foreign body include: Potential or actual injury to tendons, nerves, vasculature Toxic substance or reactive agent Continued pain Irrigation and debridement: Surrounding intact skin may be cleaned with an antiseptic solution (povidone-iodine, chlorhexidine): Do not use antiseptic solution within the wound itself because it may impair healing. Scrub with a fine-pore sponge only if significant contamination or particulate matter. Clip if necessary: Increased skin infection rate after shaving Never shave or clip eyebrow as it may not grow back with a normal appearance Debride devitalized and contaminated tissue. Single-layered closure: Simple interrupted sutures: Avoid in lacerations under tension. Horizontal mattress sutures (running or interrupted): Edematous finger and hand wounds Ideal in skin flaps where edges at risk for necrosis Vertical mattress: For wounds under greater tension 1 stitch that provides both deep and skin closure Half-buried horizontal mattress sutures: Ideal for closing the vertex of a v or y-shaped laceration where ischemia is a concern Multiple-layered closure: Closes deep tissue dead space Lessens tension at the epidermal level, improves cosmetic result Buried interrupted absorbable suture, simple or running nonabsorbable sutures for epidermis Dressing: Dress wound with antibiotic ointment and nonadherent semiporous dressing. Antimicrobial agents: Uncomplicated lacerations do not need prophylactic antibiotics. If antibiotics are used, initiate before wound manipulation or as early as possible. Adhesive tapes (Steri-Strips): For lacerations that are clean, small, and under minimal tension Avoid in wounds that have potential to become very swollen. Tissue adhesives: Good cosmetic results have been achieved in simple lacerations with low skin tension. Discharge Criteria Wounds at risk for infection or poor healing require a wound check within 48 hr. Time of suture removal dependent on location and peripheral perfusion: Scalp: 7–10 days Face: 3–5 days Oral: 7 days Neck: 4–6 days Abdomen, back, chest, hands, feet: 7–10 days Upper extremity: 7–10 days Lower extremity: 10–14 days Overlying joints: 10–14 days Issues for Referral Lacerations of the eye where tear duct injury is suspected require immediate referral. Complicated lacerations (tendon involvement) may require further repair in the outpatient surgical office. Be sure to discuss temporary skin closure and splinting with your surgical consultant. Patients with >3 wk of laryngitis without obvious benign cause should be evaluated with laryngoscopy to rule out more serious conditions such as carcinoma. Typical mechanism is hyperextension of neck with a direct blow to the exposed anterior neck. Iatrogenic injuries from intubation are becoming more common with an aging population. Pediatric Considerations Bicycle handlebars: Extended neck hits the bar, compressing structures between the bar and vertebral column. Loosely attached submucosal tissue allows for greater soft-tissue trauma, massive edema, and hematoma formation: With smaller airway diameter, airway compromise can occur rapidly. Symptoms can vary from neck tenderness or hoarseness to respiratory distress and stridor. Formal tracheostomy under local anesthesia may be required rather than endotracheal intubation when more severe neck injury is present.

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It is ill-advised to symptoms for bronchitis order dramamine 50 mg without a prescription transport a snake to medicine 4839 cheap dramamine 50 mg a health care facility for identification purposes: If you are close enough to medicine organizer box generic 50mg dramamine overnight delivery get a good picture with a camera/phone, you are too close to a potentially venomous snake. These include: Incision and drainage Mechanical suction devices Oral suction Tourniquets Cryotherapy Electrocution Pressure immobilization Incision attempts by inexperienced can lead to severe tendon, nerve, and vascular damage. Severity due to relatively low body weight of small child with same volume of venom. Elevated compartment pressures are treated with more antivenom, as surgical intervention with fasciotomy causes more damage to the area. If hypotensive or with serious active bleeding, initial dose is 8–12 vials Evaluate for envenomation control 1 hr after antivenom bolus infusion. Control is defined by stable wound appearance, improving coagulation studies, and hemodynamic stability. If envenomation control achieved after 1st bolus of antivenom, may need maintenance antivenom therapy at 2 vials q6h × 3 doses. If envenomation control not achieved after 1st bolus of antivenom, repeat initial bolus and reassess. Victims of envenomation who develop an allergic reaction to antivenom: Stop infusion of antivenom Administer antihistamines, corticosteroids, and fluids. Discussion of risks/benefits of restarting antivenom should take place with regional poison center or medical toxicologist Coral snake antivenom: No longer being manufactured, but stockpile exists in geographically appropriate locales. Effective against more toxic eastern coral snake but not against western coral snakes After proper skin testing, 3–5 vials of antivenin recommended. Coral snake venom is neurotoxic; watch for respiratory depression, control airway International exotic venomous snakes: Specific antivenoms may be available at local zoos or through the Antivenom Index. Pediatric Considerations Proportionally more antivenin per body weight Standard adult doses required Pregnancy Considerations If mother has systemic signs of envenomation toxicity, fetus is also at risk; timely antivenom therapy is still indicated. Consult obstetrician Treatment Assistance Contact local poison center 800-222-1222, medical toxicologist, local zoo, or regional herpetologist. Minor envenomations should be observed for 12–24 hr and have labs repeated 6 hr after presentation, then again before discharge. Be sure to administer proper dose of antivenom in a timely fashion when clinically indicated. A large single-center experience with treatment of patients with crotalid envenomations: Outcomes with and evolution of antivenin therapy. Unified treatment algorithm for the management of crotaline snakebite in the United States: Results of an evidence informed consensus workshop. Clinical presentation and treatment of black widow spider envenomation: A review of 163 cases. History An isolated cutaneous lesion is the most common presentation Bite sites are usually located in areas under clothing where spider gets trapped between clothing and skin Local wound symptom onset: Bite onset is usually asymptomatic, but some may report burning or stinging sensation 1–24 hr later, patients may report aching or pruritis locally Systemic features: Rare complication More common in children than adults Develop during the 1st 1–3 days postenvenomation. Patient may report: Fever, chills Weakness, malaise Nausea, vomiting, diarrhea Dyspnea Myalgias, muscle cramps, arthralgias Jaundice Petechial or urticarial rash Generalized pruritic rash Hematuria or dark urine Physical-Exam Bite wound: Usually no visible injury if examined within the 1st 1–3 days There may be a pinprick lesion, local blanching and induration, or erythema. Loxoscelism and negative pressure wound therapy (vacuum-assisted closure): A clinical case series. Dorsal cord syndrome: Associated with hyperextension injuries Complete cord syndrome: Blunt or penetrating trauma that results in complete disruption of spinal cord Symptoms that remain >24 hr generally are permanent. Patients with arthritis, osteoporosis, metastatic disease, or other chronic spinal disorders are at risk of developing spinal injuries as the result of minor trauma. Central cord syndrome: Loss of motor function affects upper extremities more severely than lower extremities. Consider sedimentation rate and C-reactive protein to risk-stratify other potential diagnoses. A lumbar puncture may be required if considering Guillain–Barré, multiple sclerosis, or transverse myelitis. Patients should be transported to the nearest trauma center: Prompt evaluation and neurosurgical intervention may lead to a better outcome.

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