...term for difficulty with swallowing and is common in patients with neurological disease, dementia and parkinson’s disease (Chang and Roberts 2011). Tee has a pureed diet and thickened fluids. I collected her meal and dessert from the trolley, sat next to Tee then started to feed her. After the first helping I proceeded and gave her a second helping while she still had food in her mouth. As I hurriedly continued with the feed, Tee started to cough, her eyes started to blink rapidly, I thought I should give her some juice and realised I had left it on the trolley, I rushed to get the juice and gave Tee but the food and the juice was coming out from her mouth. Tee continued to cough but I was not sure if it was a cough or she was choking. I hastily cleared the...
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...esophagus (Potts & Mandleco, 2013, p. 669). There are five different types of EA/TEF: 1) Esophageal atresia with distal tracheoesophageal fistula (87%) 2) isolated or pure esophageal atresia (8%) 3) pure tracheoesophageal fistula (4%) 4) esophageal atresia with proximal tracheoesophageal fistula (<1%) (Clark, n.d.). According to the CDC, 1 in 4,608 births are a case of EA/TEF, and there are 905 estimated annual cases with infants having EA/TEF in the United States (“Data & Statistics”, 2015). Clinical manifestations of EA/TEF includes: vomiting and choking with the first feeding, difficulty swallowing, drooling, coughing, cyanosis, apnea and abdominal distention. Diagnosis includes a history of polyhydramnios and radiographic studies. Treatment of EA/TEF may vary depending of the infant’s health status however; treatment is usually through surgical correction. Nursing management goals pre-operatively is geared towards preventing aspiration and post-operatively to maintain patent airway, prevent trauma, and family teaching. Pathophysiology In a normal embryonic anatomy and development, the trachea, esophagus, and lungs are derived from the foregut. During the fourth week of embryonic life it is divided into the ventral respiratory and dorsal esophagus components. Esophageal atresia and tracheoesophageal fistula occurs when the esophagus terminates before it reaches the stomach, ending a blind pouch or a fistula forms and connects to the trachea (Saunders 2013, p. 409). There...
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...a pillow or a bottle is propped with a blanket. This increases the risk of choking and aspiration. The recommended position for infant sleeping is on the back without propping the head; this position is not recommended for feeding. Spoon-feeding is most successful when an infant is capable of controlling its head and mouth. Placing babies in a seated position with good support of their back and feet helps them control their mouth and head better. The person offering the food should sit directly in front of the infant, and the baby should not have to turn the head to receive the food. A high chair is the best support for infants when they are capable of sitting on their own. Ensure that the infant is sitting with legs and torso at a 90-degree...
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...neurodegenerative disease that portrays progressive muscle paralysis, and eventually ends with death. As many as twenty thousand to thirty thousand people in the United States have amyotrophic lateral sclerosis, and an estimated five thousand people in the United States are diagnosed with the disease each year (Shiel, 2012). The etiology of the disease is unknown, but it plays a genetic factor. Less than ten percent has been shown to be inherited in families. ALS begins with the client with muscle weakness, stiffness, eventually to paralysis, then death caused by respiratory failure. Dysphagia occurs at onset in about one third of case, although generally it occurs in later stage of the disease (Noh, 2010). The nursing diagnosis is risk for aspiration related to impaired swallowing. Intervention for the diagnosis includes positioning the client in a 90 degree angle while in bed, a wheel chair or a chair. There is no known cure for the disease, but symptoms can be treated. Riluzole is administered to slow the progression of the disease. Pathophysiology Amyotrophic lateral sclerosis is a neurodegenerative disease that begins with rapid, progressive muscle weakness. It attacks the neurons that are responsible for moving voluntary muscles. Once the person is diagnosed with the disease, the person will inevitably face death during the later stages of the disease. Respiratory failure limits survival to 2-5 years after disease onset (Noh, 2010). The etiology of ALS...
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...the hazards that could occur. To touch on the subject of first aid in febrile seizure, it is most important for the parent or caregiver to stay calm and carefully note all that happens with a seizure noting the time and duration, also what part of the body is affected and if the child has lost consciousness. This information will be vital for the medical personal that will be involved in the pediatrics care. To prevent major injuries associated to a fall, the patient or caregiver should place the patient on the floor or ground. The pediatric should not be restrained to stop movement as this could result in adding injury to the pediatric. To prevent choking and aspiration the pediatric should be placed in the recovery position. If safe and possible to do so objects in the patients mount should be removed as these could provoke choking. On the other side of this note, nothing should ever be placed into the convulsing patients mouth trying to prevent the pediatric from biting the tongue as these can cause a possible choke hazard risk. If the seizure lasts for more than ten minutes it is highly recommended to call the emergency response system. If the seizure is shorter then it is greatly advised to take the pediatric to his or her pediatrician. It is important to figure out what is causing the fever to get the issue stabilized. It is important to seek medical attention if the pediatric is experiencing symptoms of stiffened neck, weakness or severe vomiting. Response I can attest...
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...Patients won’t need to spend money on medicine or surgery’s. According to The Good Short Life, Clendinen shares, “There is no meaningful treatment. No cure. There is one medication, Rilutek, which might make a few months’ difference. It retails for about $14,000 a year“” (Clendinen 57). A treatment won’t fix his illness. He knows he’ll pass away by any means. With assisted suicide he won’t be required to pay large amounts of money. He continues to mention, “If I choose to have the tracheotomy that I will need in the next several months to avoid choking and perhaps dying of aspiration pneumonia, the respirator and the staff and support system necessary to maintain me will easily cost me half a million dollars a year. Whose half a million. I don't know. I’d rather die”” (Clendinen 58). He would rather confront death than to pay money he doesn't have in hand. Clendinen won’t have to worry financially because he knows he won’t continue to grow old and healthy, it won’t make a difference, therefore assisted suicide is an option for him (Clendinen...
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...finished you should fasten the nasogastric tube to the patient’s gown using a clip or piece of tape. When delegating responsibilities verification of the tubing cannot be delegated. The NAP may be delegated to inform the nurse of any nausea, choking, excessive coughing or shortness of breath. With every procedure you must know what risk could occur. Aspiration is a risk that involves food or medicine accidentally going into your lungs. This could happen from the nasogastric tube accidently being threaded into from your windpipe into your lungs. Aspirations can lead to pneumonia if not corrected. If you suspect that your patient is aspirating you should turn them onto their side and order an x-ray if one has not been done previously to verify the placement of the tubing. (Feeding tube insertion - gastrostomy. (n.d.). Retrieved October 25, 2017, from https://medlineplus.gov/ency/article/002937.htm) Gastric tubes commonly known as PEG (percutaneous endoscopic gastrostomy) tubes are a type of permanent but reversible feeding tube. PEG tubes allows fluids, food, and medicines to be passed directly into the stomach from a thin tube through the skin of the stomach. PEG tubes are used when the patient cannot swallow or there is a risk for aspiration. PEG tubes are easier to manage and are more comfortable if needed outside of the hospital setting. When receiving a PEG tube it is important that the patient does not eat for at least 6 hours before the procedure and fluids may be given...
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...Peds Unit 4 Study Guide 1. Symptoms of tracheoesophageal fistula. a) Vomiting, choking, and inability to swallow 2. What to assess for in an infant with gastroenteritis. What is the priority for these patients? b) Improper feeding techniques; preventing aspiration 3. Why are rapid respirations a concern in children in regards to dehydration? c) It causes increased evaporation through the lungs 4. Symptoms of pyloric stenosis. d) Projectile vomiting, hunger, malnutrition, dehydration, decreased urination 5. Symptoms of pinworms. e) Anal itching, irritability, restlessness, weight loss, poor appetite, and fretfulness 6. Symptoms of intussusceptions. f) Severe abd. Px, vomiting, green or greenish yellow bilious stomach content, currant jelly stool, fever, signs of shock, rigid abd. 7. Home diet for constipation. g) Low iron formula, high fiber, increase fluids, exercise, stool softener 8. Causes of lead poisoning. h) Paint from old buildings, food, water, and air 9. Diet for celiac disease, what, if any grains are allowed? i) Gluten free diet, no wheat, barley, oats, or rye 10. Symptoms of UTIs, treatment, prevention strategies. j) High fever, vomiting, chills; low dose antimicrobial medications; wipe front to back 11. What are hypospadias and hydroceles? How are they treated? k) Urinary meatus is at the lower shaft; surgical repair. Swelling of the scrotum by excess...
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...Excessive drinking has become one with the “college experience” for students and in hand has altered many lives. Students who are a part of the college campus drinking culture are at risk to encounter life threatening experiences due to binge drinking. Binge drinking can be defined as one consuming 4/5 drinks at least once in a two week span. After plenty of observations, I would say that this definition is consumer friendly. With that being said, I think it is safe to say that binge drinking is “normal” and is somewhat expected among college students. So I would assume since excessive drinking is so normal that one would also consider the consequences but as some of us know, that this is not always the case. Binge drinking can lead to impaired judgment and alcohol poisoning. Both can lead to life threatening experiences. Being on a campus that is known for working hard and playing hard, I have noticed that with excessive drinking comes impaired judgment. For instance I have seen students drink way too much and the more they drink, the more their motors skills decrease or their ability to make sound decisions decrease. Basic motor skills are affected due to the consumption of alcohol, especially if you are excessively drinking and this is because alcohol acts as a depressant on the central nervous system. One can lose muscle control, reaction time is impaired, and basic senses are affected as well, like vision and hearing, making someone less aware of danger and injury. That...
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...RNQuiz.com - NCLEX-RN Study Guide Neonatal Care 1 Cardiovascular system: o Closer of the foramen ovale secondary to: Expansion of the lungs, decreases pulmonary resistance Clamping of umbilical cord: Increases systemic vascular resistance Increases left atrial pressure Respiratory system: o First breath is a reflex to noise and light Renal system: o Not fully functional for the first year o Neonate’s ability to filter waste products improve over first year of life Gastrointestinal system: o No normal bacterial flora o Unable to digest fat Thermogenesis: o Rapid heat loss can occur in less than optimal environment Immunity: o Depends on immunity provided by mother o Neonate begins to development of own immune system within 3 months Hematopoietic system: o Prolonged coagulation time secondary to low vitamin K levels RNQUIZ.com Changes in the Neonate post delivery: RNQuiz.com - NCLEX-RN Study Guide Neurologic system: o Equal strength and symmetrical responses and reflexes Hepatic system: o Physiological jaundice is mild and last first few days after birth Apgar Assessment: 2 This is a way to evaluate the neonate’s cardiopulmonary and neurological status at 1 and 5 minutes after birth. A score of 8-10 indicates no immediate distress, less than 8; possible CPR. Sign Heart rate Respiratory Muscle tone Reflex irritability Color 0 Absent Absent Flaccid None Pale blue 1 Less than 100beats/min...
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...observation of staff within the company to see which areas are needed and which areas could use assistance. Within the mental health field, there is a need for hands on supports and services. These supports and services range from assisting with medication administration to assisting with apartment or room maintenance; other supports include escorting individuals to and from medical appointments, money management and budgeting to travel training. These supports are mandated from the state to be implemented into each agencies programming. There are safety factor that play a huge role in securing overall staff and consumers staff, fire safety, First Aid and CPR; as well as, strategies in crisis intervention and prevention and choking prevention and aspiration. It would be ideal to select staffs that have already completed the required course. This would save the agency from paying to train new employees on these courses. Also when a new employee is hired with all the necessary training they will be given a pay increase for usually two to four dollars. I.e. starting salary is $10.00 hourly they can get anywhere from $12.00-$14.00 to start. When...
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...The eggs represent Walter’s hope and dreams but the egg does not turn that way he desired it to because of his wife, Ruth, who informs him to come back to reality. It becomes self-evident when the text states,“Man say to his woman: I got me a dream. His woman say: Eat your eggs. (Sadly, but gaining in power)… Eat your eggs and go to work. (Passionately now) Man say: I got to change my life, I’m choking to death, baby! And his woman say—(In utter anguish as he brings his fists down on his thighs) —Your eggs is getting cold!” (Hansberry 33-34). This quote shows that Walter is trying to tell Ruth about his dream and how he is going to change his life, but Ruth keeps on telling him to eat his eggs because she is exhausted of hearing something they cannot achieve. Walter has been trying to inform everyone in his family about his aspiration of opening a liquor store, but no one listens to him, for example, “See—I’m trying to talk to you ’bout myself—(Shaking his head with the repetition)— and all you can say is eat them eggs and go to work” (Hansberry 34). Walter is complaining to Ruth that she is not listening to him but keeps on telling him to eat his eggs and go to work because of the time period they live in. In addition, the eggs can also...
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...Tracheostomies * Short-term reasons: * Anaphylactic shock * Trauma * Choking * Impaired airway baby drinking bleach throat is now swollen impairing airway needs trach * Croup cause upper airway swelling * If they couldn’t be intubated need an airway asap * Long-term reasons: * Syndrome have TEF an opening between trachea and esophagus unable to breathe * Cancer post surgery * Congenital abnormalities * Neuromuscular d/o’s MS, CP, spinal Cord injury or muscular dystrophy * Brain trauma/tumor or brain genetic disease (brain tells lungs to breathe so if its not working you’re not going to breathe) ***In pedi, there is only one cannula because if not the child will be taking the cannula out all day*** * Cuff will keep trach in place and will prevent aspiration. * Can be cuffed or uncuffed depending on the situation. * Keep scissors at bedside in case you need to cut the ties. ***DO NOT LET TRACH KID BE AROUND THE CHALKBOARD*** PARTICLES CAN ENTER THE TRACH. * Put a filter on the trach if the child will be outdoors. * What kind of trach is most likely to be used in pedi? * Shiley 3.5, 4.0, 4.5 or 5.0 (the whole point is to always have a smaller half size replacement at the bedside at all times) * Example: Your patient currently has a 4.0 trach, need to have a 3.5 at bedside in case kid pulls out current trach. * Kids...
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...makes no sense in America, best translated by Babylon as “Fools rush in.” Who are the fools now? A far less remarkable issue, but vital to me anyway, is how we (I mean you, my non-readers) fail to hear the truth when it’s not said by a recognized pundit with millions of social media followers. It was far easier to spread the wrong notion that athletes and visitors would surely be contaminated by Zika at the Rio Olympics — an “official” truth for a while — than to read from yours truly that, in fact, there’s no contamination in the winter, which is now the official truth disseminated by WHO. Who? Oops. I apologize. Too late for too many of us. To my chagrin, the games in Rio are almost certainly ruined. Also ruined, by the way, are the aspirations of a number of athletes who have fiercely trained for four years in a row, having in Rio their last opportunity to shine. Who cares. What needs to be changed is the way we react, ready to accept anything we hear on the Internet (I heard that it was decided last week we should no longer capitalize “internet,” which makes a lot of sense, by the way). Let’s face it, only fools fall for the first rushed version of anything that hasn’t been thoroughly examined, and only “unthinking people” use their energy to spread around such questionable news to make us panic. I’m no exception. I also spread “news” around. And I panic too. The point is, I’m getting so tired of having my sensitivities routinely overstretched. I can feel it coming: I’m eventually...
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...noise, and excessive handling. * Recognize that the neonate’s behavior is largely reflex in nature. * Facilitate bonding with the parents, especially the mother. INFANT (29 days – 2 years) Developmental Task = Trust versus Mistrust * Mistrust may result in failure to thrive. * Give familiar objects for comfort. * Limit number of strangers present. * Promote bonding to parents. * Keep parents in infant’s line of vision. * Assess carefully and use mother or primary caregiver’s insights to interpret behavior. * Minimize stressors: strangers, loud noises, bright lights, and sudden environmental changes. * Risk-prevention * Prevent choking or other injury due to foreign objects in the mouth. * Protect from upper respiratory infection and aspiration. * Protect from infection. * Assess respiratory status carefully. * Assess fluid balance carefully. * Assess nutritional needs. * Provide visual, auditory, and tactile stimulation to support development. TODDLER (1-3 years) Developmental Task = Autonomy versus Shame or Doubt * Give...
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