Archive | October 2010

Anasarca

An extreme generalized edema characterized by the accumulation of serum in the tissues due to effusion of fluid into the extracellular space.

Urinary Catheterization

 

Types:

  1. Straight or intermittent catheter
  • single lumen catheter inserted into bladder through the urethra only to empty the bladder, then is removed

 

Applications:

  • to determine residual volume
  • if pt cannot urinate related to urinary obstruction or neurological disorder such as spinal injury
  • patients use clean technique in home setting
  • in hospital sterile technique is used due to high nosocomial infection rate

 

  1. Indwelling (foley)
  • catheter is pre-connected or connected after insertion to a closed drainage system that acts as a reservoir for urine drainage.
  • In the foley, a separate lumen is used to inflate a balloon sot he catheter placement is maintained

 

Indications

  1. presence of stage 3 or 4 pressure ulcers that fail to heal as a result of continued incontinence
  2. When accurate measurement of urinary output in critically ill patients is needed
  3. relief of urinary obstruction
  4. postoperatively (spinal anesthesia, bladder injury)

 

Prior to insertion:

  • review patient’s history
  • check for physician’s order
  • determine previous catheterization and size

 

Assess:

  1. last time pt voided
  2. check I&O
  3. LOC
  4. Mobility and physical limitations
  5. gender and age
  • infant 5-6 French
  • child 8-10 Fr
  • adult female 14-16 Fr
  • young girl or woman 12 Fr
  • Men 16-18 Fr

 

  1. allergies
  2. Assess bladder for palpable distention above the symphysis pubis
  3. Use bladder scanner to determine post void residual
  4. Determine patient’s previous experience with catheterization

 

Post-insertion assessment

  • 30ml/hr

 

Documentation:

  • type and size of catheter
  • amt of fluid used to inflate catheter balloon
  • state reason for catheterization, specimen collection
  • patient’s response to procedure
  • patient’s understanding of teaching or self-care
  • start in and out record

Pressure Sore Prevention

Areas of bony prominence are at risk for developing decubitus ulcers or pressure sores:

Positioning and turning patients at 30 degree angles relieves pressure from bony prominences. This allows existing pressure sores in these areas to heal or prevents pressure sores occurring in the first place.

Postpartum hemorrhage pathophysiology

At term, the uterus and placenta receive 500-800 mL of blood per minute through their low resistance network of vessels. The high circulatory exchange predisposes a gravid uterus to significant bleeding if not well physiologically or medically controlled. 

Biologic hemorrhage protection:

Maternal blood volume increases by 50%  the third trimester (increases the body’s tolerance of blood loss during delivery).

Biological protection of the maternal body against postpartum hemorrhage:

Reduction in uterine size:

The gravid uterus contracts down significantly after delivery given the reduction in volume. This allows the placenta to separate from the uterine interface, exposing maternal blood vessels that interface with the placental surface. 

Constriction of vasculature

After separation and delivery of the placenta, the uterus initiates a process of contraction and retraction, shortening its fiber and kinking the supplying blood vessels, like physiologic sutures or “living ligatures.”

Complications:
If the uterus fails to contract, or the placenta fails to separate or deliver, then significant hemorrhage may ensue. 

Risk factors for complications:

  1. Uterine atony, or diminished myometrial contractility, accounts for 80% of postpartum hemorrhage. 
  2. Abnormal placental attachment
  3. Retained placental tissue
  4. Laceration of tissues or blood vessels in the pelvis and genital tract
  5. Maternal coagulopathies. 
  6. Uterine inversion during placental delivery (rare). 

Etiology Pneumonic:

 
The traditional pneumonic “4Ts: 

  1. tone
  2. tissue
  3. trauma
  4. thrombosis

Carusi, Daniela,Yaa, Maame,  and Yiadom, A B. 2010. Pregnancy, Postpartum Hemorrhage. Emedicine. Retrieved October 24, 2010 from http://emedicine.medscape.com/article/796785-overview

Postpartum hemorrhage

The loss of 500ml or more of blood following a vagial delivery or the loss of 1000ml of blood following a cesearean delivery.

Risk factors:

  1. Large placenta (large surface area that  seperates from the uterine wall)
  2. Over disteeded uterus
  3. Uterine atony or low uterine muscle tone (decreases ability of the uterus to contract and close off vasculature that fed the placenta after it seperates from the uterine wall).

Pain Assessment tool (Socrate)

Site – where?

Onset – sudden, gradual? when?

Character – what is the pain like? ache? stabbing?

Radiation

Associations – other sites with pain? what provokes it?

Time course – Does it follow a time pattern?

Exacerbating/relieving factors – what relieves it?

Severity – Pain scale

Neonatal Reflexes

 Reflex Stimulation Infants Response Development Patterns
 Blinking Flash of light puff of air Closes both eyes  Permanent
 Babinski Stroke sole of foot Twists foot, fans out toes Disappears 9 months to one year
Moro Loud noise, being dropped Arches back and throws out arms and legs, then closes Disappears after 3 to 4 months
 Grasping  Palms touched  Grasp tightly Weakens after 3 months, disappears after 1 year 
 Rooting  Cheeks stroked or side of mouth touched  Turns head, opens mouth and begins sucking  Disappears after 3 to 4 months
Stepping   Infants held above surface and feet lowered to touch surface  Moves feet as if to walk  Disappears after 3 to 4 months
 Sucking  Object touching mouth  Sucks automatically  Disappears after 3 to 4 months
 Swimming  Infant put face down in water  Makes coordinating swimming movements  Disappears after 6 to 7 months
 Tonic Neck  Infant placed on back  Forms fist with hands and makes a “fencers” pose  Disappears after 2 months

 

Developmental psychology. 2010. Infant Development: Infant Reflexes. Retrieved October 22, 2010 from http://www.mesacc.edu/dept/d46/psy/dev/Fall98/Infant/Infant.html