FAQ W Ans (Pott 32-FAQ)

Frequently Asked Questions

Three-year-old Hannah was found on the bottom of her family’s pool by her father. He dove into the pool, pulled her out, and began resuscitation immediately while his wife called 911. Hannah began to breathe spontaneously after about 3 minutes. Paramedics arrived within 12 minutes. They obtained vital signs, monitored her oxygen saturation level, and performed a neurological evaluation. They then suggested that Hannah be taken by ambulance to the hospital emergency department. Hannah’s parents responded, “She seems just fine now.” Why should Hannah be taken to the hospital for evaluation and a possible short stay?

Although Hannah is awake, alert, and breathing on her own, complications can still occur. Because Hannah was alone when she fell into the pool, no one knows if she hit her head, had a seizure, or vomited and possibly aspirated the vomitus and pool water. Other concerns include the degree of hypoxemia she might have experienced, whether or not lung damage has occurred, and if she is able to regain her normal body temperature. While in the hospital, Hannah will undergo a thorough physical assessment evaluating her airway, ventilatory status, and circulation. The nurse will continue to monitor Hannah’s status, assessing her temperature, level of consciousness, and respiration.

You are caring for Shirley, a 5-year-old with cerebral palsy and severe accompanying disabilities. Shirley has been admitted for placement of a gastrostomy tube (GT). What should your plan of care include in addition to standard postoperative care?

Caring for Shirley can be quite challenging due to her contractures, rigid extremities, spastic movements, inability to handle secretions or swallow, and inability to communicate. Considering these, you will focus on repositioning Shirley every 2 hours, making sure that her body is in an aligned position. You will also monitor her skin, assessing for redness or blanched areas that are slow to regain color. Shirley will also require frequent evaluation of her pain and respiratory status with nursing care focused on managing pain and preventing pneumonia. Shirley will need good oral care and management of her oral secretions, which can begin to cause skin breakdownif left to collect. Until Shirley begins feedings in her GT, it will be important to monitor her fluid status by doing intake and output. You will also talk to Shirley, describing what you are doing and engaging her in discussion and in her care. Shirley’s parent will need to be provided with updates on Shirley’s status and may desire to be actively involved in her care. This will be supported. They will also need education on the care and use of the GT.

Ramona has been taking phenytoin (Dilantin) for her seizures. Because of her family’s lack of insurance or money for regular health care visits, Ramona has not had her seizures or her drug therapy monitored for 3 years. She has come to the emergency department because her gums are bleeding and painful. What is the reason for this?

One of the side effects of taking phenytoin (Dilantin) is gingival hyperplasia. Failing to follow good dental hygiene practices makes this problem worse. Earlier assessment and follow-up by a health care provider may have determined this problem sooner, and care and treatment could have been started to prevent further gum deterioration. Ramona may possibly need reevaluation of her seizures. She and her family need education on her seizure management as well as on normal growth and development concepts such as dental care, hygiene, and nutrition.

Mrs. Morales has brought her son Julio, 6 months old, to the clinic because he is fussy, vomiting, has a fever, and seems to be in pain. After reading his medical history (hydrocephalus and VP shunt placement), you complete your assessment. You find that he is febrile, his heart rate is elevated, his blood pressure is up, his pupils are equal but slow to react, his anterior fontanel is full and tense, and he is extremely irritable. What is the most likely cause of Julio’s clinical manifestations?

Based on Julio’s medical history and his presenting symptoms there are two diagnoses you would think about. Either the shunt is infected or it is obstructed. Both conditions will require further testing ordered by the physician: blood cultures, a possible lumbar puncture, and a complete blood count (CBC). Mrs. Morales will need support and education regarding Julio’s condition, further medical orders, and probable hospitalization.

Mrs. Higgins has just delivered her first baby in the medical center where you work. She did not receive any prenatal care until just before her delivery. The baby is born with a myelomeningocele, a saclike protrusion through a bony defect which contains cerebrospinal fluid, pieces of spinal cord bone, and meninges. How will you provide protection of the sac and its contents?

Protecting the sac is important to prevent rupture and possible infection development. Positioning the infant prone or in a supported side-lying position, keeping the sac moist with normal saline gauze pads, and a “bumper pad” positioned to prevent feces coming into contact with the sac are basic cares used to protect the sac. In addition, it will be important to monitor the sac and to note any cracks or fluid leaks.