Category Archives: Nursing

Appendicitis

Introduction:

Appendicitis is an inflammation of the appendix.
It is a medical emergency that usually leads to removal of the appendix before it can rupture, as this can cause infection and even death.
Surgically removing the appendix appears to have no effect on the digestive system.
Appendicitis can occur at any age but usually affects children and young adults.
Appendicitis is found on the right lower side of the abdomen and connects to the cecum of the large intestine. It looks like a protruding worm or finger-like structure coming out of the large intestine, specifically the ascending colon.
The role of the appendix: it plays a role in storing the “good” bacteria in your GI tract while the tract is recovering from a diarrhea illness (so it helps maintain healthy GI flora.

Types of Appendicitis
The two types of appendicitis depending on the onset, which are:

  • Acute Appendicitis – It develops very fast within a few days to hours, and requires prompt medical treatment or surgery.
  • Chronic Appendicitis – Here, the inflammation lasts for a long time. It is a rare condition.

And depending on the complications:

  • Simple Appendicitis – Cases with no complications.
  • Complex Appendicitis – Cases that involve complications like appendix rupture or abscess.

Causes
The exact causes are not clear, but it usually involves:

  • a blockage of the lumen of the appendix (leading to increased pressure and impaired bloodflow, which results in inflammation).
  • This is usually caused by faeces, but bacterial or viral infections in the digestive tract can lead to swelling of lymph nodes (lymphoid hyperplasia), which puts pressure on the appendix and causes obstruction.
  • Untreated, the appendix can become gangrenous or rupture. If it ruptures, the infection may be released into the abdomen.
  • inflammatory bowel disease.
  • stool, parasites, or growths that can clog your appendiceal lumen.
  • trauma to your abdomen.

Pathophysiology
Appendicitis occurs when the appendix becomes acutely inflamed. It’s not entirely known why appendicitis occurs however it is thought to be due to the lumen of the appendix becoming blocked by a faecolith, normal faecal matter or lymphoid hyperplasia due to a viral infection.

https://teachmepaediatrics.com/wp-content/uploads/2018/10/Appendicitis-e1540220601487-1024x733.jpeg Once obstructed, there is reduced blood flow to the tissue and bacteria is able to multiply. Due to the lumen being obstructed, the pressure within the appendix increases and this reduces venous drainage, resulting in ischaemia. If untreated the ischaemia can lead to necrosis and gangrene. At this stage, the appendix is at risk of perforating. It takes around 72hrs for perforation to occur from when the appendix becomes obstructed. Once the appendix perforates, bacteria and inflammatory cells are released into the surrounding structures. This then causes inflammation of the peritoneum and the child develops peritonitis causing diffuse abdominal pain.

Signs and Symptoms of Appendicitis

Remember “Appendix”

  • Abdominal pain (will be dull at first with pain at or around the belly button that radiates to the right lower quadrant and it will localize at this spot)
  • Point of McBurney’s will have the most pain (found one-third distance between the belly button and anterior superior iliac spine)
  • Poor appetite
  • Elevated temperature
  • Nausea/vomiting
  • Desire to be in the fetal position to relieve pain (side lying with knees bent)
  • Increased WBC, inability to pass gas or have a bowel movement (constipation..can have diarrhea too)
  • eXperiences rebound tenderness (when pressure is applied to the right lower quadrant it hurts but it HURTS MORE when the pressure is released) and abdominal rigidity on palpation (involuntary stiffening of the abdominal muscle when abdomen palpated).

Complications

If appendicitis is left untreated, a complication could occur.

Perforation of the appendix. This is a major complication of appendicitis, which can lead to peritonitis, abscess formation, or portal pylephlebitis.
Perforation generally occurs 24 hours after the onset of pain.
Symptoms include a fever of 37.7⁰C or greater, a toxic appearance, and continued abdominal pain or tenderness.

Assessment and Diagnostic Findings
Diagnosis is based on the results of a complete physical examination and on laboratory findings and imaging studies.

  • CBC count: A complete blood cell count shows an elevated WBC count, with an elevation of the neutrophils.
  • Imaging studies: Abdominal x-ray films, ultrasound studies, and CT scans may reveal a right lower quadrant density or localized distention of the bowel.
  • Pregnancy test: A pregnancy test may be performed for women of childbearing age to rule out ectopic pregnancy and before x-rays are obtained.
  • Laparoscopy: A diagnostic laparoscopy may be used to rule out acute appendicitis in equivocal cases.
  • C-reactive protein: Protein produced by the liver when bacterial infections occur and rapidly increases within the first 12 hours.

Medical Management
Medical management should be performed carefully to avoid altering the presenting symptoms.

  • IV fluids: To correct fluid and electrolyte imbalance and dehydration, IV fluids are administered prior to surgery.
  • Antibiotic therapy: To prevent sepsis, antibiotics are administered until surgery is performed.
  • Drainage: When perforation of the appendix occurs, an abscess may form and patient is initially treated with antibiotics and the surgeon may place a drain in the abscess.

Surgical Management
Immediate surgery is typically indicated if appendicitis is diagnosed.

  • Appendectomy. Appendectomy or the surgical removal of the appendix is performed as soon as it is possible to decrease the risk of perforation.
  • Laparotomy and laparoscopy. Both of these procedures are safe and effective in the treatment of appendicitis with perforation.

Nursing Management

  • A focus of the nurses’ management is the preparation of the patient for surgery.

Nursing Assessment

Assessment of a patient with appendicitis may be both objective and subjective.

  • Assess the level of pain.
  • Assess relevant laboratory findings.
  • Assess patient’s vital signs in preparation for surgery.

Diagnosis
Based on the assessment data, the most appropriate diagnoses for a patient with appendicitis are:

  • Acute pain related to obstructed appendix.
  • Risk for deficient fluid volume related to preoperative vomiting, postoperative restrictions.
  • Risk for infection related to ruptured appendix.
  • Planning & Goals
  • Main Article: 4 Appendectomy Nursing Care Plans

Goals for a patient with appendicitis include:

  • Relieving pain.
  • Preventing fluid volume deficit.
  • Reducing anxiety.
  • Eliminating infection due to the potential or actual disruption of the GI tract.
  • Maintaining skin integrity.
  • Attaining optimal nutrition.

Nursing Interventions

  • The nurse prepares the patient for surgery.
  • IV infusion. An IV infusion is made to replace fluid loss and promote adequate renal functioning.
  • Antibiotic therapy. Antibiotic therapy is given to prevent infection.
  • Positioning. After the surgery, the nurse places the patient on a High-fowler’s position to reduce the tension on the incision and abdominal organs, thereby reducing pain.
  • Oral fluids. When tolerated, oral fluids could be administered.

Evaluation

  • Relieved pain.
  • Prevented fluid volume deficit.
  • Reduced anxiety.
  • Eliminated infection due to the potential or actual disruption of the GI tract.
  • Maintained skin integrity.
  • Attained optimal nutrition.

Discharge and Home Care Guidelines

Discharge teaching for patient and family is imperative.

  • Removal of sutures. The nurse instructs the patient to make an appointment with the surgeon to remove the sutures between the 5th and 7th days after surgery.
  • Activities. Heavy lifting is to be avoided postoperatively; however, normal activity can be resumed within 2 to 4 weeks.
  • Home care. A home care nurse may be needed to assist with incision care and to monitor the patient for complications and wound healing.

Documentation Guidelines

The focus of documentation in patients with appendicitis should include:

  • Client’s description of response to pain.
  • Acceptable level of pain.
  • Prior medication use.
  • Results of laboratory tests.
  • Surgical site.
  • Signs and symptoms of infectious process.
  • Recent or current antibiotic therapy.
  • Plan of care.

Teaching plan.

  • Response to interventions, teaching, and actions performed.
  • Attainment or progress toward desired outcomes.
  • Modifications to plan of care.

Long term needs.

Nursing Intervention

Preoperative interventions

  • Maintain NPO status.
  • Administer fluids intravenously to prevent dehydration.
  • Monitor for changes in level of pain.
  • Monitor for signs of ruptured appendix and peritonitis
  • Position right-side lying or low to semi fowler position to promote comfort.
  • Monitor bowel sounds.
  • Apply ice packs to abdomen every hour for 20-30 minutes as prescribed.
  • Administer antibiotics as prescribed
  • Avoid the application of heat in the abdomen.
  • Avoid laxatives or enema.

Postoperative interventions

  • Monitor temperature for signs of infection.
  • Assess incision for signs of infection such as redness, swelling and pain.
  • Maintain NPO status until bowel function has returned.
  • Advance diet gradually or as tolerated or as prescribed when bowel sound return.
  • If ruptured of appendix occurred, expect a Penros drain to be inserted, or the incision maybe left to heal inside out.
  • Expect that drainage from the Penros drain maybe profuse for the first 2 hours.

Frequently Asked Questions

1. How Do You Rule Out Appendicitis?

  • Appendicitis can be ruled out by using brief case history, physical examinations, computed tomography scan, urine analysis, ultrasound abdomen, anal examinations, an x-ray of the abdomen, and blood examination.

2. How Long Can You Have Appendicitis Before It Bursts?

  • The duration taken for bursting depends on the type of appendicitis. In the case of chronic appendicitis, it lasts for a long period, whereas in the case of acute conditions, symptoms will appear suddenly and immediate surgery is needed.

3. What Does Appendicitis Feel Like?

  • Appendicitis pain might be mild or severe. There will be fever, abdominal pain, navel pain, difficulty in moving around, loss of appetite, and anal pain in some cases. There may also be vomiting, diarrhea, and nausea.

4. How Bad Is Appendicitis Pain?

  • There will be sharp pricking pain in the abdomen and the pain worsens by pressing the painful area, moving around. Sometimes, even coughing, and sneezing worsens the pain. There will be difficulty in sitting in a particular place for a long time. There will also be difficulty in passing urine.

5. How Do You Check for Appendicitis at Home?

  • There are no standard methods for the examination of appendicitis at home, but we can check for any swelling in the abdominal area. If we have basic knowledge and ideas about appendicitis we can palpate the abdomen and rule out in some cases.

6. How Does Someone Get Appendicitis?

  • Any blockages in the lining of the appendix lead to appendicitis. This is mainly due to the food items we consume and seeds of fruits that block the passage. It may lead to infection and rupture in the appendix region and sometimes pus discharges also.

7. Should You Feel for Appendicitis?

  • Appendicitis treated at an early time is easily curable but in cases where it is left untreated leads to fatal conditions. So, it is necessary to start the treatment faster. This will make the condition simple.

8. How Does Appendicitis Pain Start?

  • The pain usually comes and goes for a short period of time in the belly and navel region. It starts with pain around the navel region which makes it difficult in sitting and moving. If you are feeling too much pain, you should consult your doctor immediately.

9. What Is the Recovery Time for Appendicitis?

  • Usually, it takes around one to three days for recovery for laparoscopy. It usually takes two to four weeks after surgery to return to our routine life. Depending on the severity of the surgery, and the patient the recovery time may be extended. You should ask your doctor for instructions that are to be followed.

10. How Quickly Does Appendicitis Come On?

  • Appendicitis comes so quickly that symptoms appear within the first 24 hours. Later on, any disturbance and food items lead to further signs and rupture. Any disturbance to the regions leads to further signs.

11. How Long Are a Patient Stays in the Hospital for Appendicitis?

  • The patient stays in the hospital just for three days. The patient is admitted to the hospital one day before the surgery. This is done so that the patient can adapt to the environment before the surgery. The next day surgery is performed. The patient is asked to stay in the hospital for another day and then they can be discharged if the doctor advises them to do so.

12. How Quickly Does Appendicitis Develop?

  • The degree of pain and the duration it takes to show the symptoms might vary. Appendicitis usually develops in teenagers, the symptoms appear very early in addition some food items lead to rupture of the appendix. Symptoms and signs appear in an early stage. However, you should consult your doctor if you experience pain for more than one day.

13. Where Does Your Stomach Hurt With Appendicitis?

  • Initially, the pain starts near the belly and in the navel region, and later on the pain travels to the abdominal region, mainly to the right abdomen. There will be swelling in the stomach region which can be identified by palpation by the doctors. Palpation is the procedure of investigation done by touching and pressing.

14. What Is Appendicitis Surgery?

  • For severe cases of appendicitis, appendectomy is done. It is the surgical removal of the appendix. This is usually done by open surgery. Nowadays, it is done using a laser. The surgery that is done using a laser is known as laparoscopy. In which three holes are made and the further procedure is carried out.

15. What Foods Make Appendicitis Worse?

  • Undigested food makes the condition of the appendix to worsen. Seeds of fruits and vegetables are also harmful. Medications that are taken to relieve pain leads to the rupture of the appendix. This makes the condition even worsen. Some doctors say that spicy food items also worsen the condition of appendicitis.

16. What are the early signs and symptoms of appendicitis?

The signs and symptoms of appendicitis are:

– Nausea.

– Vomiting.

– Loss of appetite.

– Sudden and severe pain in the right side of the lower abdomen.

– The pain begins in the navel that shifts to the right side of the abdomen.

– Severe pain will be experienced while walking, coughing, and movements.

References:

https://nurseslabs.com/appendicitis/

http://nursingfile.com/nursing-care-plan/nursing-interventions/nursing-interventions-for-appendicitis.html

https://www.hopkinsmedicine.org/health/treatment-tests-and-therapies/appendectomy

https://www.healthline.com/health/appendicitis#tests

https://www.icliniq.com/articles/gastro-health/appendicitis

https://teachmepaediatrics.com/surgery/abdominal/acute-appendicitis/

First Aid

Wound: Abnormal break in skin which permits the escape of blood, and may allow the entrance of germs, causing infection.

Types of Wound:

  1. Incise Wound – Clean cut caused by sharp instrument.
  2. Laceration Wound – Jagged cut or tear caused by sharp irregular edges.
  3. Contusion – Caused by blunt instrument / fall against hard surface. Skin is not broken.
  4. Abrasion – Simple scrapes and scratches usually from a sliding fall.
  5. Puncture Wound – Penetrating wound by sharp, pointed instrument. Can result in serious internal injury.
  6. Stab Wound – Caused by a bladed object.
  7. Gun Shot Wound

Ways to Stop Bleeding:

  1. Direct pressure
  2. Indirect pressure
  3. Elevation

Wound Management:
Slight Bleeding
-Wash your hands and wear a pair of gloves.
– Rinse wound with running water.
– Dab gently to dry.
– Apply direct pressure or elevation if bleeding still occurs.
– Cover wound with sterile swab.
– Clean surrounding area of skin with water and soap.
– When cleaning, wipe away from wound and use each swab only once.
– Avoid wiping away blood clots.
– Pat dry.
– Dress wound with adhesive dressing.

Severe Bleeding
Aim of managing severe bleeding: a) control bleeding b) minimize risk of infection
– Lay casualty down to prevent shock.
– Support injured part.
– Send to hospital.
– Wash hands.

Bandaging:

  1. Triangular bandage (Reef Knot – L over R; R over L)
  2. Broad bandage
  3. Narrow bandage

Slings and Bandaging:

  1. Simple sling
  2. Elevated sling
  3. Scalp bandage
  4. Palm bandage
  5. Fist bandage

Fracture: A break or crack in the bone caused by direct force and indirect force.

Type:

  1. Closed or simple fracture (no wound)
  2. Open or compound fracture (wound is present)
  3. Comminuted (totally crushed)
  4. Green stick injury (In children; mixture of bend and break)
  5. Unstable fracture

Management of Closed Fractures:

  1. Do not move the casualty until you support the injured part.
  2. Steady and support the injured part.
  3. Immobilize the injured part using bandages and slings.
  4. Elevate the injured part.
  5. Treat for shock if possible.
  6. Check circulation every 10 minutes.
  7. Send to hospital.
  8. Do not give him anything to eat or drink.

Management of Open Fractures:

  1. Cover wound with sterile / clean dressing.
  2. Control bleeding.
  3. If wound is jutting, place padding.
  4. Immobilize the injured part.

Dislocation: Displacement of a bone at a joint caused by strong force, wrenching the bone into an abnormal position or violent muscle contraction.

Sprain: Injury to a ligament at or near a joint frequently caused by wrenching movement at joint that tears the surrounding tissue.

Strains: Partial tearing of the muscles at the junction of muscle and tendon that joins it to a bone.

Management of Sprain and Strains (Soft Tissue Injury):

R Rest
I Ice – Reduce swelling
C Compression
E Elevation

If injury is very bad, send the casualty to the hospital.

Cramps: Sudden, involuntary and painful muscle spasm.

Cramp in Foot:

  1. Ask casualty to stand on toes.
  2. Massage foot with fingers.

Cramp in Calve:

  1. Straighten the knee.
  2. Draw the foot firmly and steadily upwards towards the shin.
  3. Massage.

Cramp in Back of Thigh:

  1. Straighten the knee by raising his leg.
  2. Massage the muscles.

Cramp in Front of Thigh:

  1. Bend knee.
  2. Massage muscles slowly.

Signs & Symptoms:

  1. Difficult to move a limb
  2. Pain near the site of injury
  3. Tenderness
  4. Distortion
  5. Swelling
  6. Bruising
  7. Shortening, bending or twisting of the limb
  8. Crepitus (sound) caused by grating of the bone end

Lifting and Moving Casualty

Rules:

  1. Do not move casualty unless absolutely necessary.
  2. Explain to casualty what you are doing.
  3. Never move casualty alone.
  4. Instruct helpers what they are supposed to do.
  5. Protect yourself using the correct techniques.
  6. Ensure casualty’s safety.

Correct Lifting Techniques:

  1. Place feet comfortably apart, one slightly in front of the other.
  2. Keep back straight.
  3. Bend your knees.
  4. Grip with both hands.
  5. Keep weight of person you are lifting as close to you as possible.

Lifting Method:

Casualty is conscious and able to walk:

  1. Use the human crutch

Casualty is conscious but unable to walk:

  1. Pick-a-back
  2. Drag method
  3. 4 handed seat
  4. 3 handed seat
  5. 2 handed seat
  6. Fore & aft
  7. Carry chair

Casualty is unconscious:

  1. Cradle method
  2. Drag method
  3. Fore & aft
  4. Stretcher method

 

Cancer

CANCER/NEO-PLASM/NEW GROWTH

  1. Cancer is also called neoplasm
  2. Cancer is also defined as abnormal growth in the tissue either slow (benign) & or fast (malignant)
  3. Cancer is the new growth, a tumor which is either cancerous or non-cancerous
  4. Abnormal mass that is referred as a neoplasm or new growth. The cells of the neoplasm serve the no useful purpose and use nutrients and oxygen
  5. Nursing involvement in the care of the patient education, assessment, monitoring, and treatment support and require knowledge of both the bio-medical and physiological components of the cancerous care.

Difference between the Benign & Malignant

Benign Malignant
1 Increase in size slowly Increases in size rapidly
2 Growth is limited as a capsule Growth is unlimited
shaped
3 Do not spread towards neighboring Spread towards neighboring tissue or
tissue or organ organ
4 Do not spread to a lymphatic system Spread to a lymphatic system
5 No tendency to re-occur, even after Tendency to re-occur, even after
surgery surgery
6 Benign is the opposite of the Malignant is the opposite of the Benign
malignant
7 Benign may re-occur if surgeon Malignant possess the property of the
can’t get successive result anaplasia
8 It can be treated with the medicines It cannot be treated with the medicines

Anaplasia= loss of distinctive characteristics of a cell associated with proliferate activity as in cancer.

Metastasis (Secondary Malignant)

  1. Secondary malignant is also called Metastasis
  2. Secondary Malignant is defined as the transfer of a disease from one part of the organ to the part throughout the blood vessels and lymph.
  3. Metastasis may occurs due to the primary Malignant
No: Tissue types Benign Malignant
A. Epithelial
i Surface skin Popilloma Squamous cell carcinoma
ii Glandular Adenoma Adino-carcinoma
i Fibrous Fibroma Fibro-carcinoma
ii Adipose Lipoma Lipo-carcinoma
iii Cartilage Chondroma Chondro-carcinoma
iv Bone Oestoma Oesteo-carcinoma

Common sites of Metastasis are lungs, liver, brain and bone.

  1. Connective
  2. Muscular
i Smooth Leiomyoma Leiomyo-sarcoma
ii Striated Rhambdomyoma Rhabdo-sarcoma
  1. Nerve
i Nerve Neuroma Neuro-blastoma
ii Gliel Glioma Glio-blastoma
iii Nerve sheath Neurilemmoma Neirilemmal-sarcoma
iv Menings Meningioma Meningeal-sarcoma
  1. Hematological
i Granulocytic Myelocytic leukemia
ii Erythrocytic Erythrocytic leukemia
iii Lymphocytic Lymphocytic leukemia
iv Monocytic Monocytic leukemia
v Plasma cell Multiple myeloma
  1. Endothelial
i Blood vessel Hemangioma Hemangio-sarcoma
ii Lymph vessel Lymphangioma Lymphagio-sarcoma
iii Lymph tissue Lymphogioma Lympho-sarcoma

Treatment of the neo-plasm:

At present three methods have proved their values in the treatment of the neo-plasm

  1. Chemo-therapy
  2. Radio-therapy
  3. Surgery

The hope for cure of neo-plasm especially for malignant depends on the chemotherapy. In general, it can be said that as yet no drugs have been discovered to cure malignant tumor however, cancer chemotherapy may or may not offer some help to patients for home surgery and radiation are no longer beneficial. Chemotherapeutic agents at the time of surgery may reduce or slow up the appearance of secondary growth. In some patients pain and other symptoms are relieved for the time.

Chemotherapeutic agents are especially used for the lymphomea and leukemia, diffuse tumor usually not amenable to surgical therapy.

The rational for administrating chemotherapeutic drug is that they are capable and destroying young rapidly multiplying cells. It is believed that these drugs interfere with the manufacturing of nucleic acid that is necessary for the building of genetic structures in the cells. As a result cellular growth and building reproduction inhabited.

Specific agents used as chemotherapy

  1. Poly-functional alkyl ting agents:

These poison destroy both cells either tumor cells or normal. It is believed that tumor cells are more sensitive to toxicity than normal cells, as a result cell growth and division is hindered.

The chief disadvantage of most of these drugs is destructive effect on the bone marrow, which is the body’s chief source of new born blood cells other side effect is vomiting, nausea and Stomatitis.

  1. Antimetabolytes:

e.g.: Folic acid, purine antagonistic

These are the synthetic substance, similar to those that nourish the normal cells during its growth and development.

  1. Steroids compounds:
  2. ACTH: control on cortisol (kidney).
  3. Castration: control on secretion on prostate gland.

These drugs changes the endocrine environment because tumor arising in organs usually under hormonal influences such as prostate and breast.

The patient receiving the type of therapy will be need to be observed by toxicity signs such as fluid retention, increases libido (the vital force or impulse which brings about purposeful action) and hirutism (excessive hair ness) as well as nausea and vomiting.

  1. Miscellaneous drugs:

Antibiotics drugs such as Actynomycin-D, Mytomycin-C and Streptomycin.

Note:

None of above drug can cure Malignancy. They are efforts to make the physiology of the host cells less favorable for the growth of the cancer.

These drugs may be given orally, IV, IM depending on the drug and Carcinoma.

Side effects of the chemotherapeutic drugs:

  1. Stomatitis
  2. Neuro toxicity
  3. Hepatic toxicity
  4. Ocular toxicity
  5. Diarrhea
  6. Nephro toxicity
  7. Bladder toxicity
  8. Oto toxicity
  9. Endocrinal changes
  10. Pulmonary toxicity
  11. Cardio toxicity

General Nursing & Medical care of the onco-patient (Cancerous-patient):

  • To control the Carcinoma growth by surgery, radiation and chemotherapy
  • Combats on local and systemic infection
  • Correct existing enema and electrolytic imbalance
  • Give the patient psychological support by the explaining the treatment by re-assurance, listen and observe the patient anxiety
  • Administrator vitamin-B as prescribed and blood transmission is needed
  • Give sedatives, anti-emetics, anti-histamines (allergic)
  • Offer small frequent feeding of high caloric
  • Increase fluid intake
  1. Report patient’s reaction response
  2. Control on diarrhea
  3. Remove constipation by giving low residue or balanced diet
  4. Give enema if required as suppository if needed
  5. Take care of skin especially of perineal area
  6. Apply oil or cream to radiation site.
  7. Protect skin from sun-light, heat, injury and tight clothing
  8. Advice for blood CP
  9. Protect the patient from the infection
  10. Evaluate the quality, intensity duration of pain as well as patient response to pain
  11. Promote the general comfort of patient by turning, moving and rest
  12. Administer drug as prescribed
  13. Use specific drug for nausea and vomiting
  14. Apply cold or hot compression if needed
  15. Apply local anesthetic to relieve the pain
  16. Prepare for alcohol injection to block narrow path
  17. Control on the odor and remove odor
  18. Encourage for good personal hygiene
  19. Give normal saline irrigation to external areas if required
  20. If administrator prescribed vaginal irrigation, when discharge of vaginal secretion of the patient
  21. Keep perineal area shaved
  22. Observe for increasing pulse rate
  23. Observe the amount and color of the blood if bleeding
  24. Apply digital pressure if site is accessible
  25. Apply vaginal or rectum packing if required
  26. Care the bladder frequently and incontinence
  27. Maintain I/O chart
  28. Insert catheter if all other measures fails
  29. Encourage patient for fluid & regular meal for constipation
  30. Reduce edema by ROM (range of motion)
  31. Evaluate edematic extremity
  32. Prevent the patient from bed sore by providing stimulation circulation
  33. Assess the patient to cope with his/her situation
  34. Develop a supportive relationship with patient (Psychotherapy)
  35. Encourage the patient to make decision
  36. Listen the patient attentively and answer the patient frequently and politely
  37. Provide a daily schedule to the patient
  38. Encourage the patient to be active
  39. Maintain the patient optimal physical, mentally and emotionally satisfaction
  40. Maintain a cheerful and optimistic attitude
  41. Encourage for verbalization
  42. Do little more for the patient
  43. Include the family in the patient’s care.

Side effects of the chemotherapeutic drugs:

  1. Stomatitis
  2. Neuro-toxicity
  3. Hepatic-toxicity
  4. Ocular toxicity
  5. Diarrhea
  6. Nephro toxicity
  7. Bladder toxicity
  8. Oto toxicity
  9. Hormonal changes
  10. Pulmonary toxicity
  11. Cardio toxicity
Cases of Neoplasm as re Registered in United Kingdom in 1985:
MALE FEMALE.
Lung 24% Lung 19%
Skin 12% Skin 09%
Prostate 09% Cervix 03%
Bladder 06% Ovary 04%
Colon 06% Colon 07%
Stomach 06% Stomach 04%
Rectum 05% Rectum 03%
Pancreas 03% Pancreas 02%
Esophagus 02% Breast 19%
Leukemia 02% Uterus 03%
Others 25% Other 37%
  1. Esophageal Carcinoma Definition:

Carcinoma of the esophagus is unique in its geographic distribution. Both benign & malignant tumor occurs in the esophagus. Benign tumor are usually leimyomas, and extremely rare & usually asymptomatic. They require no intervention unless symptoms necessitate local excision. Malignant tumors of the esophagus are not common but they assume increased importance because of their virulence.

Location of esophagus:

Esophagus lies behind the trachea to which it adopts and in front of the vertebral column. Passing through the thorax it pierces the diaphragm to enter in abdomen where it communicates with the stomach. Its size is 9-10 inches.

Causes:
© Exact cause is idiopathic,
© Pre-disposing factors are: © Taking alcohol
© Usage of tobacco and opium © Excessive usage of beverages
© Induced caustic esophagus sphincter © Ultra-violet radiations

  1. Tumor
  2. Dysphagia
  3. Odynophagia (typically)
  4. Heart burn
  5. Anorexia
  6. Weight loss
  7. Feeling mass in throat
  8. Painful swallowing
  9. Regurgitation
  10. Hiccup
  11. Chest pain
  12. Supera-clavicular lymphodenopathy

Complication:

  1. Hemorrhage
  2. Esophageal perforation
  3. Esophageal obstruction

Investigations:

  1. Chest X-ray
  2. CT scan
  3. Barium esophagography
  4. Bronchoscopy
  5. Biopsy
  6. MRI
  7. Blood CP

Medical treatment:

  1. Poly-functional alkyl ting agents:
  2. Antimetabolytes:
  3. e.g.: Folic acid, purine antagonistic
  4. ACTH
  5. Castration
  6. Miscellaneous drugs:
  7. Antibiotics drugs such as Actinomycin-D, Mytomycin

Surgical treatment:

  1. Surgical, the resection of the esophagus provides the most rapid durable relief of the Dysphagia, the standard surgical Management including partial removal of the esophagus.
  2. Esophagectomy
  3. Esophagogastrotomy
  4. Esophagoenterostomy

Radio-therapy:

  1. The radiotherapy may be given for a short time to provide relief to pain. Nursing Management:
  2. Please revise the general Nursing Management of the Neoplasm.

PROBLEM SOLVING

PROBLEM SOLVING:

A. DEFINITION OF PROBLEM SOLVING:

A Greek word “problema = throw” or to put forward. Problem solving and decision making are different due to the over-lapping of subject malt and method approach.

  1. METHODS OF PROBLEM SOLVING:
    • Tract & errors
    • Experimentation
    • Problem critical
    • Brain storming
    • Decision
    • Stress
    • Self solving
    • Metaphor biased
    • Technique
  2. STEPS OF PROBLEM SOLVING:
    • Identifying problem
    • Reviewing the data
    • Presenting hypothesis
    • Moving towards a solution
  3. OBSTICLES OF PROBLEM SOLVING:
    • Rigidity
    • Pre-conception
    • Personality characteristics
  4. FACTORS EFFECTING ON PROBLEM SOLVING:
    • Experience
    • Motivation
    • Concept

DELEGATION

DELEGATION

A. DEFINITION OF DELEGATION:

Delegation is defined as to give own’s power to others for decision making. Responsibility & authority is delegated to lowest level at what it can be completely discharged. It should be no cause of sub- ordinates to become over-loaded.

  1. DELEGATION AUTHORITY & RESPONSIBILITY:

The leader is the responsible for failure or success of the team. At the same time each health worker is also responsible for the particular task of his/her special job. On the way of using authority is to delegate. It means to give it to others the power to make the decision.

  1. ADVANTAGES OF DELEGATION:

    • To save time for others.
    • The workers on spot must be able to make decision
    • To save delayed time, long delayed decision
    • Workers enjoy their work
    • Workers become more skillful
  2. DISADVANTAGES OF DELEGATION:

    • Work may not be done or less well due to lack of knowledge
    • Wrong decision may be taken by workers
    • Leader may pass all his/her work on followers.
    • If delegation is not done properly, then it is very harmful.
  3. RULES FOR DELEGATION AUTHORITY & RESPONSIBILITY:

    • Classify exactly that what is delegated
    • Select the right person & make sure that he/she can do properly
    • Explain to others that I have delegated work & to whom
    • Do not interfere unless asked for
    • Give support as needed.

CONFLICTS

CONFLICTS

A. DEFINITION OF CONFLICTS:

It is a mental struggle resulting from opposite ideas is called conflict.

  1. TYPES OF CONFLICTS:

    1. Intra-individual conflict

      • Frustration
      • Goal-conflict
      • Approach-approach conflict
      • Avoidance-avoidance conflict
      • Approach-avoidance conflict
    2. Inter-personal conflict
    3. Inter-group conflict
    4. Organizational conflict
  2. STAGES OF CONFLICTS:
  • Anticipation
  • Open dispute
  • Known & expressed difference
  • Discussion
  1. PERSONAL PROBLEM OF THE STAFF:
  • Finance problem
  • Child sickness problem
  • Relative death problem
  • Quarrel with his wife prodem
  • Personal worries problem
  1. HOW TO PREVENT FROM CONFLICTS:
  • Frequent meeting of team members
  • Allowing people to express views openly & telling the whole decide
  • Sharing agreed objectives
  • Distributing work freely
  • Distributing work fairly having clear & detailed job description.
  1. SETTING OF THE CONFLICTS:
  • First, the leader should interview each person involved separates.
  • Second, the leader must try to decide what is the real problem
  • Third, the each person should be asked repeatly, how they stop the argument and whether willing to overcome.

When the real cause is understood & solution suggested, leader should participate the both sides for work again in fairly manner.

EVALUATION

EVALUATION

A. DEFINITION OF EVALUATION:

It is an appraised work performance. It is a process of making judgment on the basis of assessment. Appraisal means to estimate the value (often use).

  1. BASIC STEPS OF THE EVALUATION:
    • What is to be evaluated?
    • Collect the information(needed)
    • Compare your result with the objectives.
    • Judge whether and to what extra, the objective has been decided, whether continue the programme as such to change it or stop it.
  2. IN SERVICE TRAINING PROGRAMME:
    • Method of training and learning
    • Individual reading
    • Small group learning in class-room
    • Learning new skills
    • Individual on job training
  3. STEPS OF LEARNING SKILLS:
    • Learning skills usually begin with observation of the trainee
    • Initiates the action of the trainee
    • Skills have been acquired individual
    • Segments & the trainee must begin to practice skills as whole
    • Finally skills is practiced more or less automatically
    • It’s almost never lost.
  1. GENERAL PLAN FOR THE WARD TO EVALUATE:

Generally plan of the ward facilities are:

    • Lighting
    • Ventilation
    • Artificial lighting
    • Night lighting
    • Walls & floors
    • Relative rooms
    • Cubicles
    • Call system
    • Toilet facility
    • Treatment facility
    • Waiting room
    • Emergency exit

WARD TEAM

  1. DEFINITION OF WARD TEAM:

The ward team induced all members of the staff who are working in the ward under the supervision of the leader of the ward sister.

  1. MEMBERS OF THE WARD TEAM:

    • Staff nurse
    • Clinical nurse (Specialist)
    • Night Staff
    • Student nurse
    • Un-trained nursing staff
    • Non-nursing staff
  2. MANAGEMENT OF HEALTH TEAM:

A group of people working together to give health care of individual and families in the community is called Health team. Management is done by the all above staff.

  1. RESOURCES FOR WORKING POORLY BY HEALTH TEAM:

    • Inadequate salary
    • Poor security
    • Un-interesting work
    • Lack of opportunities
    • Poor supervision
  2. PREVENTIVE MEASURES FOR FIRE:

    • Remove the cause, point of the fire
    • Manage the electric point
    • Ovoid aver-load on electric point
    • Use the board of no smoking
    • Check the gas points
    • Water arrangement
  3. PREVENTIVE MEASURES FROM FALL ACCIDENT:

    • Use the bed side rails
    • Avoid from sloppy & slippery
    • Avoid from long heel shoe
    • Lubricant wheel of the bed
    • Usage of good light at the night time
  4. PREVENTIVE MEASURES FOR NOISE POLLUTION:

    • Use the silent boards
    • Keep media room separate
    • Use the soft sound shoes
    • Isolate dead body from ward
    • Use the cubicle screen system
  5. SUGGESTION FOR IMPROVING WORK:

    • Good salary
    • Good security
    • Interesting ward
    • Good working conditions
    • Good behavior

Good supervision.

ART OF SPEAKING, LISTENING & WRITING

A. DEFINITION OF SPEAKING:

  • The ability to express his feelings by means of verbal communication is called speaking.
  1. VITAL FACTORS OF THE SPEAKING:

    • Knowing the audiences
    • Knowing the situation
    • Art of using language
    • Art of speech preparation
    • Art of delivering a speech.
  2. PRINCIPLES OF THE SPEAKING:

    • Fully prepared
    • Be clear
    • Be simple
    • Be natural
  3. GUIDANCE FOR AN EFFECTIVE LISTNER:

    • Give full attention
    • Capitalize on though speech
    • Show interest in speech
    • Listen with an open mind
    • Judge contents not delivery
    • Listen to the main ideas
    • Find area of interest
    • Avoid interruption
    • Resist distraction
    • Hold your excitements
    • Do not avoid difficult things
    • Avoid from fantasy
  4. RULES FOR GOOD WRITING:

    • Do not write more words than required
    • Use similar words rather than fetched
    • The words with a phrase meaning that those are ill defined
    • Keep your sentence short & simple
    • Keep & make your writing interest to look out
    • Drafting should be neat & clean