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Nursing Diagnosis: Impaired physical mobility related to symptoms 6 days dpo discount 50 mg thorazine with visa positioning medications for ocd generic thorazine 100mg overnight delivery, weight-bearing medicine hollywood undead buy discount thorazine 100mg on line, and activity restrictions after hip replacement Goal: Achieves pain-free medicine zoloft trusted thorazine 50mg, functional, stable hip joint 1. Maintain proper positioning of hip joint (abduction, neutral rotation, limited flexion). In consultation with physical therapist, instruct and supervise progressive safe ambulation within limitations of weightbearing prescription. Reconditioning exercises can be uncomfortable and fatiguing; encouragement helps patient comply with exercise program. Changes in pulse, blood pressure, and respirations may indicate development of shock. Within 48 hours, bloody drainage collected in portable suction device should decrease to 2530 mL per 8 hours. Excessive drainage (more than 250 mL in first 8 hours after surgery) and bright red drainage may indicate active bleeding. Vital signs stabilize within normal limits Amount of drainage decreases No bright red bloody drainage Hematology values are within normal limits 3. Notify surgeon if patient develops shock or excessive bleeding and prepare for administration of fluids, blood component therapy, and medications. After compression of the nail, rapid return of pink color indicates good capillary perfusion. Excessive swelling and hematoma formation can compromise circulation and function. Surgical pain can be controlled; pain due to neurovascular compromise is not relieved by treatment. Sensation in web between great and second toe- peroneal nerve; sensation on sole of foot-tibial nerve. Support leg and place pillows between legs when patient is turning and sidelying; turn to the unaffected side. Assess for dislocation of prosthesis (extremity shortens, internally or externally rotated, severe hip pain, patient unable to move extremity) 7. Hip component positioning (femoral component in acetabular component) needs to be maintained. Joint dislocations compromise neurovascular status and future function of extremity. Avoid pressure on popliteal blood vessels from equipment (eg, abductor splint straps, sequential compression stockings) or pillows. Pain may be due to wound hematoma-a possible locus of infection-that needs to be surgically evacuated. Chapter 67 Musculoskeletal Care Modalities 2039 Plan of Nursing Care the Patient With a Total Hip Replacement (Continued) Nursing Interventions Rationale Expected Outcomes Nursing Diagnosis: Risk for ineffective health maintenance related to total hip replacement Goal: Cares for self at home 1. Encourage patient to express concerns about care at home; explore together possible solutions to the problem. Because of limitation of mobility and limited hip range of motion, patient may require some assistance in routine health care. Drainage ranges from 200 to 400 mL during the first 24 hours after surgery and diminishes to less than 25 mL by 48 hours. If extensive bleeding is anticipated, an autotransfusion drainage system may be used during the immediate postoperative period. The color, type, and amount of drainage are documented, and any excessive drainage or change in characteristics of the drainage are promptly reported to the physician. Usually, 10 degrees of extension and 50 degrees of flexion are prescribed initially, increasing to 90 degrees of flexion with full extension (0 degrees) by discharge. If satisfactory flexion is not achieved, gentle manipulation of the knee joint under general anesthesia may be necessary about 2 weeks after surgery. The nurse assists the patient to get out of bed on the evening or the day after surgery. The knee is usually protected with a knee immobilizer (splint, cast, or brace) and is elevated when the patient sits in a chair.

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When surgery is recommended 3 medications that cannot be crushed order thorazine 100mg on line, the risk for postoperative complications is minimized by ensuring a preoperative euthyroid state by treatment with antithyroid medications and iodide to symptoms uti in women cheap thorazine 50mg on line reduce the size and vascularity of the goiter treatment 3rd nerve palsy thorazine 50 mg without prescription. Providing children in iodine-poor regions with iodine compounds can prevent simple or endemic goiter symptoms weight loss order 100 mg thorazine otc. If the mean iodine intake is less than 40 fg/day, the thyroid gland hypertrophies. The World Health Organization recommends that salt be iodized to a concentration of 1 part in 100,000, which is adequate for the prevention of endemic goiter. The introduction of iodized salt has been the single most effective means of preventing goiter in at-risk populations. No symptoms may arise as a result of this condition, but not uncommonly these nodules slowly increase in size, with some descending into the thorax, where they cause local pressure symptoms. According to the American Cancer Society (2002), about 20,700 new cases of thyroid cancer are diagnosed each year. There are several types of cancer of the thyroid gland; the type determines the course and prognosis (Table 42-3). External radiation of the head, neck, or chest in infancy and childhood increases the risk of thyroid carcinoma. Between 1940 and 1960, radiation therapy was occasionally used to shrink enlarged tonsillar and adenoid tissue, to treat acne, or to reduce an enlarged thymus. For people exposed to external radiation in childhood, there appears to be an increased incidence of thyroid cancer 5 to 40 years after irradiation. Consequently, people who underwent such treatment should consult a physician, request an isotope thyroid scan as part of the evaluation, follow recommended treatment of abnormalities of the gland, and continue with annual checkups (Chart 42-6). Needle biopsy of the thyroid gland is used as an outpatient procedure to make a diagnosis of thyroid cancer, to differentiate cancerous thyroid nodules from noncancerous nodules, and to stage the cancer if detected. Patients who undergo the procedure are followed closely, however, because cancerous tissues may be missed during the procedure. A second type of aspiration or biopsy uses a largebore needle rather than the fine needle used in standard biopsy; it may be used when the results of the standard biopsy are inconclusive, or with rapidly growing tumors. Medical Management the treatment of choice for thyroid carcinoma is surgical removal. Modified neck dissection or more extensive radical neck dissection is performed if there is lymph node involvement. After surgery, ablation procedures are carried out with radioactive iodine to eradicate residual thyroid tissue if the tumor is radiosensitive. Radioactive iodine also maximizes the chance of discovering thyroid metastasis at a later date if total-body scans are carried out. The effectiveness of this mechanism to concentrate iodide is reflected in a concentration of iodide 20 to 40 times the concentration of iodide in the plasma. If milk and other food sources become contaminated with radioactivity as a result of a nuclear detonation or a nuclear power plant incident or mishap, the radioactive iodide would become concentrated in the thyroid gland at a very high concentration and would irradiate the thyroid gland, increasing the risk for thyroid gland cancer. Therefore, in communities exposed to increased radioactivity, attempts have been made to block the uptake of radioactive iodide by flooding or saturating the thyroid gland with nonradioactive iodide. If remaining thyroid tissue is inadequate to produce sufficient thyroid hormone, thyroxine is required permanently. Several routes are available for administering radiation to the thyroid or tissues of the neck, including oral administration of radioactive iodine and external administration of radiation therapy. The patient who receives external sources of radiation therapy is at risk for mucositis, dryness of the mouth, dysphagia, redness of the skin, anorexia, and fatigue (see Chap. Patients whose thyroid cancer is detected early and who are appropriately treated usually do very well. Patients who have had papillary cancer, the most common and least aggressive tumor, have a 10-year survival rate greater than 90%. Long-term survival is also common in follicular cancer, a more aggressive form of thyroid cancer (Tierney et al. Postoperatively, the patient is instructed to take exogenous thyroid hormone to prevent hypothyroidism.

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Assess vascular access sites symptoms for pneumonia purchase 100 mg thorazine with amex, wound sites treatment 4 ulcer purchase thorazine 100mg line, pressure ulcers nioxin scalp treatment buy thorazine 100 mg mastercard, and other appropriate sites for apparent collections of purulent material medications prescribed for migraines effective thorazine 100 mg. Assess the patient who has had abdominal surgery or trauma to abdominal area for localized signs of intra-abdominal abscess. Assess patient who has had percutaneous abscess drainage to determine whether drainage has been successful. Collections of purulent material often require drainage before antimicrobial therapy is effective. After percutaneous drainage, recurrent or persistent signs of abscess may indicate the need for surgical treatment. Antibiotics, along with drainage, are the most important elements of intraabdominal abscess management. Teach patients with the following conditions about the value of antibiotic prophylaxis for events and procedures that may introduce the risk of endocarditis: a. Obtain a detailed history about the duration of fever in the absence of wellrecognized cause. Patients with underlying valvular disease and other cardiac abnormalities are at increased risk for "seeding" of the cardiac valves during procedures that can cause bacteremia. Careful adherence to following the scheduled administration is therefore essential. Infectious Disease-Related Cancers and Infertility these potential complications of infectious diseases are prevented by primary avoidance of infection. Management of them is directed toward treating each of them as a non-infectious entity. For example, the management of cancer secondary to hepatitis B is handled as an oncology issue, not as an infectious disease issue. Critical Thinking Exercises Several patients on your nursing unit have become infected with the same bacteria. The staff wants to develop a campaign to reduce the risk of bacterial transmission between patients. You are supervising a patient care technician who is preparing to perform a venipuncture. An elderly patient with cardiac disease and diabetes asks you why her physician suggested that she receive influenza and pneumococcal vaccinations. Describe the line of reasoning you would follow to persuade her to get the vaccine. If she rejects your explanation, examine the different courses of action you could take and the pros and cons of each strategy. Analysis of factors related to the development of ventilator-associated pneumonia: Use of existing databases. The management of acute diarrhea in children: Oral rehydration, maintenance, and nutritional therapy. Measles, mumps, and rubella: Vaccine use and strategies for elimination of measles, rubella, congenital rubella syndrome and control of mumps. Recommendations for preventing transmission of infections among chronic hemodialysis patients. National Nosocomial Infections Surveillance System report: Data summary, from January 1992June 2001, issued August 2001. Prevention and control of influenza: Recommendations of the Advisory Committee on Immunization Practices. Epidemic/ epizootic West Nile virus control in the United States: Revised guidelines for prevention, surveillance and control. Society for Healthcare Epidemiology of America and the Infectious Diseases Society of America Joint Committee on the Prevention of Antimicrobial Resistance. The current state of infectious disease: A clinical perspective on antimicrobial resistance. Conference summary: the fifth international conference on hemorrhagic fever with renal syndrome, hantavirus pulmonary syndrome, and hantaviruses. Healthcare Infection Control Practices Advisory Committee: Draft guideline for prevention of healthcare-associated pneumonia. Bacterial contamination of animal feed and its relationship to human foodborne illness.

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Total penectomy is indicated when the tumor is not amenable to symptoms menopause buy thorazine 50 mg on line conservative treatment medicine jar cheap thorazine 100 mg with mastercard. After a total penectomy treatment menopause proven 50mg thorazine, the patient may still experience orgasm with stimulation of the perineum and scrotal area xerostomia medications that cause 50 mg thorazine with visa. These anatomic abnormalities may be repaired by various types of plastic surgery, usually when the boy is very young. With the trend away from routine circumcision of newborns, early instruction should be given about cleansing the prepuce. If the preputial area is not cleaned, normal secretions accumulate, causing inflammation (balanitis), which can lead to adhesions and fibrosis. The thickened secretions become encrusted with urinary salts and calcify, forming calculi in the prepuce. It occurs from either neural or vascular causes, including sickle cell thrombosis, leukemic cell infiltration, spinal cord tumors or injury, and tumor invasion of the penis or its vessels. It may also occur with use of medications that affect the central nervous system, antihypertensive agents, antidepressant medications, and substances injected into the penis to treat erectile dysfunction. This condition may result in gangrene and often results in impotence, whether treated or not. The goal of therapy is to improve venous drainage of the corpora cavernosa to prevent is- Chapter 49 Assessment and Management of Problems Related to Male Reproductive Processes 1513 chemia, fibrosis, and impotence. The initial treatment is directed at relieving the erection and includes bed rest and sedation. The corpora may be irrigated with an anticoagulant, which allows stagnant blood to be aspirated. Shunting procedures to divert the blood from the turgid corpora cavernosa to the venous system (corpora cavernosasaphenous vein shunt) or into the corpus spongiosumglans penis compartment may be attempted. When erect, however, curvature of the penis occurs that can be painful and can make sexual intercourse difficult or impossible. Although the plaques may shrink over time, surgical removal of the plaques may be necessary. In addition to assisting with medical management and follow-up, what other interventions would you consider for this patient? How would your teaching differ if the patient revealed that he had sex with men only? During a routine pre-employment physical examination, a 23-year-old man is found to have a mass in the left testicle. He dismisses its significance, saying that it is nothing to be concerned about and that he cannot interrupt his plans to have it evaluated, as he will be getting married in a month and beginning a new job. What explanation would you give to him about the evaluation of the testicular mass and possible outcomes? Traumatic injury to the urethra (for example, from instrumentation or infections) can result in strictures. Treatment involves dilation of the urethra or, in severe cases, urethrotomy (surgical removal of the stricture). In adults, it is part of the treatment for phimosis, paraphimosis, and recurrent infections of the glans and foreskin and may be performed at the personal desire of the patient. Postoperatively, a petrolatum (Vaseline) gauze dressing is applied and changed as indicated. Because considerable pain may occur after circumcision, analgesic agents are administered as needed. Critical Thinking Exercises During a community health fair, you are approached by a 49-year-old African American man who asks you about his risks for prostate cancer. Develop a plan to address this issue with him at the health fair and provide the rationale for your plan. One of your patients, a 44-year-old man with multiple sclerosis, asks you about Viagra. What information would you give him about Viagra, and what teaching approach would you use? How would your approach differ if your patient were a 56-year-old man with long-standing diabetes?

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