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Asphyxia:
Treatment (Tx)
(Professional Guide to Diseases (Eighth Edition))
CPR, intubation and mechanical ventilation, bronchoscopy, opioid antagonist, gastric lavage
» READ BOOK EXCERPT ONLINE »
Source: Professional Guide to Diseases (Eighth Edition), 2005
Cesarean birth:
Treatment
(Professional Guide to Diseases (Eighth Edition))
The most common type of cesarean birth is the lower segment cesarean, in which a transverse incision across the lower abdomen opens the visceral peritoneum over the uterus. The lower anterior uterine wall is then incised (transversely or longitudinally) behind the bladder.
The classic cesarean — in which a longitudinal incision is made into the body of the uterus, extending into the fundus and opening the top of the uterus — is rarely performed because it exaggerates the risk of infection and of uterine rupture in subsequent pregnancies. Cesarean hysterectomy removes the entire uterus and is reserved for such cases as malignant tumors, severe infection, and placenta accreta.
Patients may have general or regional anesthetic for surgery, depending on the extent of maternal or fetal distress. Possible maternal complications of cesarean delivery include respiratory tract infection, wound dehiscence, thromboembolism, paralytic ileus, hemorrhage, and genitourinary tract infection.
» READ BOOK EXCERPT ONLINE »
Source: Professional Guide to Diseases (Eighth Edition), 2005
Premature labor:
Treatment
(Professional Guide to Diseases (Eighth Edition))
Treatment is intended to suppress premature labor when tests show immature fetal pulmonary development, cervical dilation is less than 1½"(4 cm), and the absence of factors that contraindicate continuation of pregnancy. Such treatment consists of bed rest and, when necessary, drug therapy, but neither has been proven beneficial in all patients.
The following pharmacologic agents can suppress premature labor for up to 48 hours:
❑ Beta-adrenergic stimulants (terbutaline, isoxsuprine, or ritodrine): Stimulation of the beta2-adrenergic receptors inhibits contractility of uterine smooth muscle. Adverse effects include maternal tachycardia and hypotension, and fetal tachycardia.
❑ Magnesium sulfate: Direct action on the myometrium relaxes the muscle. It also produces maternal adverse effects, such as drowsiness, slurred speech, flushing, decreased reflexes, decreased GI motility, and decreased respirations. Fetal and neonatal adverse effects may include central nervous system (CNS) depression, decreased respirations, and decreased sucking reflex.
Maternal factors that jeopardize the fetus, making premature delivery the lesser risk, include intrauterine infection, abruptio placentae, placental insufficiency, and severe preeclampsia. Among the fetal problems that become more perilous as pregnancy nears term are severe isoimmunization and congenital anomalies.
Ideally, treatment for active premature labor should take place in a regional perinatal intensive care center, where the staff is specially trained to handle this situation. In such settings, the neonate can remain close to his parents. (Community health care facilities commonly lack the equipment necessary for special neonatal care and transfer the neonate alone to a perinatal center.)
Treatment and delivery require an intensive team effort, focusing on:
❑ continuous assessment of the neonate’s health through fetal monitoring
❑ administration of antenatal steroids to assist fetal lung development, unless contraindicated
❑ maintenance of adequate hydration through I.V. fluids.
Prevention of premature labor requires good prenatal care, adequate nutrition, and proper rest. Insertion of a purse-string suture (cerclage) to reinforce an incompetent cervix at 14 to 18 weeks’gestation may prevent premature labor in patients with histories of this disorder. However, this can be dangerous if an incompetent cervix is misdiagnosed and premature labor is the true cause.
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Source: Professional Guide to Diseases (Eighth Edition), 2005
Open trauma wounds:
Treatment
(Professional Guide to Diseases (Eighth Edition))
If hemorrhage occurs, stop bleeding by applying direct pressure on the wound and, if necessary, on arterial pressure points. If the wound is on an extremity, elevate it if possible. Don’t apply a tourniquet except in a life-threatening hemorrhage. If you must do so, be aware that resulting lack of perfusion to tissue could require limb amputation. (For a description of types of wounds and specific management, see Managing open trauma wounds.)
» READ BOOK EXCERPT ONLINE »
Source: Professional Guide to Diseases (Eighth Edition), 2005
Abdominal trauma:
Treatment (Tx)
(Professional Guide to Diseases (Eighth Edition))
I.V. fluid replacement, surgical repair, analgesics, antibiotics
» READ BOOK EXCERPT ONLINE »
Source: Professional Guide to Diseases (Eighth Edition), 2005
Rape trauma syndrome:
Treatment
(Professional Guide to Diseases (Eighth Edition))
Treatment consists of supportive measures and protection against venereal disease, human immunodeficiency virus (HIV) testing and, if the patient wishes, testing for pregnancy.
» READ BOOK EXCERPT ONLINE »
Source: Professional Guide to Diseases (Eighth Edition), 2005
Low birth weight:
Emergency Interventions
(Professional Guide to Signs & Symptoms (Fifth Edition))
Because low birth weight may be associated with poorly developed body systems, particularly the respiratory system, your priority is to monitor the neonate’s respiratory status. Be alert for signs of distress, such as apnea, grunting respirations, intercostal or xiphoid retractions, or a respiratory rate exceeding 60 breaths/minute after the first hour of life. If you detect any of these signs, prepare to provide respiratory support. Endotracheal intubation or supplemental oxygen with an oxygen hood may be needed.
Monitor the neonate’s axillary temperature. Decreased fat reserves may keep him from maintaining normal body temperature, and a drop below 97.8° F (36.5° C) exacerbates respiratory distress by increasing oxygen consumption. To maintain normal body temperature, use an overbed warmer or an Isolette. (If these are unavailable, use a wrapped rubber bottle filled with warm water, but be careful to avoid hyperthermia.) Cover neonate’s head to prevent heat loss.
» READ BOOK EXCERPT ONLINE »
Source: Professional Guide to Signs & Symptoms (Fifth Edition), 2006
Asphyxia:
Treatment
(Handbook of Diseases)
Asphyxia requires immediate respiratory support — with cardiopulmonary resuscitation, endotracheal intubation, and supplemental oxygen as needed. The underlying cause must be remedied: bronchoscopy for extraction of a foreign body; a narcotic antagonist, such as naloxone, for narcotic overdose; gastric lavage for poisoning; and limited, graded use of supplemental oxygen for carbon dioxide narcosis caused by excessive oxygen therapy.
» READ BOOK EXCERPT ONLINE »
Source: Handbook of Diseases, 2003
Wounds, open trauma:
Treatment
(Handbook of Diseases)
❑ If hemorrhage occurs, stop bleeding by applying direct pressure on the wound and, if necessary, on arterial pressure points. If the wound is on an extremity, elevate it if possible. Don’t apply a tourniquet except in a life-threatening hemorrhage. If you must do so, be aware that resulting lack of perfusion to tissue could require limb amputation. (For a description of types of wounds and specific management, see Managing open trauma wounds, pages 911 to 914.)
» READ BOOK EXCERPT ONLINE »
Source: Handbook of Diseases, 2003
Rape trauma syndrome:
Treatment
(Handbook of Diseases)
The rape victim should receive supportive care and protection against venereal disease and, if she wishes, against pregnancy.
Antibiotics are given to prevent venereal disease. To prevent pregnancy as a result of the rape, the patient may be given the “morning-after pill” (norqestrel/ethinyl estradiol) within 72 hours of the assault. If a pregnancy test is negative, two pills are given and the dose is repeated in 12 hours. Menses follows in 3 to 4 days. Or she may wait 3 to 4 weeks and undergo a dilatation and curettage or a vacuum aspiration to abort a pregnancy.
If the patient has vulvar lacerations and minor cuts, the area will be cleaned and the lacerations repaired after all the evidence is obtained. Topical use of ice packs may reduce vulvar swelling.
All victims of rape should be offered testing for human immunodeficiency virus infection and receive medical counseling and follow-up. Testing for hepatitis B and C should be considered and prophylaxis given.
Recovery from rape, which may be prolonged, consists of the acute phase (immediate reaction) and the reorganization phase. During the acute phase, physical aspects include pain, loss of appetite, and wound healing; emotional reactions typically include shaking, crying, and mood swings. Feelings of grief, anger, fear, or revenge may color the victim’s social interactions.
Counseling helps the victim identify her coping mechanisms. She may relate more easily to a counselor of the same sex.
During the reorganization phase, which usually begins a week after the rape and may last months or years, the victim is concerned with restructuring her life. Initially, she may have nightmares in which she’s powerless; later dreams should show her gradually gaining more control. When she’s alone, she may also suffer from “daymares” — frightening thoughts about the rape. She may have reduced sexual desire or may develop fear of intercourse or mistrust of men.
» READ BOOK EXCERPT ONLINE »
Source: Handbook of Diseases, 2003
Low birth weight:
Nursing considerations
(Nursing: Interpreting Signs and Symptoms)
▪ Initiate feedings as soon as possible and continue to feed the neonate every 2 to 3 hours.
▪ Provide gavage or I.V. nutrition for the sick or very premature neonate.
▪ Check abdominal girth daily or more frequently if indicated, and check stools for blood to detect necrotizing enterocolitis.
▪ Prepare for a sepsis workup if signs of infection are associated with low birth weight.
▪ Check the neonate's vital signs every 15 minutes for the first hour and at least once every hour thereafter until his condition stabilizes.
▪ Be alert for changes in temperature or behavior, feeding problems, respiratory distress, or periods of apnea—possible indications of infection.
▪ Monitor blood glucose levels and watch for signs and symptoms of hypoglycemia, such as irritability, jitteriness, tremors, seizures, irregular respirations, lethargy, and a high-pitched or weak cry.
▪ If the neonate is receiving supplemental oxygen, carefully monitor arterial blood gas values and the oxygen concentration of inspired air to prevent retinopathy.
▪ Monitor the neonate's urine output by weighing diapers before and after voiding.
▪ Check urine color, measure specific gravity, and test for the presence of glucose, blood, or protein.
▪ Watch for changes in the neonate's skin color because increasing jaundice may indicate hyperbilirubinemia.
Patient teaching
▪ Explain disorder and all procedures and treatments to the parents.
▪ Encourage the parents to participate in their neonate's care to strengthen bonding.
» READ BOOK EXCERPT ONLINE »
Source: Nursing: Interpreting Signs and Symptoms, 2007
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