6. Tobramycin may be administered to neonates at a dose of up to 4 mg/Kg/day in two equal doses every 12 hours. One kilogram = approximately 2.2 lb. Tobramycin is available in a pediatric vial with a concentration of 20 mg/2mL. If the neonate weighs 4.0 lb, what volume of tobramycin should be withdrawn for the dose described above?…
The purpose of the policy is to provide an interactive dialogue that allows for up-to-date information on the patient’s care. The policy is referenced to the Joint Commission-mandated focus on improving patient safety through effective caregiver communication. According to the Joint Commission, as estimated 80% of serious medical errors are attributable to miscommunication between caregivers when transferring responsibly for patients (Wakefield, Ragan, Brandt & Tregnago, 2012). Shift report happens two, three, or more times in a day, but nurses receive little formal training in this vital responsibility. Nurses may be found legally liable for failing to report necessary information during handoffs (Riesenberg, Leitzsch, & Cunningham, 2010). Therefore, it is imperative for a handoff procedure incorporate an effective way to communicate in order to provide safe patient care.…
As a senior, I had the opportunity to job shadow an OB nurse at. During my time in the baby/mother area of Carilion Hospital, I experienced the admission process and discharge process of patients. I observed both mother patients and baby patients being assessed for vitals and given vaccinations. After each assessment was done, I observed my mentor as she put the information into the hospital date base program called “EPIC”. I observed 2 babies getting their hearing screened. I was also able to observe the tasks of a baby photographer, a nutritionist, and a brief consultation with a lactation educator. My mentor allowed me to listen to two heart beats of different babies; one with a murmur, the other without. I helped with simple tasks such as retrieving ice water and drinks and preparing a bed for a patient. My mentor showed me how to analyze the abundance of data on the main computer screen. This computer screen showed information such as what type of delivery was preformed (C-section or vaginal delivery), how the baby is to be fed (i.e. breastfeeding, formula), where the baby is being kept (NICU or nursery), etc. I witnessed a baby’s first bath, which can only be given after the baby is has a stable temperature. For this reason, most babies in the NICU will not have their first bath until weeks or months after they have been born. One thing that is not common that I had the opportunity to see was a patient with a nasogastric intubation (aspiration). The reason for her having this was because she had an abundance of fluids in her stomach, even after she had delivered her baby, and these fluids were not draining. Although I did not get to observe this next condition first hand due to the baby being placed in the NICU, I was informed that there was a baby born with gastroschisis. Gastroschisis is a disorder in which the baby is born with part of its intestines outside of its body, via the umbilical cord. My mentor described this…
He is a choking risk because he eats his food fast, does not chew his food properly, and swallows big chunks of food. He is therefore at risk of choking. Stroke or…
During the next session, Kasten should continue to work on articulation of /s/ sounds with ES, focusing on phonetic placement, and making E.S more comfortable with correct speech sounds. Kasten appeared to be a good clinician. However, at times I think she was a little too picky in her assessment of E.S’s pronunciations. Being that this was such a long session for an eight year old, in future sessions I suggest more breaks during transitions. Lastly, I recommend more competition based games between Kasten and E.S; it will be a great way to get E.S to work hard, and strive to do her best during…
Some people have restricted movement for feeding, for example they have a physical disability such as a tremor or a spasticity, a weak grip, joint pain which makes it difficult for them to eat and drink independently or they are unable to sit up.…
Infants with just a cleft lip may require a change in position to facilitate their ability to obtain fluids from a nipple on a bottle or from their mother’s breasts. However, infants who have both a cleft lip and cleft palate require more than a change in position. These infants cannot properly seal their lips around their mother’s nipples or the nipples of standard bottles to produce negative intraoral pressure to obtain nutrients (Clarren, Anderson, & Wolf, 1987). Therefore, breastfeeding and the use of standard bottles are inefficient and will result in prolonged feeding periods that are beyond 30 minutes. During this time, the infant takes in excessive air which may cause fatigue, nasal regurgitation, coughing, or gagging and a loss of engagement (Clarren et al., 1987). Consequently, these children do not consume adequate amounts of nutrition and have difficulty gaining weight. Thus, SLPs use adaptive management approaches such as feeding products, techniques and nutritional knowledge to help facilitate the process of feeding and swallowing for children who have a cleft lip and/or palate and for their families (Reid,…
1.1 Explain the anatomy and physiology of the gastrointestinal tract in relation to extended feeding.…
Liebert, M. (2007, March). Caregiver injury and safe patient handling. Bariatric Nursing and Surgical Patient Care, 2(1), 7-16. Retrieved from http://search.proquest.com.ezproxy.apollolibrary.com…
Prior to the presentation of evidence-based info showing the risks of formula feeding and the benefits of breastfeeding, nurses believed that bottle-feeding the first few days was not harmful and therefore just a cultural variation that could be supported. Allowing the mothers to formula-feed under this assumption is called cultural accommodation which “supports and facilitates the use of cultural practices that have not been proven harmful” (Huber, 2009, p. 14).…
On 6/19/15 San Diego Youth Services staff took Jesus to a doctor's appointment at the FFAST Program. The staff were informed by the doctor that the foster parents have not picked up Jesus medication (Ritalin). According to the RP the medication was filled 30 days ago. Jesus has aggressive and impulsive behaviors that are unmanageable at times. The behaviors seem to increase when Jesus is not on his medication. The RP stated that Jesus has not been on his medication for 30 days due to the foster parents not acquiring his medications. The RP stated the foster parent have been contacted to no…
This reflection is based on my observations of the need for of effective communication skills and knowledge of nurses regarding the management of aggression in elderly patients with dementia. Clinician need to be equipped with seclusion, medication and de-escalation skills to be able to manage patient aggressive behaviours safely. I have chosen these particular observations after realising how fundamental they are in implementation aggressive behaviour management strategies in patients. While working in mental health I have observed how effective it is to communicate with a patient as a way of de-escalation during verbal and physical aggression incidents. Ford, Byrt, Dooher, & ebrary (2010) point out that it is imperative for health professionals…
In promoting positive outcomes, Tanner and Culberson, (2014) mention five strategies, but one stands out as a nursing function, “be familiar with the dysphagia assessment”. Tanner and Culberson (2014) also mention the vital role nurses play in preventing additional problems. Nurses should have a thorough understanding of the degree of dysphagia as it is important for the nurse to competently evaluate the patient during meals and maintain effective communication with speech-language pathologists, which are two suggested elements in reducing negative outcomes. In evaluating patients, it should be noted that assessing the ability to swallow is as important as assessing a patients lungs or…
Physical examination is the second step in the four step process in diagnosis. Observing the patient’s physical signs, such as mobility and changes in skin color, is usually the first step when conducting a physical examination. A physical examination also includes: observing the patient’s vital signs, the auscultation procedure, percussion, and palpation. Observing a patient’s vital signs, include heart rate, blood pressure, and also taking the temperature. Auscultation procedure is the use of a stethoscope, which listens to the heart, lungs, and bowel movement. The percussion procedure is the tapping on the chest and abdomen. By disguising the specific sound that it creates, can help a physician determine the size of the lungs and the size…
In society today, we often have to make decisions. Some of these decisions may mean the life or death of a loved one. The decision of whether or not to administer artificial nutrition and hydration as a form of life support is one decision that some people have to make. I feel that tube feedings, while okay for short term use are fine, but they should not be used as a form of long term care because the risks outweigh the benefits of having a feeding tube.…