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Specimens
•    Obtain all specimens using gloves and sterile equipment
•    Seal all specimen containers tightly
•    Label all specimens with client’s name, content and date obtained
X-rays
•    Correct views to isolate possible fracture: two view minimum
•    Include joints above and below suspected fracture
•    Not all fractures show on x-ray; diagnosis relies on clinical evidence
•    Especially in children, x-rays of unaffected limb may be needed for comparison
Ostomies
•    A stoma has no feeling, so touching it does not hurt client.
•    A colostomy may not function for a number of days after surgery.
•    Initially ileostomy drainage may be copious and green in color changing to brown after client resumes normal diet.
•    The bowel must be totally healed before attempting irrigation of colostomy.
•    Infection, diet or medication may cause spillage between colostomy irrigations.
•    Findings of bowel perforation include rigid, painful abdomen with absence of bowel sounds, no output from colostomy except small amount of blood.
•    There will always be some mucus in urinary diversions that involve segments of bowel, such as ileal loop or continent urinary diversion.
Casts
•    A cast may be heavy or impair mobility due to its location
•    Analgesics 20 to 30 minutes before casting reduce pain
•    A cast should be snug but not restrict circulation.
•    For proper drying, casts must dry from inside out; covering delays drying
•    Cast may smell sour but should never smell foul
•    Elevation and use of ice reduces swelling
•    Report signs of neurovascular impairment immediately
Traction
•    Maintain established line of pull and counter traction continuously
•    Prevent friction between device and body
•    Maintain proper body alignment
•    Effective traction correctly aligns affected body parts
•    Pain and spasms should be relieved by traction
•    Client does not have to keep other body parts immobile
Tracheostomies
•    Clients with new tracheostomy tubes may have bloody secretions for a few days after the procedure or after a tube change
•    Tracheostomy obturator should be attached to head of bed at all times
•    Pediatric trach tubes do not usually have an inner cannula
•    Children have shorter necks so stoma care may be more difficult
•    Yeast infections can form under moist tracheostomy dressings
•    The following types of clients may need more frequent trach care. Clients with:
1.    Tracheal stomatitis
2.    Pneumonia
3.    Bronchitis
4.    Short, fat neck
5.    Excessive perspiration
•    Always have another staff or family member assist with trach care in case of accidental dislodgement or extubation
•    Because upper airway is not functioning, expect more secretions