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
