Discharge And Home Healthcare Guidelines

PATIENT TEACHING. The patient can expect to return home with dressings and wound drains. Instruct the patient to do the following: empty the drainage receptacle twice a day, record the amount on a flow sheet, and take this information along when keeping a doctor's appointment; report symptoms of infection or excess drainage on the dressing or the drainage device; sponge bathe until the sutures and drains are removed; continue with daily lower arm ROM exercises until the surgeon orders more strenuous exercises; avoid caffeinated foods and drinks, nicotine, and secondary smoke for 3 weeks postoperatively. Review pain medication instructions for frequency and precautions.

Teach precautions to prevent lymphedema after node dissection (written directions or pamphlet from American Cancer Society [ACS] is desirable for lifetime referral):

Request no blood pressure or blood samples from affected arm.

Do not carry packages, handbags, or luggage with the affected arm; avoid elastic cuffs. Protect the hand and arm from burns, sticks, and cuts by wearing gloves to do gardening and housework, using a thimble to sew, applying sunscreen and insect repellent when out-of-doors. Report swelling, pain, or heat in the affected arm immediately. Put the arm above the head and pump the fist frequently throughout the day.

FOLLOW-UP. Prepare the patient and family for a variety of encounters with healthcare providers (radiologist, oncologist, phlebotomist). Try to provide a continuity between the providers (yourself, clinical nurse specialist, or nurse consultant system, if available) as a resource for the patient or family to call with questions.

Provide lists and information of local community resources and support groups for emotional support: Reach to Recovery, Y-ME, Wellness Center, Can Surmount, I Can Cope; a list of businesses that specialize in breast prostheses; phone numbers for ACS and Cancer Information System.

Bronchiolitis (Respiratory Syncytial Viral Infection) 155

Recurrence is a lifetime threat. Inform the patient that it is necessary to continue monthly BSE (even on the operative side) and annual mammogram and physician examinations of both the reconstructed and the nonreconstructed breasts. Be certain the patient can demonstrate an accurate BSE.

Bronchiolitis DRG Category: 80

Mean LOS: 4.7 days

(Respiratory Syncytial Description: MEDICAL: Respiratory Infections and

Viral Infection) Inflammations, age 0-17

Bronchiolitis is a common disease of the lower respiratory tract that is most commonly caused by the respiratory syncytial virus (RSV). The infection, which causes inflammation leading to obstruction of the small respiratory airways, can range from a mild infection that lasts only a few days to a severe episode that causes severe respiratory distress. Older children and adults often experience a "mild" upper respiratory infection with RSV because they have larger airways and can tolerate the airway swelling with fewer symptoms than do infants. The virus leads to necrosis of the bronchiolar epithelium, hypersecretion of mucus, and infiltration and edema of the surrounding cells. These changes are further complicated by mucous plugs that obstruct the bronchioles and lead to collapse of the distal lung tissue.

The incubation period is approximately 4 days from the time of exposure to the time of the first manifestation of the illness. Infants shed the virus for up to 12 days, and the spread of infection occurs when large infected droplets (airborne or through direct contact with secretions) are inoculated in the nose or eyes of a susceptible person. In temperate climates, infants most often contract RSV during the winter months. Mortality of infants with a lower respiratory infection due to RSV is approximately 2%. Young premature infants have a poorer outcome. A significant number of infants who develop bronchiolitis have reactive airway disease later in life. The peak incidence occurs during winter and spring, and bronchiolitis is a major reason for hospital admission for infants less than 12 months of age, particularly children who live in poverty and in urban areas. Bronchiolitis accounts for approximately 4500 deaths and 90,000 hospital admissions each year.

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