Discharge And Home Healthcare Guidelines

PREPARATION FOR PROSTHETIC. Teach the patient how to promote healing at the surgical site by keeping the incision clean, dry, and covered. Explain that the stump needs to be wrapped to promote shrinkage and proper shaping for the prosthesis. Teach exercises to maintain strength and range of motion and to prevent contractures. Explain the roles of the interdisciplinary team members in the patient's rehabilitation.

CONTINUING TREATMENT. If the patient receives outpatient chemotherapy or radiation, teach the patient the purpose, duration, and potential complications of those treatments.

Botulism DRG Category: 423

Mean LOS: 7.1 days Description: MEDICAL: Other Infectious and Parasitic Diseases Diagnoses

Botulism is a serious neurotoxic disorder that is caused by the gram-positive, spore-forming bacterium Clostridium botulinum, which is found in soil and in the gastrointestinal (GI) tract of birds, fish, and mammals. Although it is usually harmless in the spore state, the organism flourishes in warm anaerobic environments, causing germination with bacterial multiplication and toxin production. Botulism occurs when the bacterium is ingested into the GI tract or enters through an open wound. Once ingested or embedded, the bacterium enters the vascular system. Toxins act at the neuromuscular junction by impairing the release of the neurotransmitter acetylcholine from the presynaptic membrane. Loss of acetylcholine causes paralysis of voluntary and involuntary muscles.

Approximately 100 cases of botulism are reported each year in the United States, of which 25% are food borne, 72% are infant botulism, and the remainder are from wounds. Botulism has a mortality rate as high as 25%, with death occurring as a result of respiratory failure during the first week. If onset is rapid (<24 hours) after ingestion of the bacterium, the course of the disease is more severe and potentially fatal. Paralytic ileus is another complication of botulism.

In persons older than 12 months, the spores are unable to germinate in the gut because of the presence of gastric acid, and therefore the food-borne disease is caused by ingesting a preformed toxin. The spores, however, can germinate in the GI tract of infants younger than 1 year because infants have lower levels of gastric acid, decreased levels of normal flora, and an immature immune system. The GI environment in infants is conducive to toxin production, making infants particularly susceptible to the spores present in unprepared foods.

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