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Note: Dose is administered as soon as the diagnosis is suspected and before it is confirmed. If symptoms worsen during the next 4 hours, another vial is given intravenously. One more vial can be administered in 12 to 24 hours if indicated. Before administering the TBA, obtain a history of drug allergies from the patient. In addition, if the patient is allergic to horses, notify the physician immediately because TBA is prepared from equine (horse) serum. Have epinephrine available if the patient experiences an allergic reaction. Infants with botulism generally are not treated with medication, which has not been shown to be beneficial, but rather receive supportive care. Nonab-sorbed toxin may be removed with cathartics. Note that aminoglycosides may potentiate the neuromuscular blockade and thus are contraindicated.

Note: Dose is administered as soon as the diagnosis is suspected and before it is confirmed. If symptoms worsen during the next 4 hours, another vial is given intravenously. One more vial can be administered in 12 to 24 hours if indicated. Before administering the TBA, obtain a history of drug allergies from the patient. In addition, if the patient is allergic to horses, notify the physician immediately because TBA is prepared from equine (horse) serum. Have epinephrine available if the patient experiences an allergic reaction. Infants with botulism generally are not treated with medication, which has not been shown to be beneficial, but rather receive supportive care. Nonab-sorbed toxin may be removed with cathartics. Note that aminoglycosides may potentiate the neuromuscular blockade and thus are contraindicated.

Independent

Other family members who have been exposed to contaminated food should obtain healthcare immediately. Exposed family members should receive an immediate gastric lavage and a high colonic enema to purge their system of the toxin in the bowel if they were exposed.

Patients are not given food, fluids, or medications orally until their swallowing status is normal and they have an active gag reflex. Provide mouth care every 2 hours to improve comfort and to destroy oral flora. Because the patient has difficulty speaking, establish other routes for communication. Explain that the ability to speak returns as the condition resolves.

During periods of impaired mobility, turn patients every 2 hours, and monitor their skin for breakdown. Egg-crate mattresses or an air bed may be useful. At a minimum of every shift, perform active and/or passive range-of-motion exercises for immobile or bedridden

142 Brain Cancer patients. Position unconscious patients on their sides to prevent aspiration of stomach contents; tracheal suction and chest physiotherapy may be indicated to maintain pulmonary hygiene.

Offer clarification and support of the information regarding the diagnosis and prognosis to patients and families. Monitor the patient's and family's coping mechanisms to determine if effective coping mechanisms are in place.

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