Nursing Care Of Tracheostomy

Visiting Holland

I tacked that quote on the bulletin board in my son’s nursery the week he was born, and remembered it June 1 as he crossed the Timmons Arena auditorium to receive his high school diploma, small and resolute in his yellow honors stole.

Two blinks and it was over; he was heading back to his seat. Such a short walk hardly seemed enough. He needed a Blue Angels formation flight. Phillip Sousa and cannon fire. I’m not sure even that would be enough, considering what it cost him to earn that piece of parchment from J.L. Mann.

Every diploma awarded that day is a celebration. But for Samuel, it was the trophy finish of an endurance race that began at midnight 21 years ago, as two Greenville Memorial Hospital residents fought to make a 2 lb., 10 oz. preemie breathe.

I still remember the weary pain in the neonatologist’s eyes the next morning when he told us our firstborn would not respond to the ventilator. The NICU staff had hand-bagged him all night. “Call your family,” he said. “I’m sorry, but I don’t expect him to survive the day.” He did, though, and the race was on.

Author Emily Pearl Kingsley once wrote that having a premature baby is like planning a fabulous vacation to Italy – only the plane lands in Holland.

“Holland?” you say to the stewardess. “What do you mean Holland? I signed up for Italy! I’m supposed to be in Italy. All my life I’ve dreamed of going to Italy.”

But there’s been a change in the flight plan, and in Holland you must stay. You must buy new guidebooks and learn a whole new language. You will meet people you never would have met.

Every NICU parent knows that essay. Samuel spent nine months in Memorial’s neonatal intensive care unit, so long that sometimes even now, if I happen to be at the intersection of Church Street and Augusta, I will drive on automatic pilot to Grove Road and find myself in the hospital parking lot. He stayed because he was so premature – he skipped the whole last trimester – and in the terrible Catch-22 of NICUs, his lungs were scarred by the ventilator he did finally tolerate and did save his life.

Nursing Care Plan - Providing arm and leg care for Burn patients ...

Providing arm and leg care:

1. apply dressing from distal to proximal area to stimulate circulation and prevent constriction. wrap the burn gauze once around the arm or leg so the edges overlap slightly, until it cover the wound.

2. apply a dry roller gauze dressing to hold the bottom layers in place, secure with tape.

Providing hand and foot care

1. wrap each finger separately with a sterile layer of 4x4 sterile gauze pad to allow the patient to use his hand and to prevent contractures.

2. place the hand in a functional position, and secure this position using a dressing, apply splint if ordered.

3. put gauze between each toes as appropriate.

Providing chest, abdomen And back care

1. apply the ordered medication to the wound in a thin layer. Then cover the entire burned area with sheets of burn gauze.

2. wrap the area with roller gauze or apply a specialty vest dressing to hold burn gauze in place.

3. secure the dressing with elastic netting or tape, make sure that dressing doesn't restrict respiratory motion, especially in very young or elderly patients or in those with circumferential injuries.

Providing facial Nursing care

1. if the patient has scalp burns, clip or shave the hair around the burn as ordered, clip other hair until its about 5cm long to prevent contamination of burned scalp areas.

2. shave facial hair if it become in contact with burn areas.

3. facial burns managed with mild antibiotics ointment and lift open to air, if dressing required, don't cover eyes, nostrils and mouth.

Providing Nursing ear care

1. clip or shave the hair around the affected ear.

2. remove exudate and crust with cotton- tipped applicators dipped in normal saline solution.

3. place 4x4 layer of gauze behind the auricle to prevent webbing.

4. apply the ordered medication to 4x4 gauze pads, and place pads over the burned area, before securing the dressing with roller bandage, position the patients ears normally to avoid damaging the auricular cartilage.

5. assess patient hearing ability.

Providing Nursing eye care

1. clean the area around the eye and eyelids with a cotton tipped applicator and normal saline solution every 4-6 hours or as needed, to remove crust and drainage.

Tabbner's Nursing Care, Theory and Practice

Tracheostomy, a multiprofessional handbook

Nursing care of the general pediatric surgical patient

Textbook of pediatric nursing

Nursing practice, hospital and home : the adult