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Dr. Debbie Song at Gillette Children's describes in detail selective rhizotomy surgery.

A selective dorsal rhizotomy is an operation performed to treat spasticity. It is thought that high tone and spasticity arise from abnormal signals that are transmitted through sensory or dorsal nerve roots to the spinal cord. In a selective dorsal rhizotomy we identify and cut portions of the dorsal nerve roots that carry abnormal signals thereby disrupting the mechanisms that lead to spasticity. Potential patients go through a rigorous assessment that includes an in-depth gait and motion analysis as well as a physical therapy evaluation.

They are evaluated by a multidisciplinary team that includes a pediatric rehabilitation doctor, a neurosurgeon, and an orthopedist, Appropriate patient selection is vital. Ideal candidates for selective dorsal rhizotomy are children who are between four and ten years of age, have a history of being born prematurely, and have a diagnosis of diplegia cerebral palsy. These patients usually walk independently or with the assistance of crutches or a walker. They typically function at a level one, two, or three in the gross motor function classification system or gmfcs. A selective dorsal rhizotomy involves the coordinated efforts of the neurosurgery, physiatry, anesthesia and nursing teams. The operation entails making an incision in the lower back that is approximately six to eight inches long. We perform what we call a laminoplasty in which we remove the back part of the spinal elements from the lumbar one or l1 to l5 levels. At the end of the procedure the bone is put back on. We identify and open up the Dural sac that contain the spinal fluid spinal cord and nerve roots. Once the Dural sac is opened ,we expose the lumbar and upper sacral nerve roots that transmit information to and from the muscles of the lower extremities.

At each level we isolate the dorsal nerve root, which in turn is separated into as many as 30 smaller thread light fruitlets.

Each rootlet is then electrically stimulated. Specialized members of the physiatry team look for abnormal responses in the muscles of the legs as each rootless is being stimulated. If an abnormal response is observed then the rootlet is cut.

If a normal response is observed, then the rootlet is not cut. We usually end up cutting approximately 20 to 40 percent of the rootlets. The Dural sac is sutured closed and the l1 through l5 spinal elements are put back into anatomic position, thus restoring normal spinal alignment. The overlying tissues and skin are then closed and the patient is awoken from surgery. The entire operation takes between four and five hours. A crucial component to the success of our rhizotomy program is the extensive rehabilitation course following surgery. With their tone significantly reduced after a rhizotomy, patients relearn how to use their muscles to walk more efficiently through stretching, strengthening, and gait training. Approximately one to two years after a rhizotomy patients undergo repeat gait and motion analysis. The orthopedic surgeons assess the need for interventions to correct bone deformities, muscle contractures, poor motor control, impaired balance, or other problems related to cerebral palsy.

At Gillette we work closely with patients and families to ensure that our selective dorsal rhizotomy program meets their goals for enhancing their function and improving their quality of life.

VISIT https://www.gillettechildrens.org/ to learn more

0:00 Why choose selective dorsal rhizotomy?
0:56 Who is a good candidate for selective dorsal rhizotomy?
1:31 What does a selective dorsal rhizotomy entail?
3:26 What is recovery from selective dorsal rhizotomy like?

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The most reliable clinical sign to detect ascites is checking for bilateral flank dullness. If a patient with ascites is lying supine, fluid accumulates in the flank regions, leading to dullness on percussion. At the same time, the air-filled bowel loops are forced upwards by the free fluid due to buoyancy, resulting in tympanitic percussion. To locate specifically where dullness shifts to tympany, or the air-fluid level, percussion should be performed from the sides towards the middle. To confirm that the dullness is caused by ascites, ask the patient to switch to a lateral decubitus position. If ascites is present, the air-filled bowel loops will shift accordingly and remain at the surface of the fluid. As a result, the air-fluid level will shift as well. This is known as shifting dullness.

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NURSING VIDEO ACTUAL CATHETERIZATION PROCEDURE OF MALE. FULL LENGTH VERSION Clear quality photography. This video provides an excellant clinical view of the entire procedure.

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his patient had spilled boiling water on his lower leg a couple days before. This isn't complicated but the teaching points should focus on draining the large blistered areas and attempting to maintain moisture as long as we can so the skin doesn't contract down on itself.

Percutaneous transluminal coronary angioplasty (PTCA) is a minimally invasive procedure to open up blocked coronary arteries, allowing blood to circulate unobstructed to the heart muscle.

Vasectomy is a minor surgical procedure wherein the vasa deferentia of a man are severed, and then tied or sealed in a manner such to prevent sperm from entering the seminal stream (ejaculate). Typically done in an outpatient setting, a traditional vasectomy involves numbing (local anesthetic) of the scrotum after which 1 (or 2) small incisions are made, allowing a surgeon to gain access to the vas deferens.

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It is very important to instruct your patients about how to self exam their breasts for any abnormalities or masses for early detection of any changes

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How to start a peripheral IV in the dorsum of the hand: clinical nursing skill technique.

Starting an IV (intravenous catheter) can be an intimidating experience for nurses, especially nursing students and new nurses. However, nurses will perform IV insertions often, so this is an important nursing skill to learn.

Before starting an IV, always follow the protocols of your facility, as well as manufacturer's instructions for any supplies used.

In this video, Nurse Sarah demonstrates how to start a peripheral IV in the dorsum of the hand. Prior to inserting the IV, you'll want to do the following:

-Gather supplies
-Perform hand hygiene
-Prepare supplies (including priming the saline flush, removing air from extension tubing, opening packages, completing labels, and any other steps required by your facility.
-Locate a suitable vein
-Perform hand hygiene
-Don gloves


If the patient has a lot of hair, you might want to use clippers to trim the hairs prior to starting the IV. You may also apply a tourniquet to help veins move near the surface of the skin.


Next, you'll want to clean the site using the cleaner that came in the IV start kit, such as ChloraPrep.


Once the site has dried completely, you can insert the IV. Stabilize the vein with your non-dominant hand, and insert the IV's needle into the vein, watching carefully for blood return (or a blood flash) in the chamber. Advance the IV around 2mm more to ensure the plastic cannula is in the vein, then thread the cannula into the vein and press the needle safety button.

Notes: https://www.registerednursern.....com/how-to-start-an-
IV Video Series: https://www.youtube.com/watch?v=MbG_1-_mnoo&list=PLQrdx7rRsKfXr6kruqEpIovf66sxo0gxh



This video also demonstrates how to flush the IV using the push-pause method, how to secure the IV using the Tegaderm dressing that came with the IV start kit, considerations of the different cap types and the clamp sequence, and more.



For more information, watch the complete tutorial.

#nurse #nursing #iv #startiv #ivtherapy



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