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Stoma Care- Changing a Colostomy Bag (Nursing Skills)

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05.01 Stoma Care (Colostomy bag) | NURSING.com

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Stoma Care- Changing a Colostomy Bag (Nursing Skills)

In this video, we’re going to talk about stoma care. Now, the wafer and bag for an ostomy only NEEDS to be changed every 3 days, or if it’s leaking. But, you still need to be able to assess the stoma itself. In this case we’re going to show you how to replace the bag and clean and assess the stoma. Start by putting a towel under the patient on the side of the stoma. We love you guys! Go out and be your best selves today! And, as always, happy nursing!

Bookmarks:
0.05 Introduction to Stoma Care
0:20 Assessing the stoma
0:47 Cleaning the stoma
1:12 Inspecting the stoma
1:25 Measuring and cutting the stoma
2:00 Applying and sealing the bag
2:35 Documentation
2:41 Outro

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Clinical Examination of the respiratory system

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Panic attack from Injection:'(

Phacolytic glaucoma usually is associated with a mature or hypermature cataract and typically occurs in elderly patients. Today, phacolytic glaucoma is rare in the United States, found primarily in areas where access to care is poor. Will the increase in the number of under- and uninsured patients lead to an increase in this condition? Evaluation and Diagnosis Signs and symptoms. Patients typically report acute-onset pain, decreased vision, tearing and photophobia. Examination will reveal injection, corneal edema, elevated IOP, anterior chamber reaction with or without pseudohypopyon, particles on the lens capsule and anterior capsule wrinkling. Patient history. The duration of symptoms should be elicited; a delayed presentation of more than five days since onset can result in glaucomatous disc damage and poorer prognosis.¹ The ocular history may reveal that the patient decided against removal of an advanced cataract. Prior intraocular surgery or trauma may have left residual lens material that could cause phacoanaphylactic glaucoma or exacerbate infectious endophthalmitis. Visual acuity and visual potential should be assessed. Exam essentials. A complete ophthalmologic examination should be done. The eye should be inflamed, and the cornea may be edematous due to the high IOP. The anterior chamber will demonstrate massive inflammation and/ or pseudohypopyon. Gonioscopy is essential; it will help rule out angle closure due to phacomorphic glaucoma or neovascularization of the angle. Assess ment of the posterior pole should be performed to rule out vitreous hemorrhage (which can result in ghost-cell glaucoma) or vitritis (which may be associated with infectious endophthalmitis or panuveitis). If the view to the fundus is obstructed, B-scan ultrasonography also should be performed. Differential diagnosis. The differential diagnosis includes infectious endophthalmitis, phacoanaphylactic glaucoma, inflammatory glaucoma, glaucoma secondary to intraocular tumor, phacomorphic glaucoma, acute-angle closure glaucoma and neovascular glaucoma. Management Medication. Medical management is used to temporarily control the glaucoma and inflammation. Initial treatment consists of hyperosmotic agents, aqueous suppressants, anti-inflammatory drugs and cycloplegics. Surgery. Definitive treatment is removal of the lens via extracapsular cataract extraction with or without an IOL. Some ophthalmologists defer placement of an IOL until after the inflammation subsides; however, there is no significant difference in final visual acuity between those patients who did receive an IOL and those who did not.¹ If the phacolytic glaucoma is of long duration (more than seven days), a combined trabeculectomy may be needed to prevent postoperative IOP spikes.² In eyes with hypermature Morgagnian cataracts, one must be especially careful, as the capsule is fragile, the zonules are weak and the view is difficult due to the white, milky cortex. Vision limited to light perception on presentation is not a contraindication to performing cataract extraction. Surgical Tips For a planned extracapsular cataract extraction with a posterior chamber IOL, fashion a superior fornix-based conjunctival flap.³ Make a partial-thickness incision along the sclerolimbal junction superiorly for 120 degrees with a No. 69 blade. Forty-five degrees away, a paracentesis should be done to decompress the eye. The anterior chamber fluid can be withdrawn for analysis, to look for macrophages and high molecular-weight proteins. Inject balanced salt solution in a cannula to wash out any residual particulate matter, then inject Healon or viscoelastic into the anterior chamber. Make an incision entering the anterior chamber at the 12 o’clock position with a keratome. A 26-gauge cystotome mounted on a syringe is then introduced through the 12 o’clock incision and used to puncture the capsular bag. The milky cortex should be aspirated as much as possible, until the nucleus is visible. Withdraw the needle through the keratome incision, then inject Healon through the 12 o’clock incision into the capsular bag. Next, enlarge the corneoscleral keratome incision with curved Westcott scissors to 120 degrees. Perform a partial V-shaped capsulotomy; this can be done either with the cystotome or with an angled Vannas scissors. Place viscoelastic under the nucleus to float the nucleus and sever any adhesions between the nucleus and the capsule. The nuclear portion of the lens can then be removed with an irrigating vectis (lens loop) with or without gentle pressure at the inferior limbus (6 o’clock). Irrigate and aspirate the residual cortex with the Simcoe cannula. Inspect the capsular bag; if it is intact, place a posterior chamber IOL into the bag. Close the incision with several interrupted 10-0 monofilament nylon sutures and reattach the conjunctival flap. Potential Sequelae and Prognosis Postoperatively, the patient should be managed with topical steroids and/or aqueous suppressants and hyperosmotics if necessary. Vitreous opacification behind the posterior capsule occurs in a small percentage of eyes. These vitreous opacities are typically absorbed by one to two weeks postoperatively. IOP usually is controlled without antiglaucoma medications after the cataract removal. A detailed glaucoma evaluation (including repeat gonioscopy to assess for peripheral anterior synechiae, visual field and optic nerve status) should be done to assess the extent of glaucomatous damage. The prognosis is dependent on the duration of elevated IOP, PAS and optic nerve damage. In one study, patients who were older than 60 and whose glaucoma was present for more than five days did significantly worse than a comparison group of younger individuals with shorter disease duration.

A simple continuous stitch can be a useful technique for skin closure when speed is important, e.g. closing a scalp laceration on a screaming child. The simple running, or continuous suture, is begun in the same way as a simple interrupted suture.

Alcoholic hepatitis is inflammation of the liver caused by drinking alcohol. Alcoholic hepatitis is most likely to occur in people who drink heavily over many years. However, the relationship between drinking and alcoholic hepatitis is complex. Not all heavy drinkers develop alcoholic hepatitis, and the disease can occur in people who drink only moderately. If you're diagnosed with alcoholic hepatitis, you must stop drinking alcohol. People who continue to drink alcohol face a high risk of serious liver damage and death.

In cases when the presentation is unclear, ultrasonography is the imaging methodology of choice. The characteristic finding is the presence of a "target sign". Ultrasonography is not required in patients with obvious clinical diagnosis (as seen in this patient). Such patients can proceed directly to treatment with diagnostic and therapeutic air (pneumatic) or water-soluble (hydrostatic contrast) enema.

Urinary Bladder Medical Exam

An intrauterine device (IUD), also known as intrauterine contraceptive device (IUCD or ICD) or coil, is a small, often T-shaped birth control device that is inserted into a woman's uterus to prevent pregnancy. IUDs are one form of long-acting reversible birth control (LARC).

Furosemide is a prescription drug. It’s available in two forms that you take by mouth: a tablet and a solution. It’s also available as an injectable solution, which is given by a healthcare provider. The furosemide tablet is available as the brand-name drug Lasix. It’s also available as a generic drug. Generic drugs usually cost less. In some cases, they may not be available in every strength or form as the brand-name version.

Most C-sections are done under regional anesthesia, which numbs only the lower part of your body — allowing you to remain awake during the procedure. A common choice is a spinal block, in which pain medication is injected directly into the sac surrounding your spinal cord

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ENT Physical Examination Lecture

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This 3D medical animation shows how adhesions in the abdomen may cause complications. These problems may include obstruction, twisting, and dislocating areas of the small intestine. Adhesions can be separated with laparoscopic instruments.

ANH00037

The oral contraceptive pill, commonly known as "the pill," is a hormone-based method of preventing pregnancy. It can also help resolve irregular menstruation, painful or heavy periods, endometriosis, acne, and premenstrual syndrome (PMS). Birth control pills work by preventing ovulation. No egg is produced, so there is nothing for the sperm to fertilize. Pregnancy cannot occur. "The pill" is used by nearly 16 percent of women aged 15 to 44 years in the United States, and it has both advantages and disadvantages. People with different risk factors may be advised to use a particular kind of pill. There are different types of contraceptive pills. They all contain synthetic forms of the hormones estrogen, progesterone, or both. Synthetic progesterone is called progestin. Combination pills contain progestin and estrogen. The "mini pill," contains only progestin. Monophasic pills all contain the same balance of hormones. With phasic pills, two or three different types of pill are taken each month, each with a different balance of hormones.

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