List of Acute Health Problems and their Signs, Symptoms, and Causes

Task 1

1. Explain all following acute health problems. List at least two signs and symptoms and two causes (each). (30-40 words each)
2. Acute renal disorders

It occurs when the kidneys suddenly become unable to filter waste products from the blood. Its signs and symptoms include irregular heartbeat along with breath shortness and can be caused by blood or fluid loss along with liver failure (Chawla, Eggers, Star & Kimmel, 2014).

1. Acute gastrointestinal disorders

They are disorders engaging the digestive tract and the accessory organs of digestion, the pancreas, liver, and gallbladder. Its signs and symptoms include indigestion, nausea and vomiting and may be caused by cancer of the digestive system along with previous bowel surgery (Drossman, 2016).

1. Acute neurological disorder

It is a disease of the spine, brain along with the nerves that connect them. Its signs and symptoms are poor cognitive abilities and decreased alertness and can be caused by genetic disorders and congenital abnormalities (Patel et al., 2016).

1. Acute pain

It is a type of depression that lasts less than three to six months typically or which is directly related to soft tissue damage like a sprained ankle. Its symptoms are numbness, fatigue along with weight loss and it is caused by injuries, infections, and appendicitis (Stanton-Hicks, 2018).

1. Acute respiratory disorders

They are disorders which may interfere with normal breathing and can affect either the upper or lower respiratory system. Its symptoms are a sore throat, body aches together with a cough, and it is caused by acute pharyngitis, common cold along with bronchitis (Rochester, Fairburn & Crouch, 2014).

1. acute unconscious state

It is a coma during which a person is unresponsive of his environment. Its signs and symptoms are closed eyes, irregular breathing along with depressed brainstem reflexes and is caused by stroke, tumors, seizures or even traumatic brain injuries (Cooksley & Holland, 2017).

1. Angina

Angina is a discomfort or chest pain which occurs when a part of the heart muscle receives less blood oxygen than usual. Its signs and symptoms are difficulty breathing along with tightness and can be triggered by smoking, severe emotional stress along with exposure to extreme temperatures (Bairey Merz et al., 2015).

1. burns

Burns are injuries primarily to the skin and underlying tissue. Signs and symptoms are redness and tenderness or pain, and they may be caused by flame burns, hot liquid, sunburn or electrical burns (Dinis-Oliveira et al., 2015).

1. cellulitis

Cellulitis is a common bacterial skin infection. Its symptoms are redness or swelling and pain in the affected area, and they are commonly caused by Streptococcus and Staphylococcus bacteria when they enter through a cut on the skin (Linder & Malani, 2017).

1. deep vein thrombosis, venous thromboembolism

Key Principles of Surgical Nursing and Explanation of Surgical Procedures and Terminology

It occurs when a blood clot forms in one or more of the deep veins in the body generally in the leg. Symptoms include pain in the leg and red or discolored skin on the leg and can be caused by injury to a vein, surgery or certain medications (Ageno et al., 2016).

1. Dehydration

Dehydration occurs when the body lacks much water as it is required. Signs and symptoms include the dry or sticky mouth, headache, dehydrated skin along with rapid heartbeat and it is caused by excessive sweating and vomiting (Hooper et al., 2015).

1. Fractures

Fractures are broken bones, and its signs and symptoms include pain or swelling, warmth, bruising or redness and obvious deformity in the injured part. They are caused by bad falls, trauma or automobile accident (Miller et al., 2016).

1. Hemorrhage

Hemorrhage is when blood vessels rupture due to injury leading to excessive bleeding. Its symptoms include breath shortness along with a headache, and they can be caused by trauma or damage to a blood vessel and aneurysms or weak spots in the artery (McEvoy, Farrell, Brett & Looby, 2016).

1. head injury

It is any sort of damage to the scalp, brain or skull. Signs and symptoms include a headache, nausea along with a loss of consciousness and they can be caused by falls or blows, accidents or physical assaults (Corps, Roth & McGavern, 2015).

1. myocardial infarction

It is also called heart attack which occurs when one of the heart’s coronary arteries is blocked. Its signs and symptoms are chest pain, breathlessness along with nausea and is caused by thrombus along with atherosclerosis (Tegn et al., 2016).

1. renal calculi

Renal calculi also called kidney stones are hard deposits made of minerals and salts which form inside the kidneys. Symptoms include small amounts of urine along with pain on urination and are caused by an excessively acidic environment and lack of water in the body (Lieske et al., 2015).

1. q) Sepsis

Sepsis is the body’s extreme response to an infection. Its symptoms include severe weakness, unconsciousness along with high heart rate. It is caused by pneumonia, kidney infection along with abdominal infection (Clarke, Bird, Kakuchi, Littlewood & van Hamel Parsons, 2015).

1. Shock

It is a life-threatening state which occurs when the body is not getting enough flow of blood. Signs and symptoms are rapid, shallow breathing, nausea along with the loss of consciousness and it is caused by dehydration, heart failure and severe allergic reaction (Mouncey et al., 2015).

1. Enlist key principles of surgical nursing. Explain briefly following surgical procedures/terminology. (30-40 words each)
2. a) elective/emergency surgery

Holistic Care Approach Applied to Acute Care Environment

The key principles are measuring the generally predictable emergency/ elective surgery workload, consultant surgeon-led models of emergency/ elective surgery care, allocation of operating theatre resources matching to the emergency workload and standard hours scheduling where clinically appropriate.

1. b) General, local, epidural and spinal anesthetic and peripheral nerve block

Always aspirate before infiltration along with correct choices of infiltrative analgesia versus topical analgesia.

1. c) Amputation

It is the removal of a limb by trauma, medical illness or surgery. Key principles are that levels of amputation are chosen not by the prosthesis but by the level of involvement or injury, and the length of amputation can be preserved by coverage with split grafts over muscles or with free vascularized flaps.

1. d)    Open reduction

The key principles are the reduction to restore anatomical relationships, providing absolute or relative stability, preservation of the supply of blood along with early and safe mobilization.

1. e) Hip replacement

Minimizing joint reaction forces by transferring the trochanter to balance the muscle forces with the center line of the body and maintaining the center of rotation, hip length and offset and attention to element placement are the key principles.

1. f) Craniotomy

Principles of craniotomy are a preoperative review of the patient, preparation of scalp, the positioning of the patient on the table, scalp toilet, marking of the incision along with draping.

1. g) Tonsillectomy

The key principle in tonsillectomy is that the frequent dosing of the analgesic ladder is better than prn.

1. h) Appendectomy

General anesthesia is given, an incision made, several cuts made if laparoscopic, belly washed out if needed, drainage tube and the basic principles are the adequate exposure and simplicity along with the body habitus (Flum, 2015).

1. Laparotomy

The operation satisfies three fundamental principles which are that the wound must be inflicted without pain, hemorrhaged must be arrested, and the injury must heal.

1. j) Hysterectomy

The principles are anterior peritoneum of the broad ligament must be opened, and the uterine vessels are coagulated.

1. k) Prostatectomy

In prostatectomy, the fast-track concepts might contribute to saving resources in the long term, and the more evidence based on larger prospective trials is needed to achieve optimal quality of life.

1. l) Cataract extraction

Its fundamental principles include the adequate use of low magnification 6 to 8X, no substitute for frequent practice for mastering the operating microscope along with obtaining a sharp focus on iris or limbus.

1. m) Internal bleeding due to trauma.

Its principles are preventing further bleeding, preserving life along with promoting recovery.

1. Describe how a holistic care approach is applied to the acute care environment including nursing interventions and outcomes.

Holistic care approach has been applied through the expansion of essential oil market, hydrotherapy a centuries-old approach and acupressure which eases pain and reduces opioid use (Goeman, Koch, Fogerty & Collister, 2015).

1. List two actual and potential health issues for a patient undergoing R) total hip replacement. State the risk assessment needed to be done before ambulation including patient’s stability on their feet.

Actual and Potential Health Issues for Patient Undergoing Total Hip Replacement

Potential problems include dislocation of the joint and blood clot, and actual problems are heart attack along with pneumonia. The risk assessment should be done to the patient, environment, healthcare provider and the institution of the work. The patient is assessed whether he can cooperate and follow directions, can bear weight and if he can sit up on the bedside without support. The environment is evaluated to find if there is enough space if the equipment available is in correct working state and if all hazards have been removed (Le Manach et al., 2015). On the side of the healthcare provider, he should complete all required training, wear non-slip footwear and maintain a neutral spine. The organization should be assessed to ensure enough caregivers, adequate time for the procedure and take rest breaks along with different operations to promote optimal back health.

1. Describe briefly and list at least four purposes, complications and nursing management of the following procedures: (30-40 words each)

I/V Intravenous fluid intake

Its uses are the fluid replacement to correct dehydration, blood transfusions, to correct electrolyte imbalances along with delivering medications. Complications associated with the procedure are the hematoma, air embolism along with infiltration. Nursing management of the process is to use aseptic approach when preparing and administering medications and fluids adhering to the six rights of medication safety. 

 Central venous catheter (CVC)

The purpose of the procedure is for infusions of irritant substances, IV access, CVP monitoring, and transvenous pacing. Complications include pulmonary complications, damage to central veins, cardiac complications along with device dysfunction.

 Total parental nutrition (TPN)

The purposes are to sustain life in patients with short-bowel syndrome, assisting the healing of enterocutaneous and pancreatic fistulas and for perioperative use in nutritionally deprived patients. Complications are liver failure, thrombosis, infection, and hyperglycemia. Appropriate vascular as the clinical monitoring is required to ensure complications of therapy are detected quickly.

Nasogastric tube feed/fluid intake

They are used to deliver tube feedings to patients, test stomach contents. Its complications are vomiting, abdominal cramping, regurgitation of medicine or food along with nausea.

1. A) Briefly outline the pre- and post-operative management of a patient undergoing any surgery.

Information is obtained about the health status of the patient including baseline observations along with the correct nursing history.

1. B) List 6 common pre- and post-operative management of a patient undergoing an appendectomy

The patient’s database should be assessed, administration of IV line, skin prepared for the procedure, monitoring of the vital signs, accessing the level of consciousness along with assessing bleeding at the wound site (Flum, 2015).

1. List three indications and complications associated with peripherally inserted central catheter (PICC)/midline. Outline the nursing management of a client with a PICC line.

PICC-associated complications are thrombosis, mechanical complications like occlusion and accidental withdrawal along with infection while its indications are serial lab draws, serial transfusions of product or blood together with limited peripheral venous access. Nurses should not take the BP of patients on the arm with PICC line, assess the dressing each shift to ensure it is not wet, dirty or peeling off and also always evaluate the excellent blood flow along with natural flushing each change to ensure patency of PICC line.

1. Explain strategies to manage post-operative pain.

Explanation of Different Procedures and Nursing Management

The use of multimodal treatment strategies in which treatment with multimodal analgesia has been demonstrated to minimize the use of opioid, reduce the incidence of opioid-related adverse events along with developing pain control when compared with using opioid monotherapy. Moreover, the use of regional anesthetic strategies including epidural and perineural along with local anesthetics is another mode of postoperative pain management (Collins, Joshi, Quiroz, Steinberg & Nihira, 2015). Epidural analgesia entails the injection of a local anesthetic with or without an opioid into the epidural space within the spinal column. On the other hand, perineural nerve blocks inject anesthetics into parts adjacent to the nerve of various locations depending on the types of the performed surgery.

1. A) Explain what post-anesthetic and postoperative observations are made on a patient after a surgical procedure/surgery?

The observations made include pain score, neurological assessment, presence and patency of drains, assessment of wound sites, respiratory effort, SpO₂, BP, HR along with temperature.

1. B) Regarding a patient who is not regaining consciousness, how would you assess their level of awareness and what signs and symptoms of deterioration you need to monitor

To determine the patient’s response touch and verbal technique is used. A simple command is given like “squeeze my hand, open your eyes” which are verbal and “squeeze both shoulders firmly” as a touch. Also, administer painful stimuli, and if the patient does not respond the, he is unconscious. The signs and symptoms of deterioration that need to be observed are closed eyes, unresponsiveness to painful stimuli along with irregular breathing (Moe et al., 2018).

1. Explain how an oral fluid intake is observed, measured and documented. What tools/charts are used (provide an example or sample chart). Explain why it is important to observe this and its purpose?

Any fluid entering the body is measured and a note made on how much the patient drinks along with the time of the day. If drinking from a jug, the total intake is obtained by subtracting the fluid remaining in the jar at the end of the day plus any fluid added. Feeds through a nasogastric tube and intravenous intake is also measured the same and if water is used to flush the nasogastric tube the amount used for irrigation is recorded in the intake and output chart and Trust’s fluid balance chart (Jensen, Attridge, Lenninger & Benson, 2015). It is vital to observe since the measurements are used to assess the fluid and electrolyte intake to suggest the various diagnosis and allow prompt interventions to correct the input. The documentation is done by placing patient identification sticker in the box provided along with the date written clearly on the top of the chart, drawing a line through the unused columns in case fluid intake starts or ends at a particular time other than midnight and completes the total running column. Also, everyday amount of fluid intake should be entered clearly at the end of the 12 and 24-hour duration highlighted with color and signed by a registered nurse and escalating when indicated using the trust’s escalation flowchart.

1. Outline emergency management protocol for following:

Pre- and Post-Operative Management of a Patient Undergoing Surgery

Any two first aid procedures

Emergency management for burns is done by flushing cool running water to the burned part several minutes along with applying a light veil and ibuprofen is provided for the relief of pain. For bleeding, the wound should be covered with a cloth and direct pressure applied to stop blood flow.

Cardiac arrest

For emergencies look, feel and listen, keep ventilating and continue ECM till there is a response or you decide to stop treatment. Here the consequences of a cardiopulmonary arrest are temporarily averted. The ABC routine is lifesaving although it is for only for a few minutes. Some other medication should be provided, and normal circulations are restored if the patient is to survive. If ECG diagnosis is absent, adrenaline is lifesaving and should always be used once the diagnosis is made even if the arrest cause is unknown.

Respiratory arrest

Patient’s airways are opened and positive pressure ventilation provided with a bag-mask. The bag-mask should be attached to the flow meter of oxygen, and the oxygen turned all the way up. After provision of positive pressure, the patient may spontaneously start breathing and if it happens supplemental oxygen should be administered and continuous observation to the patient otherwise the patient will need to be intubated. However, before intubation there is need to suction the mouth and oropharynx to remove any secretions for vocal cords to be visualized.

1. Identify and explain two complications associated with acute bed rest.

Muscle weakness is a complication associated with acute bed rest whereby muscles are negatively affected with weakness and atrophy as the result of immobility. The other complication is contractures whereby when limbs are not moved the tendons along with muscles shorten making the joint stiff.

1. List clinical manifestations of at least 6 acute disease states and illnesses requiring complex nursing interventions. Explain briefly the nursing management for each disease state and illness.

A severe acute respiratory syndrome is managed via wearing disposable globes and a surgical mask and washing personal items and hands. Its clinical manifestations include a dry cough, persistent fever, headache, and dyspnea. Acute lymphocytic leukemia has clinical signs like fevers, fatigue, low back pain, and spontaneous bleeding. Presentations of strep throat include fever, acute illness with a sore throat and tender cervical adenopathy. Acute bronchitis has manifestations such as a productive cough, abnormal lung examinations and purulent sputum (Schulze, Vogelgesang & Dressel, 2014). However, the indications for acute respiratory distress syndrome are hypoxia, respiratory alkalosis, and tachypnea. Acute disseminated encephalomyelitis has signs like a headache, cranial nerve symptoms, and fever.

1. Name four critical nursing care aspects of tracheostomy suctioning to ensure the client’s safety and comfort.

For patients with a newly developed tracheostomy, tracheal dilators should be available at the patient’s bedside till after the first successful tube is changed and an information sheet providing particular information concerning the date of the last tracheostomy tube change, type and size of the tracheostomy tube must be placed above the bed of the patient. Another care aspect is that children of six years and below should have cotton ties only to secure the tracheostomy tube and for those six years and above who are regarded at risk of undoing Velcro ties must have cotton ties.

1. Explain briefly nursing care management of patient with intercostal catheter. Give two reasons for intercostal catheter insertion.

Indications, Complications, and Nursing Management of PICC/Midline

The intercostal catheter should not be clamped unless ordered by a medical staff meaning that there exists a risk of the patient developing a tension pneumothorax if a drain is clamped when there is a presence of a leak. The reasons for intercostal catheter insertion is for removal of fluid or air from the pleural space and to allow lung re-expansion following surgery.

1. List four nursing management/safety checks and considerations for a patient with an underwater chest drainage tube?

The first tube connecting the drain to drainage bottles must be broad to decreased resistance, the procedure should not be applied following pneumonectomy and the level of water above the tube in the manometer bottle determines the amount of suction applied before air drain through the tube. Moreover, if suction is turned off, then tubing must be unplugged so that air can escape into atmosphere otherwise a tension pneumonectomy.

1. List three indications and 3 complications of CPAP and BIPAP therapy. Explain nursing management of a patient on CPAP and nursing management of patient on BIPAP.

CPAP is used to maintain airway patency and may be used in the neonatal intensive care unit to treat preterm infants whose lungs have not yet fully developed and who may have respiratory distress syndrome from surfactant deficiency. Also, it can be used by physicians to treat hypoxia along with decreasing the work of infant breathing with acute infectious processes like bronchiolitis. Its complications may include a runny nose, dry mouth, and congestion (Jaoude & El Solh, 2016). For a patient on CPAP requires transfer to the Paediatric Intensive Care Unit (PICU), the initiation of the therapy may occur in the Emergency Department or PICU environment and stabilization along with ongoing management should happen in the PICU environment.

On the other hand, BIPAP is used for increased ventilation, CPAP intolerance along with acute pulmonary edema management. Its complications are worsening lung function or injury, sinus congestion, and eye irritation.

1. Enlist at least 6 equipment used in acute care environments. Outline the function and purpose of each machine.

The stethoscope is used to detect and study lungs, heart, stomach and other sounds in the body while manual handling equipment is used to move and transfer patients safely and it improves the quality of care of patients. The nasogastric tube provides access to the stomach for diagnostic and therapeutic purposes and is used to remove gastrointestinal secretions and swallowed air in patients with gastrointestinal obstructions. Another equipment is clock/ timer used for measuring particular time intervals; blood gas test measures the amount of oxygen and carbon dioxide in the blood along with determining the blood pH. Finally, an adhesive tape is used to join or bond objects together rather than using screws or fasteners.

Task 4

1. Describe briefly at least two surgical procedures your patient(s) underwent during their stay at hospital. Explain preoperative and post-operative nursing care provided and how you contributed to their pre-operative nursing care management for specific surgical procedures.

Appendectomy involves removal of the appendix (Flum, 2015). Before the surgery the consent inform is signed, IV line administered and the skin prepared for the procedure. After the surgery, the patient is taken to the post-anesthesia care unit until the anesthesia wears off. The patient is observed on the heart rate, temperature and breathing at regular intervals. When the anesthesia wears off, and the vital signs stabilize the patient is taken to their hospital room.

Strategies to Manage Post-Operative Pain

 The other surgery is hysterectomy which is a surgical procedure to remove all parts of the uterus. Before the procedure the patient was assessed of his understanding of the procedure and explanations along with clarifications are provided. The abdominal and perineal areas are cleansed, little cleansing enema administered and the patient asked to empty the bladder, preoperative drugs administered and consent form signed. After the procedure hemorrhage signs are assessed, vital signs observed after every four hours and after the removal of the catheter, the amount of urine voided is measured. Also, complications, vaginal discharge along with incision and bowel sounds every shift are assessed. Finally, turning, deep breathing, coughing, early ambulation along with fluid intake is encouraged.

1. Explain how you ensured that the pre-operative care you planned and implemented in liaison with your Registered Nurse considered the relationship between pre-operative care and post-operative care.

Through ensuring that the highest standard of care is delivered to every patient, the surgical environment being kept sterile and safe and educating the patients with their family along with observing their emotional and physical health made sure that pre and post-operative care was regarded.

1. a) Provide details of post-anesthetic observations which were done by you on your patient(s) following surgery.

I conducted post-anesthetic observations such as the patency and presence of drains, nursing care like dressings and flush, pain score in which VAS score was recorded (R) for pain related to the drain at rest and (M) for pain related to coughing and breathing.

1. b) Write about any post-operative complications/deterioration in your patient(s) condition when they did not regain consciousness.

The shock which is a drop in the blood pressure causing a dangerous reduction in the flow of blood all over the body may occur and also hemorrhage which is bleeding

1. Describe briefly nursing interventions implemented by you in assisting your patient(s) recovering from a range of anesthesia to regain ideal health status.

The interventions were to maintain the patient’s airway and ensuring that he has enough oxygen and dioxide exchange. Also, the infusion of blood, fluids, and medications was necessary.

1. Explain nursing interventions implemented to reduce the risks associated with immobility.

The patient is mobilized as soon as possible, and the mobilization efforts may include sitting and dangling. Also, vital signs are monitored before and after physical activity along with establishing correct fall prevention techniques. Another intervention is encouraging patients to perform operations of daily living and engage in physical therapy prescribed to improve mobility.

1. Discuss at least 2 (each) pain management strategies and nursing care actions that you implemented in liaison with your Registered Nurse to promote your patient’s post-operative comfort.

The implemented strategies are the use of multimodal treatment strategies which reduce the use of opioid, minimize the incidence of opioid-related adverse events and improve pain control. Also, the use of regional anesthetic strategies which include epidural analgesia which involves local anesthetic injection and peripheral nerve block used to inject anesthetic into parts adjacent to the nerve (Collins, Joshi, Quiroz, Steinberg & Nihira, 2015). The nursing care actions implemented were discharging the patient with general orders like vital signs, pain control, and laboratory investigation along with other medications. Moreover, to prevent complications, early mobilization was encouraged like active daily exercise and deep breathing, adequate nutrition was ensured and to avoid skin breakdown the patient was turned regularly.

1. Enlist members of the emergency response team. Explain in detail their roles and responsibilities. Describe briefly your role and responsibilities as a part of emergency response team during your clinical placement.

Post-Anaesthetic and Post-Operative Observations on a Patient

Federal Bureau of Investigation (FBI) deal with federal offenses, terrorist activity, national security and investigating the organized criminal activity. However, Special Weapons and Tactics (SWAT) deal with overly dangerous situations. Secret Intelligence Service (SIS) protects the efforts of counterespionage and intelligence gathering along with gathering information, countering terrorism and resolving international conflict.  Firefighters fight and protect citizens from fires along with providing help in car accidents (Gomes, Borges, Huber & Carvalho, 2014). Police respond to incidents which range from domestic disputes to natural disasters to terrorist attacks and punishing who break the law. Finally, Hazardous Materials Management (HAZMAT) responds and cleanup of hazardous materials like gases and liquids. As an emergency medical technician, my role and responsibility are to resuscitate and stabilize patients along with ensuring patients are transported safely from the incident scene to the hospital.

1. Prepare and check an emergency checklist. Prepare a checklist table using MS word, insert table option: to write the name of each emergency equipment. Explain in few words routine inspection/check you made for this emergency equipment and why?

1. Explain briefly at least two emergencies you observed and participated in providing emergency care to your patient(s) in collaboration with your Registered Nurse. Describe your response to a first aid request from the emergency team.

The situations include difficult breathing and uncontrolled bleeding. The response of difficult breathing was checking the person airway; breathing and pulse along with loosening any tight cloth and helped the person use any prescribed drug. I bandaged the open wounds that were in the neck and chest while waiting for medical assistance. On the uncontrolled bleeding in I removed the clothing on the injury, placed a sterile bandage to stop the bleeding by applying constant pressure and helped the person lie down. When the bandage started seeping some blood, I added another dressing and immobilized the injured body part.

1. Discuss briefly how you accessed and participated (in collaboration and under the supervision of Registered Nurse) in preparing drugs used during advanced cardiopulmonary resuscitation. Write the name, action, and route of administration of these drugs (write at least 2).

The onset of action of magnesium sulfate is immediately and lastly for thirty minutes approximately, and its route is through intravenous infusion. The effect of epinephrine is fast but it has a short period, and its path is through intramuscular injection.

1. Explain nursing care assistance provided to a patient with the compromised airway. How you maintained clear airway of client and which devises you utilized to monitor their health status.

The assistance provided was oxygen therapy in which an oxygen mask with a reservoir bag and on oxygen flow rate of fifteen liters per every minute was used which would give a high inspired fraction of oxygen. Client’s airway was maintained through the use of a head-tilt chin-lift technique to open the airway thereby lifting the tongue from the back of the throat. The device used was oral airway devices which relieve soft tissue obstruction of the posterior airway by displacement of the tongue and soft tissue anteriorly.

1. Briefly describe nursing care management you provided to a patient requiring NG tube feed or requiring nutrition administered through an intravenous line (choose one).

Preparation of oral or enteral syringe, enteral tube connector along with water for a flush and the flushing of enteral tubes was provided to check for tube patency and avert their clogging. The flushing was before and after feeding, before, in-between and after medication and frequently in between tube use.

Oral Fluid Intake Observation Management and Documentation

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Emergency Management Protocol

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