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Photographs of wounds or clothing are essential and should include a reference ruler in one photo and one without the ruler allergy medicine comparison buy zyrtec 5mg cheap. The only way to allergy medicine memory loss buy zyrtec 5mg line reduce the incidence of trauma is to allergy testing chicago best purchase for zyrtec prevent the injuries in the first place. The key to decreasing the incidence of trauma and saving the lives of productive members of society and children is injury prevention. Providing information and materials to help prevent violence and to maintain safety at home and in vehicles is important. Involvement in local injury prevention organizations, nursing organizations, and health fairs promotes wellness and safety. In practice, nursing and other health care professionals should avoid using the word "accident," because trauma events are preventable and should be viewed as such rather than as "fate" or "happenstance. Those who are at risk for trauma and repeated trauma should be identified and provided with education and counseling directed toward altering risky behaviors and preventing further trauma. Nurses should be actively involved in safety legislation at the local, state, and federal levels. Such legislation is meant to provide universal safety measures, not to infringe on rights. Assessment and Diagnostic Findings In conjunction with the history, the abdomen is inspected for obvious signs of injury, including penetrating injuries, bruises, and abrasions. Abdominal assessment continues with auscultation of bowel sounds to provide baseline data from which changes can be noted. Absence of bowel sounds may be an early sign of intraperitoneal involvement, although stress can also decrease or eliminate bowel sounds. Further abdominal assessment may reveal progressive abdominal distention, involuntary guarding, tenderness, pain, muscular rigidity, or rebound tenderness along with changes in bowel sounds, all of which are signs of peritoneal irritation. Additionally, the chest and other body systems are assessed for injuries that frequently accompany intra-abdominal injuries. Penetrating abdominal injuries (ie, gunshot wounds, stab wounds) are serious and usually require surgery. Penetrating abdominal trauma results in a high incidence of injury to hollow organs, particularly the small bowel. In gunshot wounds, the most important factor is the velocity at which the missile enters the body. All abdominal gunshot wounds that cross the peritoneum or are associated with peritoneal signs require surgical exploration. Blunt trauma to the abdomen may result from motor vehicle crashes, falls, blows, or explosions. Blunt trauma is commonly associated with extra-abdominal injuries to the chest, head, or extremities. Patients with blunt trauma are a challenge because of injuries that may be hidden and difficult to detect. The incidence of delayed and trauma-related complications is greater than for penetrating injuries. This is especially true of blunt injuries involving the liver, kidneys, spleen, or blood vessels, which can lead to massive blood loss into the peritoneal cavity. Therefore, the patient is assessed continuously for signs and symptoms of external and internal bleeding. The front of the body, flanks, and back are inspected for bluish discoloration, asymmetry, abrasion, and contusion. Abdominal ultrasound studies can rapidly assess hemodynamically unstable patients to detect intraperitoneal bleeding and pericardial tamponade. Pain in the left shoulder is common in a patient with bleeding from a ruptured spleen, whereas pain in the right shoulder can result from laceration of the liver. Even though the patient complains of pain, administration of opioids is avoided during the observation period because their effect may obscure the clinical picture. Referred pain is a significant finding because it suggests intraperitoneal injury.
Nursing Management Perimenopausal women often benefit from information about the subtle physiologic changes they are experiencing allergy testing age zyrtec 5mg without prescription. Perimenopause has been described as an opportune time for teaching women about health promotion and disease prevention strategies allergy symptoms at night only buy zyrtec 5 mg line. When discussing health-related concerns with midlife women allergy testing via blood generic zyrtec 10mg without prescription, nurses should consider the following issues: Cultural Considerations the United States is becoming more culturally diverse. Culture can be defined as the thoughts, communications, actions, customs, beliefs, and values of a racial, ethnic, religious, or social group. These aspects of culture affect many health care encounters, and these encounters can be positive if nurses understand the various cultures of their patients. Lesbians may smoke and drink more alcohol, may have a higher body mass index, may bear fewer or no children, and often have fewer health preventive screenings than heterosexual women (Carroll, 1999). These factors may predispose them to colon, lung, endometrial, ovarian, and breast cancer, as well as cardiovascular disease and diabetes. Nurses need to understand the unique needs of this population and provide appropriate and sensitive care. Lesbians can generally be defined as women who have sex with or primary emotional partnerships with women, but there is no universally accepted definition; variability exists in relationships and sexual preferences. When they are asked if they are sexually active and respond affirmatively, contraception is immediately urged as health care providers may assume incorrectly that they practice heterosexual intercourse. Similar to many other marginalized groups of women, they often underuse health care. Some health care providers are homophobic, and discrimination against lesbians has been found in health care (Blackwell & Blackwell, 1999). Nurses need to consider lesbian- Chapter 46 Assessment and Management of Female Physiologic Processes 1387 Unintended pregnancy (this is possible if contraception is not used) Oral contraceptive use. Oral contraceptives provide perimenopausal women with protection against uterine cancer, ovarian cancer, anemia, pregnancy, and fibrocystic breast changes as well as relief from perimenopausal symptoms. About 16% of cases of breast cancer occur in this group of women, so breast self-examination, routine physical examinations, and mammograms are essential. Vaginal secretions decrease, and the woman may report dyspareunia (discomfort during intercourse). The vaginal pH rises during menopause, predisposing the woman to bacterial infections (atrophic vaginitis). Some women report fatigue, dizziness, forgetfulness, weight gain, irritability, trouble sleeping, feeling "blue," and feelings of panic. Menopausal complaints need to be evaluated carefully as they may indicate other disorders. For women with grown families, menopause may result in role confusion or feelings of sexual and personal freedom. Nurses need to be aware of and sensitive to all possibilities and take their cues from the patient. Decreased vaginal lubrication may cause dyspareunia in the menopausal woman; this may be prevented by the use of a water-soluble lubricant (eg, K-Y jelly, Replens, Astro-Glide, or contraceptive foam or jelly). A vaginal cream containing estrogen or an estrogen-containing vaginal ring may be prescribed. Some have concerns based on a family history of heart disease, osteoporosis, or breast cancer. Each woman should discuss her concerns and feelings with her primary health care provider so that she can make an informed decision about managing menopausal symptoms and maintaining her health. Menopause is associated with some atrophy of breast tissue and genital organs, loss in bone density, and vascular changes. Often, the interval between periods is longer; a lapse of several months between periods is not uncommon. Clinical Manifestations Because of these hormonal changes, some women notice irregular menses, breast tenderness, and mood changes long before menopause occurs. The hot or warm flashes and night sweats reported by some women are directly attributable to hormonal changes. Hot flashes, which denote vasomotor instability, may vary in intensity from a barely perceptible warm feeling to a sensation of extreme warmth accompanied by profuse sweating, causing discomfort, sleep disturbances and subsequent fatigue, and embarrassment. Other physical changes may include atrophic changes and osteoporosis (decreased bone density), resulting in decreased stature and bone fractures. The changes that occur during menopause have adverse effects on women, placing them at increased risk for atherosclerosis, angina, and coronary artery disease.
