“Shirodkar Cerclage Procedure” plus 1 more nursing article(s): NursingCrib.com Updates
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| Shirodkar Cerclage Procedure Posted: 22 Feb 2011 06:47 PM PST 
 SHIRODKAR (Cerclage for Incompetent OS)
Definition - The placement of an encircling "tape" ligature at the level of the internal cervical os to maintain the integrity of the cervical canal.
Discussion - The procedure is usually performed to prevent premature dilation and subsequent spontaneous expulsion of the fetus prior to safe delivery.
- It is usually recommended for patients who have a history of spontaneous abortion in the first trimester of pregnancy.
- Incompetency may be related to previous lacerations or a congenital weakness.
- The procedure has the best result when perfomed before the cervix actually dilates.
Positioning - Lithotomy; arms may be extended on armboards.
Packs/ Drapes Instrumentation - D&C tray
- Cervical biopsy tray
- Short honey retractors
- Ligature carrier
Supplies/Equipment - Stirrups
- Suction
- Tape ligature
- Perineal pad
- Solutions
Procedure - The cervix is excised using a transverse incision in the vaginal mucosa, at the anterior aspect of the cervix.
- The bladder is retracted away.
- A similar incision is made posteriorly.
- The synthetic tape ligature is placed around the internal os.
- The tape is tightened and secured.
- The posterior portion of the tape loop may be sutured to the vaginal mucosa, and the cervix is closed.
Perioperative Nursing Considerations - Stirrups should be padded, and a coccygeal support placed on the table to protect the lower sacral area.
- Raise and lower the legs together slowly to prevent alteration in venous return.
- Instruments are set up on the back table in order of usage.
Related posts: - Dilation And Curettage (D&C)
- Hemorrhoidectomy
- Pancreaticoduodenectomy (Whipple Procedure)
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| Huntington’s Chorea Posted: 22 Feb 2011 06:37 PM PST 
- Chorea, the Greek word meaning "dance".
- It is described as involuntary movements of the body.
- Is a progressive neurodegenerative genetic disorder that affects muscle coordination.
Etiology and Pathophysiology - Memory loss
- Disorientation
- Eventual dementia
- Uncontrolled jerky movements of the extremities, trunk, face, or tongue.
- Disorganized gait
- Uncontrolled periods of anger
- Hesitant or explosive pattern of speech
- Grimacing facial movements
- Impaired chewing and swallowing
- Incontinence
Assessment - Neurologic status, noting uncontrolled movements and cognitive ability.
- Family history of Huntington's chorea.
Nursing Diagnoses - Risk for aspiration
- Body image disturbance
- Bowel incontinence
- Risk for injury
- Altered nutrition less than body requirements
- Self-care deficit
- Risk for impaired skin integrity
- Impaired swallowing
- Altered thought process
- Impaired verbal communication
Therapeutic Interventions - Control of jerky movements with phenothiazines, butyrophenones, and thioxanthenes.
- Reserpine may be used to decrease presynaptic dopamine and tetrabenzine to reduce dopaminergic transmission.
- Symptoms are treated as they occur.
Nursing Interventions - Provide emotional support for client and family.
- Allow client and family to express feelings about progressive deterioration and ultimate death.
- Encourage family members to seek genetic counseling.
- Modify environment to increase safety.
- Assess ability to swallow.
- Provide nutritional support as needed.
- Encourage client to remain as active as possible.
- Provide respiratory support based on changing needs of client such as airway, suctioning, oxygenation).
- Utilize community agencies to provide emotional support.
Complications - Weight loss
- Pneumonia
- Congestive heart failure
- Incapacitated
- Bed sore
Related posts: - Amputation
- Osteogenesis Imperfecta
- Head-To-Toe Assessment K. Cranial Nerve III, IV & VI (Oculomotor, Trochlear, Abducens)
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