Precautions While Performing Medical Procedures

Universal precautions should be used whenever an invasive procedure exposes the operator to potentially infectious body fluids. Not all patients infected with transmissible pathogens can be reliably identified. Because pathogens transmitted by blood and body fluids pose a hazard to personnel caring for such patients, particularly during invasive procedures, precautions are required for routine care of all patients whether or not they have been placed on isolation precautions of any type.

The CDC calls these universal precautions.

1. Wash hands before and after all patient contact.

2. Wash hands before and after all invasive procedures

.3. Wear gloves in every instance in which contact with blood or body fluid is certain or likely. For example, wear gloves for all venipunctures, for all IV starts, for IV manipulation, and for wound care.

4. Wear gloves once and discard. Do not wear the same pair to perform tasks on two different patients or to perform two different tasks at different sites on the same patient.

5. Wear gloves in every instance in which contact with any body fluid is likely, including urine, feces, wound secretions, and fluid encountered in respiratory tract care, thoracentesis, paracentesis.

6. Wear gown when splatter of blood or body fluids on clothing seems likely.

Croup or Viral Laryngotracheobronchitis in Children

Definition 
Croup or viral laryngotracheobronchitis is an acute inflammation of the entire airway, mainly in the glottis and subglottic area, resulting in airway narrowing, obstruction, and voice loss. 

Therefore, it has generally been described as a triad of 

1. hoarse voice, 
2. harsh barking cough, and 
3. inspiratory stridor.

Epidemiology

Typically, the condition affects younger children (6–36 months), with a peak incidence at 2 years of age. It is the most common cause of acute upper airway obstruction in young children; a reported 3% of children experience it before 6 years of age.
Seasonal outbreaks have been described in the fall and winter, although it may occur year round in some areas.
Males are more often affected than females.

Etiology and Pathophysiology
Viral infection is the predominant etiology; parainfluenza (types 1, 2, and 3) is the most common agent. Other common viral agents are respiratory syncytial virus (RSV) and influenza. Less commonly encountered viruses include adenovirus, rhinovirus, enterovirus, and measles virus.
Mycoplasma pneumoniae is one of the few bacterial microorganisms that has been reported as an etiologic agent.

In children, the larynx is very narrow and is comprised by the rigid ring of the cricoid cartilage; therefore, a viral infection causing inflammation of this area leads to airway edema and subsequent obstruction. This obstruction results in the classic symptoms of stridor and cough.

Clinical Presentation

• Croup usually presents initially with a coryzal prodrome (1–4 days).
• Common symptoms include clear rhinorrhea, low-grade temperature, and mild tachypnea followed by barking cough, hoarseness, and stridor.
• Obstructive symptoms occur most commonly at night.
• Severity of airway narrowing may be determined by the presence of stridor at rest, tachypnea, retractions, tracheal tug, cyanosis, and pallor, as well as decreased breath sounds, which indicate critical narrowing.

Factitious Disorder - A Brief Discussion

Definition.
A disorder characterized by the conscious production of signs and symptoms of both medical and mental disorders. The main objective is to assume the sick role and eventually hospitalization. Usually diagnosed with physical or psychological symptoms or both.

Called Factitious Disorder By Proxy if the signs and symptoms are faked for another person, as in
mother and child.

Etiology.
Seen more commonly in men and in hospital and health care workers. As children, many of the patients suffered abuse that resulted in frequent hospitalizations, thus their need to assume the sick role.

Physical and Psychiatric Presenting Symptoms.
• May have a gridiron abdomen from the multiple surgeries
• Typically demand treatment when in the hospital
• If tests return negative, they tend to accuse doctors and threaten litigation.
• Become angry when confronted.

Treatment.
Usually involves management rather than cure. Must be aware of counter-transference when the physician suspects factitious disorder.

Chorionic Villus Sampling

It is one of the obstetric procedures and is summarized as follows:

Procedure:
-This is a diagnostic outpatient office procedure performed under ultrasound guidance without anesthesia.
-The catheter is placed directly into the placental tissue without entering the amniotic cavity.
-Chorionic villi, which are placental precursors, are aspirated from a pregnant uterus between 10 and 12 weeks’ gestation.
-The tissue is sent to the laboratory for karyotyping.
-The chromosomes of the villi are almost always identical to those of the embryo.

Nature of Tissue Obtained:
The procedure can be performed either transcervically or transabdominally. Since the fetus and chorionic villi are both derived from a common origin (the zygote), their karyotype is identical more than 99% of the time.

A Brief Introduction to Infertility

Definition of Infertility:

A. Primary infertility
1. Female partner has never been pregnant
2. Couple unable to conceive after unprotected intercourse for at least 1 year

B. Secondary infertility
1. Female partner has had at least one prior conception
2. Couple unable to conceive after unprotected intercourse for at least 1 year

Scope of Problem:
Approximately 15% of couples are unable to achieve a pregnancy within 1 year of attempting conception.Fertility declines are evident at least a decade prior to the menopausal transition.

Evaluation of the Infertile Couple:
A. History and physical
1. Menstrual cycle frequency and length
2. Gravidity, parity, pregnancy outcomes
3. Coital frequency and sexual dysfunction
4. Duration of infertility
5. Surgical history, particularly pelvic/abdominal
6. Medications, allergies
7. Tobacco, alcohol, drug history
8. History of sexually transmitted diseases
9. Family history of birth defects, reproductive difficulties, spontaneous abortions, early menopause, mental retardation
10. Symptoms of thyroid disease, pelvic pain, galactorrhea, hirsutism, dyspareunia
11. Physical examination includes weight, body mass index (BMI), thyroid and breast examinations, signs of hyperandrogenism/hirsutism, pelvic tenderness, and vaginal/uterine/cervical abnormalities.