Home Management After Oral Trauma

  • Practice good oral hygiene and keep the traumatized area as clean as possible. Gargle with warm saline or alcohol-free mouthwash after every meal. Avoid brushing or touching the sutures in your mouth.
  • Oral sutures in general do not need to be removed, but if after 10 days, knots are still present or foreign body sensation persists, please make an appointment with an oral surgeon for further management.
  • Eat foods that are easy to swallow. Fluids or soft diet are suggested (e.g. juice, milk or porridge) Avoid hot food and food that may irritate your mouth, easily crumbled, hard to chew, or coarse textured, such as hot soup, popcorn, spicy, or salty food.
  • Please call or return to the hospital as soon as possible if there are following symptoms:
    1. Signs of infection such as redness, uncontrolled swelling, discharge or pus, or increasing pain. Signs of more serious infection may include neck pain or stiffness, inability to open the mouth completely, drooling, or chest pain.
    2. Fever (temperature ≥100.4ºF/38ºC) or chills.
    3. Uncontrollable bleeding.
  • Please return to our outpatient department for follow-up as scheduled.

Ice packing

  • Apply ice packs over the injured or inflamed area according to instructions.
  • Always place a towel between the skin and ice pack to prevent ice pack burn.
  • Press the ice pack firmly over the affected area for 20 minutes. Remove and rest for at least 20 minutes and repeat as needed or instructed.

Home Management After Sprain or Muscle Sprain

  • Rest. Minimize activity to prevent secondary injury.
  • The pain is usually worst 2-3 days after the injury. Ice packing to the injured area for 20 minutes is suggested for next 24 to 48 hours to reduce pain and swelling.
  • Keep the injured limb elevated. Wear comfortable well-fitting shoes. Do not wear high-heeled shoes. Avoid massaging or manipulating the injured site.
  • Seek medical help if suffering intolerable pain or progressive swelling despite treatment.

Home Management After Back Injury

  • Bed rest as much as possible.
  • Avoid bending over and carrying heavy things.
  • Support injured area with both hands during activity to reduce pain.
  • The pain is usually worst 2-3 days after the injury. Ice packing to the injured area on and off for 20 minutes may help reduce pain and swelling.
  • Take medication as instructed and follow-up as scheduled.
  • Please call or return to the hospital as soon as possible if there are following symptoms:
    1. Blood in the urine
    2. Back pain with cold sweating
    3. Lower limbs weakness or numbness
    4. Urinary or bowel incontinence

Home Management After Chest Injury

  • Potential lung contusions may occur even if hemothorax, pnemothorax or ribs fractures have been excluded. Monitor breathing pattern closely.
  • Notify our medical staff immediately if the patients presents with neck bruises, shortness of breath, difficulty breathing, cold sweating, looking pale, cyanosis, severe chest pain or back pain.
  • Rest. Avoid exertion.
  • Take medicine as instructed after discharge and follow-up as scheduled.
  • Please call or return to the hospital if there is coughing of blood, shortness of breath, difficulty breathing or other severe discomforts. In the meantime, remain in a siting position and avoid eating or standing.

Wound Care

  • The injured area will continue to swell for the next 72 hr. Consider ice packing the wound and elevating the injured limb to help decrease swelling.
  • Keep the wound clean and dry.  Minimize water contacting the wound for the first few days.
  • Changing wound dressing:
    1. Apply normal saline from the center of the wound outwards in a circular motion to remove any buildups and discharge.
    2. Apply betadine to sterilize the wound in the same way, starting from the center working outwards in a circular motion.  Let rest until the betadine has dried.
    3. Apply normal saline again in similar fashion to remove the betadine.
    4. Cover the wound with a new clean bandage if instructed.  Otherwise, leave the wound dry.
  • There may be residual foreign body that cannot be completely removed (e.g. wood splinter, tiny glass pieces, specks of sand). See a doctor if there is persistent foreign body sensation after stitch removal or signs of infection such as increasing redness, rapid swelling, intolerable pain, pus and discharge, or fever.

Home Management After Abdominal Injury

  • Pain may be exacerbated when performing abdominal activities or coughing. Apply gentle pressure  with a pillow or your hands over the injured area to support and reduce irritation and discomfort.
  • When the doctor has agreed to oral diet, take small meals of light diet.
  • The pain is usually worst 2-3 days after the injury. Ice packing the injured area on and off for 20 minutes may help reduce pain and swelling.
  • Please call or return to the hospital as soon as possible if there are following symptoms:
    1. Rapidly expanding bruising over the abdomen or back
    2. Intolerable abdominal pain
    3. Abdominal stiffness
    4. Fresh blood in the stool or urine

Home Management after Burn Injury

  • Keep the area around the burn wound clean and dry.
  • Do not break the blisters.
  • Elevate the injured limb to help decrease pain and swelling.
  • Take painkillers as prescribed.
  • Change dressing and apply topical agents as prescribed or instructed.
  • Follow-up as scheduled for wound reevaluation and change of dressing.
  • Visit a doctor if the wound rapidly swells and expand or increases in pain.

Home Management after Head Injury

  • Rest and keep head elevated at approximately 30 degree angle. Avoid strenuous exercises or activities requiring heavy concentration including watching the television or reading.
  • There might be symptoms of lethargy, dizziness, mild headache, nausea or mild vomiting after any level of head injury.  Continue to rest and observe the extent and changes of the above symptoms.
  • Withhold food temporally if there is any nausea or vomiting.  If must eat, take small amounts of only soft food only such as porridge.
  • Please call or return to the hospital as soon as possible if there are following symptoms:
    1. Intolerable and persistent headache
    2. Clear fluid or blood from the nostrils or ear canals
    3. Paralysis or change of weakness
    4. High fever
    5. Urine or stool incontinence
    6. Acute delirium or change of mental state such as not recognizing family, abnormal behaviors such as violence or hysteria, seizure, or loss of consciousness
  • Have a friend or family member accompany the patient for the first 24 hours to check on the consciousness of the patient by every one to two hour.
  • Avoid sedatives or sleeping pills. Only take the prescribed analgesics for headache relief.
  • Chronic subdural hematoma can occur in the elderly after an apparently insignificant head trauma. Symptoms are often insiduous and may take weeks or months to develop. Return to the hospital if there is persistent headache, single-sided weakness, or retarded response.
  • Parents should watch for the following symptoms in children who have experienced head injury:lowered activity, drowsiness, unconsolable crying, persistent vomiting, anorexia, seizure. Return or call the hospital if the above symptoms are noted.

Taking Care of Stitches

  • The injured area will continue to swell for the next 8-12 hours. Consider ice packing the wound and elevating the injured limb to help decrease swelling.
  • Keep the wound clean and dry. Avoid water making contact with the wound. Bandages should be changed immediately if wet. Cover the sutured area with waterproof coverings such as a plastic bag during showers.
  • If the wound is near a joint, try to minimize joint motion to prevent further bleeding and pain from wound irritation.
  • If the wound is on the face and neck, use the prescribed topical agents instead of iodine or pigmented ointments to prevent skin discoloration.
  • Return to the clinic as scheduled, usually 2 days after injury, for wound healing evaluation.
  • Depending on the nature and healing conditions of the wound, most sutures may be removed after 7 days.
  • There may be residual foreign body that cannot be completely removed (e.g. wood splinter, tiny glass pieces, specks of sand). See a doctor if there is persistent foreign body sensation after stitch removal or signs of infection such as increasing redness, rapid swelling, intolerable pain, pus and discharge, or fever.

Upper Respiratory Tract Infection

  • Most upper respiratory tract infections develop intermittent fever for three to five days.  Take medicine as instructed along with lots of warm water. Ice pillows may be used if temperature up to 38℃ without chills; a warm bath may be considered if over 38.5℃.
  • If you have coughs, drink lots of water and avoid of iced or sweet beverages and oranges. Try breathing deep and using the diaphragm to expectorate sputum. Wear masks that cover the nose and mouth area to avoid cold air exacerbating symptoms.
  • Lots of rest.  Eat more fruits and vegetables.
  • Fever may recur several times a day or does not seem to reduce after a long time. It is often the natural course of the disease and so it is important to stay calm. Contact us or other medical institutions when in doubt or have any questions regarding your condition. Otherwise, follow up as scheduled.
  • Return to the emergency department if there are following symptoms:
    1. Persistent high fever despite antipyretics
    2. Headache with neck stiffness
    3. Difficulty breathing
    4. Excessive amount of yellow sputum
    5. Unable to swallow saliva

Instilling Ear Drops

  • Wash hands thoroughly before every use.
  • Sit or lie down with the head tilted to one side, exposing the relevant ear.
  • Warm the ear drops by gently rolling the bottle between your hands or holding the bottle under your armpit for a few minutes.
  • Gently shake the bottle. Do not touch the tip of the bottle to your ear.
  • Gently pull the ear up and back.
  • Gently squeeze the bottle to drop the 2-3 drops into the ear canal. Apply 3 to 4 times per day (e.g. meal time and before bed)
  • Gently pull or press on your ear flap to squeeze out possible air bubbles.
  • Leave the medication in the ear for approximately 15 minutes to coat your ear before allow it to flow out naturally. Do not try to remove the medication with Q-tips or other materials.
  • Replace with a new sterile cotton ball in the opening of the ear canal after instilling the ear drops to block off dust and adsorb excess ear drops. Take care not to push the cotton ball too deep.
  • Store ear drops in a cool dry place and away from sun light. Do not refrigerate.

Nosebleed Care

  • Avoid prolonged stay in air-conditioned rooms or nose picking to prevent nasal mucosal drying or abrasion which may cause further nosebleeds or infections.
  • To stop the bleeding, allow the patient to sit with head tilted forward and apply gentle pressure over the nose for 5 to 10 minutes.
  • If bleeding still does not stopped, apply pressure on the nose bridge or ice-packing for about 5 to 10 minutes. In patients with facial trauma and associated nosebleeds, do not plug the nostrils due to possible suffocation from blood build up in the respiratory tract.
  • Hypertensive patients found with blood pressure higher than usual may take antihypertensive medicine as instructed by the emergency medicine physician. Rest in a half-lying position and avoid excessive activities or strains to stop the bleeding.
  • Please follow the doctor suggested medication, and related considerations; after medical treatment of nasal packing gauze into sliver, do not arbitrarily remove, and return to the hospital for follow-up examinations.
  • Take medicine as instructed and pay attention to possible side effects or related precautions. Do not remove the nasal packing tampons by yourself. Return to the scheduled otorhinolaryngologist for follow-up.
  • There is a risk of non-stop bleeding in the following conditions and should visit the emergency department or see a otorhinolaryngologist as soon as possible:
    1. On antithrombotic drugs (common in patients who have had heart surgery or have suffered of stroke)
    2. Taking aspirin regularly
    3. Have some form of blood clotting disorders (hemophilia, liver cirrhosis or liver cancer, hematopoietic dysfunction)
    4. Head and neck cancer patients (such as nasopharyngeal carcinoma)

Sorethroat

  • Avoid talking loudly. Rest to relieve sore throat and hoarseness.
  • Drink warm water.
  • Take a soft, light diet. Avoid hot, spicy, or coarse textured food.
  • If there is a loss of appetite, try pudding, jelly, or ice cream, food that are cool and easy to swallow, for some calorie boost. However, cold or sweet food should be avoided in the case of cough induced sore throat.
  • Practice good oral hygiene after eating.
  • Take medicine as prescribed, and follow up as scheduled.
  • If there is persistent high fever despite fever medication or inability to swallow saliva with drooling, return to the hospital as soon as possible.

Oral Ulcer Management

  • Oral ulcers may occur at all ages, and there are multitudes of causes: oral trauma, recurrent stomatitis, vesicular stomatitis, chickenpox, hand foot and mouth disease (enterovirus), bacteria, fungi, gastrointestinal diseases, autoimmune disease, etc… Oral ulcers may easily relapse but will usually heal within 5-10 days without leaving a scar.
  • Oral ulcer care:
    1. Make observation of the changes of the oral ulcers at least once everyday.
    2. Practice good oral hygiene. Use a soft toothbrush or a gauze wrapped on a popsicle stick and clean the mouth and teeth with normal saline or boiled water. This will help promote wound healing and prevent bad breath from bacterial growth.
    3. Drink or gurgle directly from a cup instead of a straw to avoid contact pain from the straw or wound irritation from sucking motion.
    4. A cool soft diet will temporarily paralyze the pain sensors in the mouth to help facilitate swallowing. Try ice cream, yogurt, jelly, cold drinks, or flan. Avoid strong flavored or stimulating foods that are sour, spicy, bitter, or too sweet.
    5. Try lip balms or vaseline to moisten the lips.
    6. Eat frequent small meals. Do not force feed.
    7. Always practice good hygiene. Gently wipe off drool with wet towelette. Always wash your hands before and after touching your child.
  • Oral drug application:
    1. If prescribed, use the oral anti-inflammatory spray 30 minutes before eating.
    2. When applying oral cream, gently dab a small amount of the cream with a small spatula or Q-tip on the affected areas. Do not rub as it may cause painful irritation.

At Home Fever Management

  •  Rest and drink lots of water.
  • Do not wear too heavy clothing or bundle in thick blankets. Change clothes, blankets, or sheets if they get wet.
  • Maintain normal room temperature.
  • Take drugs as instructed by the physician.
  • Take temperature every four hours.
  • If axillary temperature is over 38℃, take a warm bath (water temperature 30~34℃) will help reduce body temperature. Dry with towel. Do not rub with towel as it may increase body temperature.
  • Ice pillows may be used if there is no chills.
  • Please see a doctor if there is persistent high fever despite appropriate fever medication use, thick yellow sputum, or difficulty breathing.
  • Return to emergency room as soon as possible if there is persisted high fever with skin rash, conjunctivitis or white spots in the mouth after discharge.

Regarding Acute Stroke Care

  • Be aware of the consciousness of the patient and inform the medical staff if there is any abnormal changes.
  • Observe for any worsening of limb weakness.
  • There may be irregularities in bowel and bladder function. Regularly ask the patient if he/she needs to go and help the patient to the toilet to prevent falls and slips. Check the diaper every 2-3 hour if using.
  • For patient who cannot voluntarily move, reposition the patient every 2 hours to prevent pressure sores.
  • Patient should sit in a semi-reclined position when eating. A soft diet is suggested. Take food from the unaffected side of the mouth. Stop eating or feeding the patient if there is any choking or coughing during the swallowing process.
  • Patient should wear comfortable, changeable and easy to wash clothes. When dressing, start from the affected side. When undressing, start from the unaffected side.

Vomiting Care

  • Do not feed the patient if there is vomiting or he/she is feeling nauseous. Allow the patient to sit quietly or rest lying on the side and inform the medical staff.
  • When vomiting, please turn the body and the head to one side to prevent the patient from choking on his/her own vomitus.
  • Wash the patient’s mouth if he/she is awake and cooperative. Practice good hygiene and change clothes, sheets, and blankets if there is vomitus on them.
  • Inform the medical staff if there is persistent vomiting in equal or increasing amount, or if the vomitus contains coffee-ground like material or blood.
  • Stop eating for a while. Start with liquid diet such as, water, juice, diluted sports drink, or congee once the doctor clears the patient for oral intake.
  • Take the medicine as instructed by the physician and follow-up as scheduled.
  • Return to the emergency department if there are following symptoms:1. Persistent vomiting despite medication
    2. Coffee-like or red vomitus
    3. Severe abdominal pain
    4. Loss or change of consciousness
    5. Other serious complications

Headache Home Care

  • Bed rest and adequate sleep. Consider resting with the head in a elevated position with one or two more pillows. Take medicine as instructed by doctor.
  • Try to relax and decrease stress.
  • There are many causes of headache and some causes are still unknown. Return to the outpatient clinic for further follow-up.
  • Return to the emergency department if there are following symptoms:
    1. Blurred vision or double vision
    2. One-sided limb weakness/numbness/pain
    3. Neck stiffness
    4. Fever up to or over 39’C
    5. Persistent vomiting
    6. Loss or change of consciousness

Dizziness and Vertigo Care

  • Do not change posture suddenly during active dizziness or vertigo. Sit quietly for 10 to 15 minutes before getting up or until there is no more discomfort. Use bedpan on the bed if necessary.
  • If dizziness or vertigo is aggravated when standing up, squat down or lie down immediately to prevent falling.
  • Stop eating if there is any nausea or vomiting.
  • Rest and relax.
  • Take the medicine as instructed by the physician and follow-up as scheduled.
  • Return to the emergency room as soon as possible if the dizziness or vertigo is accompanied with unsteady gait or stance, limbs paralysis, swallowing difficulties, double vision, or even change of consciousness.

Using Eye Drops and Eye Ointments

  • Wash hands thoroughly before every use.
  • Clean and remove discharge from the eyelid and eyelashes with cotton swab, starting from the inner corner of the eye.
  •  Avoid touching the tip of the dropper to your eye or anything else.
  • Tilt head back.  Using the index finger of the non-dominant hand, gently pull down the lower eyelid to form a “pocket” in the eye.
  • While looking up, hold the eyedropper bottle above the eye with your dominant hand, supporting the heel of your hand on the non-dominant hand, and squeeze the bottle to drop the eye drop into your eyes. Repeat if unsure whether eye drops entered your eye.
  • If also using eye ointment, wait 5 minutes before after instilling eye drops. Squeeze the ointment into the lower eyelid from the inner corner of the eye to the outer. Take care not to touch your eyelash or eyelid with the eye dropper or ointment tube.
  • Close your eyes for 5-10 seconds after applying eye drops or eye ointment to allow the drug to coat the eye. Gently press the inner corner of the eye to close the tear duct.
  • Replace and tighten the cap on the dropper bottle. Do not wipe or wash to dropper tip.

Managing Shortness of Breath or Difficulty Breathing

  • Shortness of breath is often a sign of cardiovascular and respiratory disease and thus should not be ignored or left unattended. Both patients and family need to be aware of any changes in the breathing pattern.
  • Patients with chronic diseases should take their medication as instructed by their doctor. If there are any changes in the condition of the disease, the patient should visit the ER or schedule an appointment as soon as possible to visit his/her corresponding doctor for the further examination and/or prescription alteration if necessary.
  • When experiencing shortness of breath, difficulty breathing, or noticing the lips or nails turn blue or gray, the patient should sit up and take long deep breaths. Stop any oral intake of food or water. Do not get out of bed. If having been previously instructed, give the patient oxygen or emergent medication for symptom relief and immediate seek medical attention.
  • After adequate treatment for dyspnea, some patients may be discharged with new or changes in medication and scheduled for follow-up at the chest medicine outpatient department.
  • Please return to the hospital as soon as possible if there are following symptoms:
    1. Persistent high fever
    2. Chest pain
    3. Cold sweating
    4. Lips or nails turning blue or gray
    5. Inability to lie down
    6. Rapid progressive leg edema

Cough Home Care

  • Rest and drink plenty of water. Eat and swallow slowly.
  • Avoid eating iced, cold or sweet food and beverages. Hold off oranges and grapefruit temporarily.
  • Wear masks that cover the nose and mouth area to prevent spreading the disease and also to help minimize symptom exacerbation from cold air, dust, or cigarette smoke.
  • Try breathing deep and using the diaphragm to expectorate sputum.
  • Do not drink or eat for half an hour after taking cough syrup.
  • Take medication as instructed and follow-up as scheduled
  • Please call or return to the hospital as soon as possible if there are following symptoms:
    1. Persistent high fever
    2. Wheezing
    3. Large amounts of purulent yellowish sputums
    4. Severe dry cough
    5. Lips or nails turning blue or gray
    6. Coughing blood

Asthma Care

  • Always carry your asthma medications with you at all times in case of exacerbations.  Take the medications according to doctor’s instructions
  • Avoid contact with allergens such as cigarette, pollen, cold air, dust, and pets.
  • Wearing masks and scarves is suggested when there is much diurnal temperature variation. Avoid the crowded public places during flu season.
  • Adequate exercise with a  balanced and healthy diet will help minimize asthma attack frequency.
  • During acute asthma attacks, use bronchodilator or breathe oxygen masks as instructed by the physician. Sit up and take slow long breaths until symtpoms improve.  Do not eat or move excessively.
  • Please call or return to the hospital as soon as possible if there are following symptoms:
    1. Severe wheezing
    2. Breathing difficulties
    3. Lips or nails turning blue or gray
    4. Persistent symptoms despite bronchodilator use
    5. High fever
    6. Chills
    7. Cough with large amount purulent yellowish phlegm

Oxygen Therapy at Home

  • Keep your oxygen tank far away from open fire (like a gas stove) or any other heating source. Avoid smoking or using flammable substance around the tank.
  • DO NOT stop or change your flow of oxygen. Talk with your provider if you think you are not getting the right amount.
  • Dampen your damp nostrils and lips with wet swabs if you feel dry mouth, throat, and nose during oxygen use.
  • If oxygen device is causing discomfort in the face, ear or nose, please inform the medical personnel for adjustment.

Chest pain

  • Chest pain may be caused by simple chest wall neuromuscular diseases or may be a warning sign due to a cardiovascular diseases.
  • Please seek immediate help or call 119 if there is persistent chest pain accompanied by the following symptoms:
    1. Shortness of breath
    2. Cold sweating
    3. Loss of consciousness
  • Patients with chronic heart disease should adhere to their prescriptions and not alter the dosage without the doctor’s instructions.
  • Take medication as instructed and follow-up as scheduled.

Chest Tube Care

  • Please inform the medical personnel immediately if there is any shortness of breath, chest discomfort, cold sweating or dizziness.
  • Keep movements slow and deliberate. Avoid pulling or manipulating the chest tube and be careful not to knock over the collecting bottle.
  • If the drainage bottle should knock over or the chest tube slips out, exhale at once and hold your breath. Use the clamp provided at the bedside and clamp the chest tube at the exposed end (or fold and bend the tube if the clamp could not be found) and inform the medical personnel immediately.
  • Maintain a comfortable semi-reclined position. Reposition your body at least once every two hour to promote drainage and to prevent pressure sores.
  • Breathe deep and cough deep. Move and walk as instructed to improve ventilation.
  • Avoid raising the drainage bottle above the waist.

Herpes Zoster/Shingles Care

  • Herpes zoster, also known as shingles, is most common in older adults and people who have weak immune systems because of stress, injury, certain medicines, under radiotherapy or immunosuppresants, or other reasons.
  • Patients usually experience pain, itching or burning sensation over the affected area 4-5 days before skin lesion appears.
  • The skin lesions distribute along a localized strip, a dermatome, and usually involve only one side. The most commonly affected area is the chest, but lesions over the face, waist or limbs is also possible. Symptoms usually last for 7 days, and the vesicles may blister and turn into crust and then scar and peel in 2-3 weeks.
  • Take medication as instructed and follow-up as scheduled.
  • Practice good hygiene and do not burst the vesicles to prevent infection.
  • If there is persistent fever, shortness of breath, headache, loss or change consciousness, or blurry vision, return to the hospital at once.

Hyperventilation

  • Hyperventilation is usually induced by an accumulation of negative emotions (anger, fear, anxiety, etc..) The autonomic nervous system spins out of control and the patient involuntarily develops rapid and shallow breaths, resulting in the feeling of being unable to breath.
  • Associated symptoms may include dizziness, rapid heart beat, pale skin, cold extremities and unsteady gait. The hands or feet may cramp and patient may even faint in severe case.
  • Help the patient calm down and take deep and slow breaths through the nose.
  • Hyperventilation may be easily prevented by understanding the nature of the disorder and learning to control and relax in stressful situations. Visit a psychiatrist if recurrence is too frequent.
  • Shortness of breath may be caused by other cardiac, pulmonary or endocrine disorders. Schedule a doctor’s appointment when in doubt.

Chronic Obstructive Pulmonary Disease Management

  • To prevent irritation of the airway, avoid smoking or dusting (use a mop or vacuum instead) . Avoid crowded public areas or close contact with people with a respiratory tract infection.
  • Wearing masks and scarves is suggested when there is much diurnal temperature variation.  Avoid the crowded public places during flu season.
  • When there is coughing, avoid eating iced, cold or sweet food and beverages. Hold off oranges and grapefruit temporarily.
  • Eat a balanced nutrition with plenty of fruits and vegetables.  Exercise long deep breaths and maintain a healthy lifestyle with adequate exercise.
  • Take medication as instructed and follow-up as scheduled.
  • During exacerbation, sit up, minimize activities, and stop eating or drinking. Take long deep breaths and take emergent medication if previously instructed by a physician.
  • Please call or return to the hospital as soon as possible if there are following symptoms:
    1. Acute severe shortness of breath or rapid shallow breaths
    2. Much yellowish sputum
    3. Lips or nails turning blue or gray
    4. Wheezing
    5. Cold sweating

Low Back Pain Management

  • Sleep on your back or lay down to help relieve the burden on your lower back.
  • In the acute stage, lay down as much as possible. Minimize activities.
  • Place a supportive pillow underneath your knees when sleeping on your back. Place the pillow between your knees when sleeping on your side.
  • Start with ice pads after initial injury. After 2-3 days, heat pads or massage may help relieve back pain.
  • Avoid lifting or pulling heavy objects. Always lift objects from a squatting position, using your hips and your legs to do the heavy work. Avoid lifting, twisting and bending at the same time.
  • Take medicine as instructed by the physician and follow-up as scheduled.
  • Return to the emergency department if there are the following symptoms:
    1. Persistent fever
    2. Progressive weakness in the legs
    3. Incontinence
    4. Back pain combined with cold sweating or drop in blood pressure

Kidney Stone or Urinary Tract Stone (Urolithiasis) Care

  • Pain is caused by a sudden blockage in the urinary tract, resulting in a sudden sharp and severe flank or lower abdominal pain and may radiate to the groin. There may be a feeling of constant need to urinate or difficulty voiding.
  • Severe pain may also induce nausea, vomiting, paleness of skin, cold sweating.
  • If there is no contraindication, drink at least 3000 to 4000mL of water (approximately 8 glasses) to increase urine amount and to reduce urine concentration.
  • Go to the bathroom at least every two hours. Do not hold the urge to urinate.
  • Take medicine as instructed by the physician and follow-up as scheduled.
  • If there is persistent severe pain despite pain killers, high fever, changes in the location of the abdominal pain, return to the hospital as soon as possible.

Liver Cirrhosis Care

  • Visit a nutritionist to devise a diet plan.  Eat more complex carbohydrates (breads, cereals, grains, legumes, dried beans and peas, pasta, rice). Adequate but not excessive protein is also important. Patients with cirrhosis tend to better tolerate the protein from dairy and plant sources than from meat sources, and therefore may benefit from a more vegetarian type diet. Too much protein may cause hepatic encephalopathy, liver failure induced change of consciousness.
  • Avoid fibrous, coarse or hot foods in case of esophageal varices. Chew food properly before swallowing.
  • Patients with ascites or edema should restrict fluid intake and eat a low sodium diet.
  • Eat small, frequent meals following a regular daily schedule. Have adequate rest. Avoid intense physical activities, alcohol, and cigarettes.
  • Avoid raw or undercooked vegetables, meat, seafood or eggs for prevention from infection.
  • Avoid raw or undercooked vegetables, meat, seafood or eggs to prevent infection.
  • Avoid straining during defecation, and eat more fruits and vegetables to prevent constipation.
  • Watch out for spontaneous bleeding such as easy bruising, gum bleeding, and tarry stool.
  • Follow up as scheduled.
  • Return to the emergency department if there are the following symptoms:
    1. Hematemesis or bloody vomitus
    2. Bloody stools
    3. Jaundice or yellowing skin discoloration
    4. Drowsiness or conscious change
    5. Abdominal pain with fever

Urinary Tract Infection Management

  • Drink plenty of water, at least 2000ml every day if not contraindicated.
  • Do not hold the urge of urination. Urinate after sexual intercourse, and practice good perineal hygiene.  Ladies should always wipe from front to rear and change feminine pads frequently during menstrual period.
  • Eat vitamin C-rich foods, such as tangerine, orange, tomato and papaya.
  • Cranberry juice is helpful in preventing recurrent infection.
  • Take showers and avoid baths.  Do not wear tight synthetic fiber underwear, pantyhose or girdles.
  • Return to the hospital as soon as possible if there is fever with chills or flank pain.
  • Hematuria is a common symptom of cystitis, and could be treated at an outpatient department.
  • Take medicine as instructed by the physician and follow-up as scheduled.

Constipation Management

  • Keep a balanced diet, eat more fruits and vegetables, and avoid spicy foods, alcohols or coffee. Drink eight glasses of water every day if no restrictions.
  • Increase daily activity and exercise.
  • Practice regular bowel habits; 15-20 minutes after breakfast is usually the best time. Do not hold your urge of defecation.  Do not strain or rush.
  • Do not take laxatives or clyster on your own unless by instructed by physician. Follow-up regularly at the out-patient department.
  • In case of severe abdominal pain, vomiting or fever, visit a hospital as soon as possible.

Acute Pyelonephritis Care

  • If there is no contraindication, drink 2000-3000ml of water daily.
  • Practice good perineal hygiene and healthy voiding habits. Go to the bathroom every 1-2 hours. Do not hold the urge to urinate.
  • Plenty of rest during the initial phase of the illness.
  • Avoid stimulating foods, alcohol or smoking.
  • Take medicine as prescribed and follow up as scheduled. Even if all the symptoms have subsided, do not discontinue the medication without the doctors orders as incomplete treatment may cause the infection to recur or develop drug resistance.
  • Return to the hospital as soon as possible if there is any fever with chills or severe flank pain.

Acute Gastroenteritis (Stomach Flu) Management

  • Stop eating solid foods for a few hours during the early stage to allow your bowel to rest. Try sucking on ice chips or taking small sips of water.
  • Once diarrhea has stopped, you should also stop taking any anti-diarrhea medications.
  • To avoid dehydration, try drinking clear soda, clear broths or non-caffeinated sports drinks. Drink plenty of liquid every day, taking small, frequent sips.
  • Drinking boiled or disinfected water. Gradually begin to eat bland, easy-to-digest foods, such as soda crackers, toast, gelatin, bananas, rice and chicken.
  • Avoid drinking of milk and soy product or any greasy and irritant food. Stop eating if your nausea returns.
  • If there is vomiting again, stop eating for several hours again.
  • To prevent catching or spreading the virus, always wash hands thoroughly especially when eating and handling food, use separate personal items around your home, disinfect hard surfaces such as counters, doorknobs, faucets, separate raw food and from, practice good kitchen hygiene and separate raw from cooked food.
  • Mild diarrhea may persist for a few days.  Get plenty of rest and continue to observe for symptom changes. Please return to the hospital as soon as possible if there are following symptoms:
    1. Vomiting and diarrhea worsens causing dehydration
    2. Shock or loss of consioucness
    3. Abdominal pain shifting to the right lower abdomen
    4. High fever

Peptic Ulcer Care

  • Take time and relax when eating. Chew your food thoroughly and swallow it slowly. Take a small break to allow time for digestion after a meal before going back to work.
  • Eat a healthy diet and don’t skip or delay your meals. Don’t eat too much or too little at a time.
  • Avoid stimulants, such as tobacco, alcohol, coke or coffeine.
  • Maintain a healthy lifestyle. Don’t stay up too late. Stay in a good mood.
  • Follow-up regularly at the gastrointestinal outpatient clinic.
  • Return to the emergency department if there are following symptoms:
    1. Severe intolerable abdominal pain
    2. Pain shifting to right lower abdomen
    3. Fever
    4. Repeated passing of tarry stool

Pelvic Inflammatory Disease (PID) Care

  • PID is an infection of the pelvic organs thus all the prescription medicine should be taken as instructed to complete the treatment. Even if all the symptoms have subsided, do not discontinue the medication without the doctors orders as incomplete treatment may cause the infection to recur or develop drug resistance.
  • To prevent repeated infection, urinate after sexual intercourse, practice good perineal hygiene, and always wipe from front to rear. Wear underwear made of cotton or breathable material. Minimize baths or hot tubs and avoid vaginal douching.
  • Take plenty of rest during acute infection.
  • Take medicine as prescribed, and follow up as scheduled.
  • In case of fever or severe abdominal pain, return to the hospital as soon as possible.

Hemorrhoid Care

  • Develop good bowel habits. Use the bathroom when you need to. Don’t ignore the urge to move your bowels.
  • Keep the anal area and the surrounding skin clean. Take a warm sitz bath after stool passage by immersing the hips and buttocks in warm water for 10-15 minutes. Three to four times a day can provide welcome relief from painful hemorrhoids.  Lying down and resting calmly after stool passage may also provide
  • Eat plenty of high-fiber foods and vegetables and at least 2L of water a day.  Avoid eating bowel irritating foods that are spicy, oily or deep fried, drinking too much alcohol, or staying up too late.
  • Avoid activities that increase intraabdominal pressure such as lifting heavy weights. Take small walks after sitting or squatting for prolonged periods of time.
  • Nonprescription hemorrhoid creams, suppositories containing hydrocortisone or pads containing witch hazel or a topical numbing agent may provide relief. However, they should not be used longer than a week unless directed by a doctor. Self-enema should be avoided.
  • Come to the hospital if symptoms progress, including repeating or continual feeling of bowel movement, large amount of blood in the stool or non-stop bleeding, severe anal pain, or significantly prolapsed hemorrhoid.

Menstrual Cramp Management

Many women experience menstrual cramps just before and during their menstrual periods. Sometimes headache, nausea, palpitation, or diarrhea are associated.

Menstrual Cramp Management:

  • Try taking a hot bath, drink warm beverages, light abdominal massage, or placing a heat pad or a warm water bottle over the lower abdominal area to ease menstrual cramps.
  • Rest and relax.
  • Avoid alcohol, tobacco, spicy or cold food. Chocolate or bean soup may help relieve menstrual cramps.
  • Your doctor may suggest taking over-the-counter pain relievers, such as ibuprofen or naproxen sodium, at regular doses starting the day before you expect your period to begin. Prescription nonsteroidal anti-inflammatory drugs (NSAIDs), such as mefenamic acid, also are available. If you can’t take NSAIDs, acetaminophen may lessen your pain.
  • Your doctor may suggest taking over-the-counter drugs such as ibuprofen or naproxen just before you expect your period to begin or prescribe other medications to treat or prevent your pain.
  • See a gynecologist if menstrual cramps cause serious disruptions every cycle or if your symptoms have grown worse, or if you’re older than 25 and have only just started having severe menstrual cramps.

Bowel Obstruction Care

  • Patients will be asked to fast. A nasogastric tube will be inserted through your nose and into your stomach to relieve abdominal distension from air, liquid and food. Do not try to remove the nasogastric tube.
  • Try peppermint oil and massage it onto the abdomen clockwise or take light walks to help promote digestion.
  • Once condition has improved and the doctor has agreed to oral intake, try drinking water.  If no further discomfort after half an hour, start with many small meals throughout the day. Space out your meals and wait about the same amount of time between each one. Choose a light diet.  Avoid gas producing foods such as sweet potato, potato, corn, taro, or beans.
  • Take medicine as prescribed, and follow up as scheduled.
  • Please inform the medical staff or return to the hospital as soon as possible if the following conditions are noted :
    1. Pain that does not go away or is getting worse
    2. Vomiting or anorexia
    3. Fever or chills
    4. A rigid or stiff abdomen
    5. No gas passage for over a day

Abdominal Pain Management

  • Be aware of or even record the pattern, intensity, and character of your pain.
  • Take medication as instructed and follow-up as scheduled.
  • Eat many small meals throughout the day. Chew food properly. Choose simple and easy to digest foods; avoid strong stimulating foods that are spicy or greasy.
  • Avoid smoking, alcohol, coffee and random drugs including unapproved pain killers.
  • If you have severe vomiting or abdominal pain, please do not intake food or drink until the symptom improve and only light food can be allowed.
  • Please call or return to the hospital as soon as possible if there are following symptoms:
    1. Continuous nausea or vomiting or persistent diarrhea
    2. Abdominal pain shifting towards the right lower abdomen or the right shoulder
    3. Severe intolerable abdominal pain
    4. Rigid abdomen or lowering blood pressure
    5. Stool or greenish-bile or bloody vomitus
    6. Sudden flank pain radiating to the inguinal region
    7. Pain during urination
    8. Fever or chills
    9. Cold sweating and chest pain

Abdominal Bloat Management

  • Try peppermint oil and massage it onto the abdomen clockwise or take light walks to help promote digestion.
  • Eat many small meals throughout the day. Space out your meals and wait about the same amount of time between each one.
  • Choose a light diet.  Avoid gas producing foods such as sweet potato, potato, corn, taro, or beans. Eat more fruits and vegetables to prevent constipation.
  • Avoid breathing with mouth open.
  • Please call or return to the hospital as soon as possible if the following conditions are noted:
    1. Pain that does not go away or is getting worse
    2. Vomiting or nausea
    3. Fever or chills
    4. A swollen or tender belly

Diarrhea Management

  • Temporarily fast according to doctor’s instructions. When symptoms improve, start with liquid diet such as, water, juice, or diluted sports drink. Begin with soft diet once there is no more diarrhea.  Try rice, toast, congee, noodles, or bland steamed buns with minimal flavoring.
  • Avoid coffee, alcohol, spicy food, oily food, or dairy products which may cause further bowel irritation.
  • Wash hands thoroughly after going to the bathroom.
  • Please call or return to the hospital as soon as possible if there are following symptoms:
    1. Abdominal pain shifting to the right lower abdomen
    2. Fever
    3. Bloody stools
    4. Profuse diarrhea or dehydration

Gallstone Home Care

  • Patients with gallstones may have the following symptoms:
    1. Epigastric cramping pain after eating fried or fatty foods
    2. Pain usually localized over right upper abdomen but may sometimes radiate to the right shoulder and scapula
    3. Nausea, Vomiting, Heart-Burn
  • Patients with the following symptoms should seek medical help as soon as possible:
    1. Fever or chills
    2. Pain with cold sweating
    3. Jaundice or yellowish skin
    4. Tea-colored urine or clay-colored stool
    5. Frequent non-specific skin itch or pruritis
    6. Abdominal distention and poor appetite
    7. Steatorrhea or oily stool

Watch your diet. Minimize fatty or high cholesterol food. Avoid the following foods:

  • Vegetables:vegetables that cause gas such as sweet potato, potato, corn, taro
  • Oils and fats:Avoid butter, salad dressing, fried food or fried snacks.
  • Grains:Avoid instant noodles, cakes, fritters, fried noodles, fried snacks. Choose rice, noodles, or steamed buns instead, preferably whole grain.
  • Meat, dairy, legumes:Avoid fatty meat, pork knuckles, pig or chicken skin, fat drippings, oiled tofu, walnuts, chestnuts, cashews, fava beans, peanuts, whole milk, cream, ice cream, and cheese.

Sciatica Care

  • Avoid heavy lifting, intense movements in the involving the waist and back area, or rapid or suddenly bending over.
  • Maintain good posture. Sit and stand up straight. Avoid wearing high-heeled shoes.
  • Bed rest as much as possible if there is any pain.
  • Sleep on hard flat surfaces rather than spring or foam mattresses.
  • Eat plenty of fruits and vegetables to avoid constipation.
  • Wear a corset or brace to protect the back.
  • Try cold packs during the first few days. Apply hot packs after 2-3 days. Alternating between cold and hot packs may help with the pain. Stretching may also help relieve root compression related discomfort.
  • Take medicine and pain killers as instructed and follow-up regularly at the orthopedic or neurosurgical outpatient department.
  • Return to the emergency department if there are the following symptoms:
    1. Sudden, severe pain in your low back or leg and numbness or muscle weakness in your leg
    2. Trouble controlling the bladder and bowels
    3. Severe abdominal pain

Joint Dislocation Management and Home Care

  • Joint dislocations are improper positioning of the bones in the joint, resulting in painful immobilization of the joint. The nerves, muscles and nearby blood vessels may be compressed or damaged from the injury. Dislocations, if returned to their normal positions promptly, should return to their normal functions after adequate rest and rehabilitation. However, a small number of dislocations may lead to permanent irreversible peripheral nerve damage.
  • Simple dislocations may be reduced (maneuvred back into the original position) in the ER. If the dislocation cannot be successfully reduced in the ER, surgery may be required.
  • A light sedative and respiratory status monitoring will be provided during joint reduction at our ER.
  • Dislocations may cause blood vessel damage. It is essential to closely observe the blood flow of the injured extremities. When necessary, angiography or surgery may be needed to repair the injured blood vessels.
  • After reduction, the injured joint will be immobilized. Return to the orthopedic outpatient department for further instructions and when the sling or splint may be removed.
  • Patients with recent dislocations are vulnerable to re-dislocation and avascular necrosis of the joints (inadequate circulation to the bones). Please follow-up at the outpatient departments as scheduled.

Gout Management

  • During acute attacks, take an anti-inflammatory medication as soon as possible and ice and elevate the joint.
  • Drink lots of fluids (3-4 liter per day) if no contraindication. Avoid alcohol or sweet beverages.
  • Avoid foods rich in purines, such as organ meats, fatty fish, shellfish, asparagus, spinach, peas, cauliflower, mushrooms or fermented food. Eat more vegetables, whole grains, plant proteins such as nuts and legumes, and low-fat dairy. Refined carbohydrates and processed foods should be kept to a minimum.
  • Avoid strenuous activity and maintain a healthy weight. Relax; stress can aggravate gout.
  • Take medicine as prescribed and follow up in the out-patient department as scheduled.
  • Return to the hospital if there is persistent fever or poor response to medications.

Home Management after Percutaneous Transluminal Angioplasty (PTA)

  • PTA is a is a minimally invasive procedure to open up blocked arteries or dialysis fistula or tube. Most procedures can be done only under local anesthesia and the patient may return home after a few hours of observation.
  • Wound care:check for active wound bleeding or blood build up under skin. Try ice-packing if there is any swelling. Like any wound, keep it clean and dry. Return to the ER if there is any discharge, or local heat with severe stabbing pain.
  • Return to the emergency department if there are following symptoms in the finger or toes distal to the PTA wound site:
    1. Turning grey or blue
    2. Tingling or growing numb
    3. Growing very cold

Cellulitis

  • Take antibiotics as ordered and follow-up at the outpatient department as scheduled.
  • Change wound dressing as instructed. Keep wound dry and clean.
  • Elevating the infected limb can help reduce edema.
  • Fever is a common result of the infection. Drink lots of water. Ice pillow and ice packing over the wound if necessary.
  • Return to the emergency department as soon as possible if there are following symptoms:
    1. Skin around wound becoming swollen, hard, and stiff
    2. Stinging pain around the wound
    3. Rapidly swelling or wound expansion of the wound
    4. High fever with chills

Arthritis Care

  • Take medicines as prescribed, get adequate rest, follow-up as scheduled, and receive and continue physical therapy as suggested.
  • Sleep on a firm mattress. When sitting, keep the bottom pressed against the back of the chair as much as possible.
  • Wear appropriate supportive footwear. Avoid of soft open-toed slippers.
  • When performing daily activities, using larger joints in the body (e.g. shoulder, elbow) can reduce the stress on the smaller joints (e.g. finger, wrist) thus preventing joint deformities. For example, clean the floor using a mop instead of kneeling on the floor with a towel.
  • Maintain a balanced diet and healthy weight. Overweight patients should try and lose some weight to reduce the stress on the joints.
  • Visit your doctor if there’s any fever or poor response or adverse events to the drugs.

Low Blood Sugar (Hypoglycemia) 

Hypoglycemia usually means having a blood sugar level below 70mg/dl. However, in some diabetic patients, symptoms of hypoglycemia may happen when blood sugar rapidly decreases, even if it is above 70mg/dl.

  • Hypoglycemia may occur in the following events:
    1. Inappropriate dosing of insulin or oral medication
    2. Skipping a meal, eating a small meal, or eating later than usual
    3. Eating a meal with mostly simple sugars
    4. Drink alcohol without eating
    5. Too much energy consumption without snacking, such as strenuous or prolonged exercising
    6. Diarrhea
  • Symptoms of low blood sugar:
    1. Early on when hypoglycemia has just begun, there might be hunger, shivering, cold sweating, palpitation or rapid heart rate, weakness, dizziness, or lip numbness.
    2. In severe conditions, patients may develop disturbances in consciousness, seizure, or pass out.
  • If the patient is clear and may cooperate, eat or drink 15 grams of a fast-acting carbohydrate every 15 minutes until symptoms improve or if tested blood sugar is over 70mg/dL. Try:
    1. Juice or soft drink (about 120mL)
    2. Milk (about 240mL)
    3. Hard candy (about 3 sugar cubes)
    4. Honey (1 tbsp under the tongue)
    *If symptoms persist for over 30min, please go to the ER immediately.
  • Once symptoms improve, have an earlier meal if anticipating to eat within the hour, or have a piece of toast or 3 pieces of saltine crackers if at least anther hour until the expecting meal.
  • For the unconscious patient
    Carefully apply 1 tbsp of syrup or honey into the pocket between the patient’s lip and gums, then gently rub the cheeks. Repeat every 15 minutes. Bring patient to the hospital immediately.
  • Prevention:
    1. Learn to spot symptoms of hypoglycemia.
    2. Inject insulin or take oral diabetic medication in appropriate doses
    3. Eat at a regular scheduled meal time in appropriate proportions and amount.
    4. Check blood sugar before and after exercise. Have a snack if the sugar level is below 180 mg/dl.
    5. Carry candy or biscuit everywhere in case of hypoglycemic episode.
  • When feeling sick or having poor appetite, call your doctor or nutritionist for medication adjustment.

High Blood Sugar (Hyperglycemia) 

  • Hyperglycemia develops when your body does not produce enough insulin or does not respond well to insulin. Without enough insulin, your body begins to use fat as fuel instead of sugar. Sugar level increases while metabolic products of fatty acids called ketones buildup.
    When left untreated, hyperglycemia may lead to a serious condition called diabetic ketoacidosis.
    Hyperglycemic hyperosmolar syndrome is another serious condition that may develop when blood sugar is over 600mg/dl and blood osmolarity is over 320mosm/mL with no ketones in blood.
  • Early symptoms of high blood sugar:
    1. Increased thirst
    2. Frequent peeing
    3. Nausea or vomiting, abdominal pain
    4. Weight loss
    5. Dry skin and dry mouth
    6. Sunken eyes
  • Symptoms of ongoing or serious complications of hyperglycemia:
    1. Fruity smelling breath and shortness of breath in ketoacidosis
    2. Long and slow deep breaths in hyperglycemic hyperosmolar syndrome
    3. Rapid heart rate
    4. Postural hypotension or rapid drop in blood pressure when standing
    5. Change or loss of consciousness
    *If suspect a hyperglycemic event, drink lots of water, stop all ongoing activities, and go to the ER.
  • Preventing hyperglycemic complications:
    1. Take medication as instructed and follow-up as scheduled.
    2. Follow the suggested diet plan of the nutritionist.
    3. Regularly check and record blood sugar.
    4. Regular exercises.
    5. Understand your own body’s limitations and learn to recognize symptoms of increasing blood sugar.

High Blood Pressure Management

  • High blood pressure or hypertension is a subtle chronic disease often with mild or no symptoms at all. However, it should not be overlooked just because there is minimal or no discomfort.
  • Medication should be taken as instructed even if there is no discomfort.
  • Monitor blood pressure on a regular basis. Return to the cardiology outpatient department regularly.
  • Limit salt intake. Avoid adding excess salt, MSG, or soy sauce on food.
  • Eat fewer processed or packaged foods such as canned, pickled, or instant foods. Make a habit of reading packaging labels. Opt for lower-sodium options at restaurants and airplanes.
  • Limit or stop drinking caffeinated drinks such as coffee, cocoa, tea, etc.
  • Quit smoking.
  • Watch your weight. Lose weight if necessary.
  • Avoid anxious or stressful situations such as staying up late working or getting in an argument. Do not stress eat or binge drink.
  • Avoid overworking and take time to relax.
  • Return to the emergency department as soon as possible if there are following symptoms:
    1. Chest pain or chest tightness
    2. Severe headache with vomiting
    3. Limb weakness, speech difficulties, or unsteady gait

Hypokalemia/Low Potassium Considerations

  • Hypokalemia is a metabolic imbalance characterized by extremely low potassium levels in the blood. It is a symptom of another disease or condition, or a side effect of diuretic drugs.
  • Patients with hypokalemia are encouraged to eat more bananas, oranges, guavas, hard persimmons, melons, tomatoes, dark green vegetables, chicken soup, or broth.
  • Patients with a history of hypokalemia should go to the ER if there is persistent diarrhea, vomiting, worsening muscle weakness, or other recently managed symptoms showing no improvements.
  • For further treatment and tests, please follow up at the nephrology or endocrinology outpatient department as scheduled.

Low Fat Diet

  • Target patients:those with hyperlipidemia, cholecystitis, gall bladder stone, severe diarrhea, and coronary artery disease.
  • Goal:
    1. To decrease the absorption of fat from food.
    2. To decrease the work and stress on the following organs:pancreas, intestines, gall bladder, coronary artery.
  • Suggested foods:
    1. More plant foods:whole-grain products, fruits, non-fried soy products, beans and peas, and vegetables.
    2. Moderate amount of lean and low-fat, meat and dairy products:low-fat or skim milk and yogurt, low-fat cheese, lean meat, liver, heart, kidney, eggs, oysters, shrimp, eel, abalone, octopus, sardines, scallops, squid ….
  • Low-fat cooking:steamed, boiled, braised, stewed, roasted, braised without oil. Try adding non-irritating condiments such as lemon juice, herbs, and spices on cooked vegetables instead of using cheese, butter, or cream-based sauces.

Hyperkalemia/High Potassium Considerations

  • Hyperkalemia is a condition of abnormally high potassium levels in the blood. The concentration of potassium in the body is regulated by kidneys and hormones, and balance is maintained through excretion in urine. Abnormally high levels of potassium in the blood or urine suggest the presence of another underlying medical condition. Because potassium helps to regulate muscle activity, including the activity of heart muscle, hyperkalemia needs to be taken seriously, especially in patients with known hyperkalemia history and kidney diseases.
  • Potassium ions are stored in various types of foods and are easily soluble in water. Cutting vegetables into small pieces then blanching them in hot water can reduce the intake of potassium as most of the potassium will be left in the cooking water. Don’t drink the cooking water and avoid drinking soup.
  • Drink less animal based soup (including chicken, beef, fish, pork soup, hot pot soup, and stock). Avoid soaking rice or noodles in vegetable soup or broth.
  • Tomatoes should not be eaten raw or try eating it after it has been blanched or cooked and had the tomato juice strained.
  • Starfruit is strongly discouraged as it contains neurotoxins which uremic patients cannot metabolize. Consequences include persistent hiccups or other uncomfortable symptoms to severe convulsions or coma.
  • Eating fruits is still encouraged for their fiber and prevention of constipation. Eat whole fruits (not just the pulp or juice) up to portions of no more than 2 fist size per day.
  • Avoid chocolate, kiwi and bananas because they are high in potassium, which may cause the arrhythmia.
  • Do not use low-sodium soy sauce as they are actually high in potassium from substituting sodium for potassium.

High Calcium Diet

  • Target patients:Patients with osteoporosis, calcium deficiency, or those who have had a recent bone fracture and need to increase the intake of calcium.
  • Suggested foods:
    1. Dairy:milk, yogurt, cheese
    2. Legumes:soybeans, bean curd, almonds, peanuts, black sesame
    3. Seafood:shrimp, seaweed, kelp, milkfish, oysters, shrimp, Salmon and sardines canned with their soft bones
    4. Mushrooms and fungi
    5. Green leafy vegetables:broccoli, collards, kale, mustard greens, turnip greens, and bok choy or Chinese cabbage, Thai basil, cabbage
  • When making bone soup or fish soup, adding some vinegar or lemon can help release the calcium from the bones. Eating vitamin C rich fruits after meals (such as oranges and guavas) can also help with calcium absorption.
  • Talk to a nutritionist or health care provider for possible need of supplements. Too much calcium may cause bloating, gas, and constipation. Very high doses of calcium can also cause kidney stones. Any supplement should be checked with your doctor if you are taking prescription drugs.

High Iron Diet

  • Target patients:Those with chronic anemia or iron deficiency anemia.
    1. About 20% of women, 50% of pregnant women, and 3% of men do not have enough iron in their body.
  • Suggested foods (iron-rich foods):
    1. Proteins:Beef or chicken liver, pork and pork loin, sausage, beef, sardines, oyster, egg yolk, soybeans.
    2. Fruits & vegetables:Raisins, spinach, cherries, parsley, beans, lentils, peas, dates, apples, pumpkin, sesame, or squash seeds.
    3. Carbohydrates:Brown rice, oatmeal, wheat germ.
  • Increasing vitamin C rich foods such as oranges and guavas, can also help promote the absorption of iron.
  • Limit the amount of coffee, tea or calcium-rich foods which may hinder iron absorption.
  • Talk to a nutritionist or health care provider for possible need of supplements. Although iron toxicity from food sources is rare, deadly overdoses are possible with supplements.

High Fiber Diet

  • Target patients:People with constipation, diverticular disease, diabetes, cardiovascular disease.
  • Goal:To increase the volume and weight of stool, increase water retained in the stool, soften the stool, and facilitate excretion thus promoting healthier bowel movement by shortenening the duration of stool staying in the intestinal tract and reducing waste retention in the body.
  • Suggested foods:
    1. Beans and legumes:red beans, mung beans, soybeans
    2. Fruit & vegetables:edible fungus, mushrooms, leafy vegetables, guava (without seeds), plum, papaya, bananas, oranges
    3. Starch:sweet potato, brown rice, whole wheat products, whole grains
  • Drinking 2000-3000mL of liquid daily will help to soften the feces.

Bland Diet

  • A bland diet is a diet consisting of foods that are generally soft, low in dietary fiber, cooked rather than raw, and not spicy.
  • Target patients:those with gastric ulcer, duodenal ulcer, gastritis, ulcerative colitis, and diarrhea or irritable bowel.
  • Principle eating habit:regular meals, frequent small meals, chew thoroughly and swallow slowly.
  • Suggested foods:milk and dairy products, soft tender meat free of tendons and sinews, animal internal organs, seafood, soy products, low-fiber vegetables and fruits, peeled and seeded fruit that are less sweet, rice and oat products, saltine crackers, bland toast … etc.
  • Fried and fatty foods, strong cheeses, whole grains (rich in fiber), and the medications aspirin and ibuprofen should be avoided while on this diet.

Percutaneous Nephrostomy Aftercare

  • After completion of the procedure, the patient will need to stay in bed for at least 4 hours.
  • Due to the risk of possible kidney injury with internal bleeding, a responsible adult should stay with the patient to observe for the following possible symptoms and inform the medical staff immediately:
    1. Drained fluid turning bloody or non-stop bloody fluid
    2. Change or loss of consciousness
    3. Rapid heart rate and/or lower blood pressure
  • Look after your nephrostomy. There should be no pulling, bending or twisting of the tube.
  • Pay attention to the amount and color of the drained fluid in the bag everyday. Empty the bag when it is half full.
  • Schedule an appointment to change the drainage tube if there are signs of tube obstruction such as leaking from the wound, sudden decrease in drained volume, or evident debris buildup causing poor flow. Otherwise, the drainage tube should be changed every 3 months.
  • If there is any fever or signs of sudden evident tube malfunction, go to the ER.
  • Keep the wound clean and dry. Change wound dressing daily after proper cleaning and removal of buildup and sterilization.

Percutaneous Transhepatic Cholangial Drainage Aftercare

  • After completion of the procedure, the patient will need to stay in bed for at least 4 hours.
  • Due to the risk of possible internal bleeding from liver injury, a responsible adult should stay with the patient to observe for the following possible symptoms and inform the medical staff immediately:
    1. Progressive abdominal distension
    2. Change or loss of consciousness
    3. Rapid heart rate and/or lowered blood pressure
  • Look after your drainage tube. There should be no pulling, bending or twisting of the tube.
  • Pay attention to the amount and color of the drained fluid in the bag everyday. Empty the bag when it is half full.
  • Schedule an appointment to change the drainage tube if there are signs of tube obstruction such as leaking from the wound, sudden decrease in drained volume, or evident debris buildup causing poor flow. Otherwise, long term drainage tubes may be changed every 3 months.
  • If there is any fever or signs of sudden evident tube malfunction, go to the ER.
  • Keep the wound clean and dry. Change wound dressing daily after proper cleaning and removal of buildup and sterilization.

Angiography Aftercare

  • After completion of the procedure, the patient will need to stay in bed for at least 6 hours. A pressure bag will be placed upon the wound 2 hours to prevent bleeding. If the puncture site is over the groin area, do not bend flex the hip or waist; keep the puncture side of the body straight throughout bed rest. Change position when instructed.
  • Inform the medical staff if there are any signs of bleeding from the wound.
  • Resume usual diet few hours after the angiogram or when instructed.
  • After 6 hours, if there is no complications or signs of bleeding, you may sit up and take small walks. Avoid excessive activities, bending over, lifting heavy objects, climbing up and down stairs, showering, or driving.
  • The wound dressing may be removed after 24 hours. Keep the wound dry and clean for 2 days.
  • Inform the medical staff if there is any signs of wound bleeding or feeling of limb swelling or numbness.
  • Safe and successful recovery without completion is essential. Please call our nurses to help with any physical needs including any bladder or bowel movement or soreness and stiffness from prolonged bed rest.

Gastroscopy or Upper Endoscopy Preparation and Aftercare

  • Preparation:
    1. Other than a small amount of water, any food or drug is prohibited before the examination.
    2. If you have any chronic diseases, ask your doctor for instructions regarding your medications.
    3. If the procedure is scheduled for the following day, start fasting after midnight.
  • After the examination:
    1. The procedure requires having a tube down your throat into your stomach with a small amount of air fed into your digestive tract. Common discomforts afterwards include sore throat, bloating, gas, and cramping. These symptoms will improve over time. Try gurgling with warm water to help ease sore throat.
    2. The medical staff will inform you of your primary results after the exam. Depending on the results, you may need to continue to fast afterwards.
  • Inform the medical staff immediately if there is any spitting of blood, difficulty swallowing, or severe abdomen pain.
  • Please call or ask our medical staff if there are any questions.

Percutaneous Pleural (chest cavity) or Abdominal Drain Aftercare

  • Possible indications for drain insertion:
    1. Too much fluid or blood due to tumor growth, lymphatic obstruction, biliary tract obstruction, lung or heart disease…
    2. Infected fluid in the pleural or abdominal cavity or the biliary tract.
  • The drainage tube and drainage bag should be connected and sealed tightly. There should be no pulling, bending or twisting of the tube. Pin the bag onto your clothes using a safety pin. Avoid excessive or sudden movements that might result with the drainage tube slipping out. Keep the drainage bag lower than the puncture site to allow better flow.
  • You should be able to continue normal daily activities without limitation. Empty drainage bag when getting out of bed. Be careful not to squeeze the bag.
  • Keep the wound dry. Change wound dressing immediately after showering. Clean the skin around your tube every day using soap and water. You can cover the tube with sterile (germ-free) gauze if you like.
  • Check the stitches attaching the tube to the skin during dressing change. Also check the positioning of the tube that it has not slipped out.
  • Inform the medical stuff and ask for analgesics if there is pain.
  • Depending on your condition, you may be discharged with the tube and bag. Follow-up as scheduled and continue to practice daily wound and tube care.
  • Schedule an appointment to change the drainage tube if there are signs of tube obstruction such as leaking from the wound, sudden decrease in drained volume, or evident debris buildup causing poor flow. Otherwise, drainage tubes should be changed every 7 days.
  • Visit the ER if there are the following conditions:
    1. Sudden increase or decrease drained amount
    2. Change or color or characteristics of the drained material
    3. Fever or chills, or redness, swelling, pain, discharge over the puncture site
    4. Dislodged tube *do not try to reinsert the tube, cover the wound with clean gauze and go to the ER*

Percutaneous Transluminal Angioplasty Aftercare

  • With appropriate post-procedure pressure, bleeding from the puncture site should be minimal. If there is any bruising or hematoma, try ice packing.
  • Visit the ER if there are the following conditions:
    1. Sensation of coolness or numbness, or turning blue or grey on the limb surgery was performed
    2. Fever
    3. Shortness of breath
  • Follow-up as scheduled. If there is any questions, feel free to call your doctor or the ER.

Lumbar Puncture (Spinal Tap) Care

  • The purpose of lumbar puncture is to collect the fluid around the spinal cord to obtain information regarding the central nervous system such as infection, bleeding, elevated pressure, and etc.
  • The procedure is fairly straight forward although it may take a little while. The patient is asked to lie on the side and hug the knees. After sterilizing the back, sterile cloths (called drapes) will be placed around the area. A local anesthetic (pain-relieving medication) will be injected into the area on the back. Once the area is numb, a hollow needle is inserted in the lower back between two lumbar vertebrae. This sometimes causes pressure. The spinal canal is penetrated and cerebrospinal fluid (CSF) is collected. CSF is a colorless fluid surrounding the brain and spine. Approximately 500 mL of CSF is produced and reabsorbed per day.
  • The patient is to lay flat for 8 hours after the procedure. Do not elevat the head, bend the knees, sit up, or get out of bed. Ask the medical staff to help with any discomforts or needs (e.g. soreness or voiding)
  • Avoid strenuous or vigorous exercise for a day or so following the lumbar puncture.
  • If you have a headache, lay down as much as possible and drink plenty of fluids. Inform your health care provider if the headache persists.
  • If no contraindication, try and drink at least 2L of liquid the day of the lumbar puncture and the day after (regardless of headache).
  • Return to the emergency department or inform your medical staff as soon as possible if there are following symptoms:
    1. Unusual drainage, including bloody discharge, at the puncture site
    2. Fever
    3. Persistent severe headache

Blood Products Transfusion Care

  • To observe for possible transfusion reaction, infusion is slow for the first 15 minutes (rate at around one drop of blood every 2-3 seconds). If there are chills, fever, or shortness of breath, please inform the medical staff immediately.
  • The transfusion needle catheter is soft and flexible. You may move your limbs during transfusion. If there is any redness, swelling, pain, or oozing blood around the catheter, please inform the nurse.
  • The listed are possible transfusion reactions. Inform the nurse immediately if you have any of the following:
    1. Fever or chills
    2. Shortness of breath or difficulty breathing
    3. Skin rash
    4. Generalized skin itch
    5. Red urine

Elastic Bandaging for Hemostasis after Percutaenous Transluminal Angioplasty (PTA)

  1. After the procedure, it is necessary to adequately compress the punctured artery for one hour.
  2. After the 1st hour, loosen the bandage slightly by unwrapping 1~2 circles.
  3. After the 2nd hour, loosen the bandage again slightly still unwrapping 1~2 circles.
  4. Repeat the process every 30 minutes.
  • If bleeding is found during the loosening process, rewrap the elastic bandage until there is no more active bleeding. If there is no further bleeding after 20 minutes, continue to loosening process.
  • The elastic bandage may be completely removed after having had successfully loosened the bandage 3 times in two hours without bleeding or a growing blood clot beneath the skin. Check that there is no further bleeding for 10 minutes after the elastic bandage has been removed then cover with sterile gauze.
  • Do not to perform strenuous activity or overstretch the limb six hours after PTA. Only slight wrist movement or slight bending of the knee and ankle is allowed.
  • Bandage loosening time:__________ ,__________,__________
  • Bandage removal time:______________________
  • After discharge, keep the wound clean and dry and check for wound bleeding or hematoma/blood clot underneath the skin. Try ice packing to ease any swelling or discomfort.
  • Return to the hospital or call if there are signs of poor limb circulation (fingers or toes on the punctured limb turning blue or grey or have severe numbness) Chi Mei Hospital Emergency Department Tel:(06)2812811-57161.

Figure 8 Clavicle Brace Use and Self Care

  • Most clavicle fractures can get a good therapeutic effect by using the figure-of-eight brace fixation. On rare occasions, surgeries are needed for clavicle fracture. Talk with your orthopedic surgeons during your appointment.
  • The figure 8 brace should be worn for 4~6 weeks, or even 3 months depending on your healing condition. An arm sling may be also used to ease pain during the first 2 weeks.
  • For the first 2 weeks, the figure 8 brace should be worn at all times, including sleeping and cleaning. Sponge bath is suggested. If the brace must be removed, please assume correct posture so the broken bones stay aligned. Put it back on as soon as possible after bath.
  • Do not to wear the brace outside thick clothing. Lie on your back while sleeping.
  • To put on the figure 8 brace, maintain a chest up posture, elbows out, and both hands on the waist. Allow a friend or family member to adjust the shoulders padding in a comfortable position then tighten the straps evenly. Return to the hospital if there is any discomfort.
  • Pain usually lasts 1 to 2 weeks. You may take analgesics prescribed by a physician and follow-up at the orthopedic outpatient department regularly.

Arm Sling Use and Self Care

  • Arm slings may help to alleviate the pain and to help immobilize the injured arm.
  • Adjust the sling so that the elbow is bent at an angle just less than 90 degrees.
  • Pull the triangular bandage so that it just supports the wrist. Do not let the wrist or forearm hang or droop out.
  • Keep the sling clean.
  • The sling may be temporarily removed when lying down to sleep.
  • Return to the hospital if there is any abnormal swelling, numbness or changes in the sensation of the fingers or the arm.

Cast and Splint Care

  • Like broken skin or wound, broken bones need proper time and alignment to heal. Casts and splints limit movement or immobilize the injured limb so that the bones may regenerate and repair themselves.
  • After a cast is on, you can’t remove it yourself. Your doctor will take it off.
  • Follow your doctor’s instructions for when you can first put weight on the cast. When it’s okay to put weight on your cast, do not stand or walk on it unless it is designed for walking.
  • Keep the injured limb elevated, ideally above the level of the heart, to promote circulation and relieve pain and swelling.
  • Keep the cast clean and dry.
  • Avoid eating rich or spicy food. Do not binge or overeat.
  • Practice static muscle contractions on the injured limb or small movements in the fingers and toes daily, each lasting 15 to 20 minutes and at least three times a day.
  • Also practice elevating the entire injured limb everyday. These exercises may be done on the bed or sitting on the chair.
  • Avoid hitting the cast/splint with hard materials to prevent deformation or breaking of the cast/splint.
  • Practice good hygiene and continue to clean on the hands, fingers, feet, and toes as normal as possible. Massage the limb to increase circulation from prolonged immobilization.
  • Try blowing cool air from a hair dryer or fan into the cast to help relieve itching. Never stick items under your cast to scratch the skin.
  • Don’t use oils or lotions near your cast. If the skin gets red or irritated around the edge of the cast, you may pad the edges with a soft material or use tape to cover the edges.
  • Walking aids and supports are available for rental at our rehabilitation aids center on the first floor of the 3rd medical building. Or call 2812811-53745 during business hours for more information.
  • Return to the hospital if there are the following conditions:
    1. Pain, numbness, inability to move the fingers or toes, or find the fingers or toes turning cold and purple on the limb with the cast/splint.
    2. Increasing pain or severe swelling near the cast
    3. Cast/splint broke
    4. Cast/splint feels too tight or too loose
    5. Severe discomfort of the skin underneath the cast/splint

Indwelling Foley/Urinary Catheter Care

  • A urinary catheter is a flexible plastic tube used to drain urine from the bladder when a person cannot urinate.
  • If you are helping a loved one with a catheter, try to be as relaxed as possible. Caring for a catheter can be embarrassing for both of you.
  • Always wash your hands before and after handling a catheter.
  • Clean the area around the catheter with soap and water twice a day. Change the location in which the catheter is taped or fixed on the body every day. (Male patients may have the catheter fixed on either side of his lower abdomen; female patients may have the catheter taped on either the thighs).
  • Check for inflammation or signs of infection in the area around the catheter. Signs of infection include pus or irritated, swollen, red, or tender skin.
  • Drink plenty of water to increase urine output. (Target urine output > 1500ml/day)
  • Avoid compressing, twisting, or kinking the foley catheter. Regularly squeezes the catheter to avoid obstruction.
  • Keep the urine collection bag below the level of the bladder but do not let it drag on the floor.
  • Do not apply powder or lotion to the skin around the catheter.
  • A person should not have sexual intercourse while wearing a catheter.
  • Do not attempt to remove the catheter by yourself as it may cause urethral damage.
  • Drain the collection bag when it is 2/3 full.
  • To prevent long term indwelling infection, all forms of exposed tubes and catheter must be changed regularly. In general, plain latex catheters need to be changed more frequently than silicone catheters. Follow-up regularly at the urology outpatient department or the relevant department.
  • Eating more vitamin C rich foods (such as: oranges, guava, tomatoes and papaya) may help to prevent urinary tract infections.
  • If there are a signs of urinary tract infection such as fever, chills, pain in the urethra, foul smelling urine, blood or pus in the urine, please consult a doctor immediately.
  • Other signs to consider:
    1. No urine or very little urine is flowing into the collection bag for 4 hours or more.
    2. There is new pain in the belly or pelvic area.
    3. Urine is leaking from the insertion site.

Nitroglycerin (NTG) sublingual tablet Use and Precautions

  • Take this medicine exactly as directed by your doctor.
  • Take the tablet while sitting or lying down. Nitroglycerin sublingual tablets usually provide relief within 1 to 5 minutes. If the pain is not relieved, take a second tablet 5 minutes after taking the first tablet. If the pain continues for another 5 minutes, a third tablet may be used. Contact your doctor or go to the emergency room right away if there is still have chest pain after 3 tablets.
  • Sublingual tablets should be kept in its original glass bottle. It will expire after 6 months.
  • Do not take the NTG tablet when blood pressure is lower than normal.
  • Go to the emergency room right away if there are the following conditions:
    1. Chest pain attack becoming more frequent or more severe
    2. Chest pain attack during rest
    3. Cold sweating
    4. Syncope or loss of consciousness
    5. Shortness of breath or difficulty breathing

Feeding Tube Care

  • Nasogastric (NG) tubes (and sometimes orogastric tubes) are inserted when the patient cannot eat or swallow. The tube goes directly from the nose (nasogastric tube) or the mouth (orogastric gubes) directly to the stomach. Once this tube is in place, it can be used to give food and medicine. It can also be used to remove things from the stomach, such as toxic substances or a sample of stomach contents.
  • NG is most commonly used for patients who have facial or neck injuries or surgeries, have a mechanical ventilator, have an intestinal obstruction or blockage, are comatose, or are at risk for choking on foods due to difficulty swallowing.
  • Feeding:
    1. Elevate the head of the bed so the patient is in a semi-upright position. Stay in this position for 1 hour after feeding.
    2. If the patient needs chest percussion, sputum aspiration or repositioning, please do these 1 hour prior to feeding.
    3. Wash your hands with soap and water.
    4. Have the feeding syringe, liquid food and warm boiled water ready and close at hand. The temperature of the feeding material should be close to body temperature.
    5. Check that the NG tube is in the correct position before beginning feeding: with the feeding syringe connected to the NG tube, slightly withdraw the plunger so that you see some gastric content run into the tube.
    6. Check patient’s digestion status:
    (1) The amount of residual food in the stomach should be less than 50mL when digestion is adequate. If more than 50mL remain in the stomach, you may readminister the withdrawn stomach material as long as the material is still in the tube or the syringe. There is no need to withdraw all the material in the stomach and do not readminister material that has been drained into a different vessel.
    (2) Deduct the approximate amount still remaining in the patient’s stomach from the coming feeding. For example, if 60mL of undigested material has been drawn but the next meal is 300mL, give 240mL or less for the next meal.
    7. Detach the syringe from the feeding tube and remove the plunger in the syringe. Clamp the tube with your fingers then open the tube plug.
    8. Attach the syringe to the tube. Carefully fill feeding formula into the syringe. Hold syringe higher than the tube and unclamp your fingers. Allow formula to run by gravity. Try not to let the syringe get empty before refilling it, as air will enter the stomach.
    9. When finished, flush the tube with the prescribed amount of warm preboiled water. Manually clamp the tube then disconnect the syringe and recap feeding tube plug.
  • Feed every 2-4 hours of approximately 200-400mL. Gradually increase the amount if necessary up to 500mL per meal. Do not force-feed.
  • Always reclamp the feeding tube plug before removing the feeding syringe to avoid leakage.
  • Flush the tube with 30~60mL of water after each feeding or taking medications, or as often as your nurse recommends.
  • Each meal should take at least 15 minutes to give a feed. Feed slowly to and allow digestion and gravity to work at its own pace. Force feeding or rushing might cause air bubbles to enter the stomach which may result in nausea and vomiting.
  • Extra drinks (boiled warm water, tea, fruit juice) can be fed between meals.
  • Feeding material is not limited to formula. Milk, juice, soy milk, vegetable juice, rice water, homemade liquid food or commercially available preparations are all possible choices. Check with your nutritionist for a balanced meal plan and preparation method.
  • Keep a diary to keep track of patient weight, intake amount, undigested amount, any changes in stool or urine, any abdominal discomfort, or anything your doctor might need to know.
  • Clean the nostrils with a wet cotton swab of grease or other discharge daily. Practice good oral hygiene and brush with a soft toothbrush and toothpaste at least twice a day.
  • Change the nostril tape everyday and apply lotion or vaseline around the nostril if necessary. Slightly twist the NG tube to prevent it adhering to stomach wall.
  • NG tubes should be changed every 7 days. Silicon NG tubes may be changed once a month.

Neck (Cervical) Collar Use and Care

  • Neck collars are used to protect and support the neck after an injury. Depending on the injury, the physician will provide instructions on when during the day and how long the collar should be worn. Do not remove the the collar unless instructed by your physician. Your physician will tell you if the collar may be removed when sleeping.
  • Adjust the collar so that two fingers may still be inserted between the neck and the collar to avoid compression.
  • Use a small handkerchief or gauze as a padded liner to protect the skin. Watch for reddened or broken skin under the brace. Skin breakdown can be caused by rubbing, pressure, or moisture. This may indicate that the brace does not fit properly or is not being worn properly. An orthotist can adjust the fit and provide tips for comfort and proper wear.
  • Eat easy to swallow soft foods. Avoid sticky rice products.
  • Your brace will restrict your ability to move. You will not be able to see your feet, so take care when walking.
  • Wash and deodorize your brace with a mild soap and damp cloth every day. If your brace has padded liners, let air dry or use a hair dryer on “cool” setting.

Repositioning

  • Bed-bound or immobilized patients should be repositioned every 2 hours.
  • Make sure clothes, blankets, pads or any other materials underneath the patient is flat and that there are no unnecessary materials causing excess pressure on the patient.
  • Avoid repositioning within half an hour of feeding.
  • All tubes and lines should be carefully placed to the side the patient is to be repositioned towards. Take care not to remove any tubes or lines.
  • After patient is repositioned, appropriate materials such as pillows or rolled up blankets may be used to support the limbs in a comfortable angle to avoid poor circulation or limbs dangling off the bed.
  • Use air-filled or water-filled mattresses, and gel or foam cushions to help with positioning, relieving pressure and protecting vulnerable areas from the formation of pressure sores .
  • How to reposition (e.g. Helping patient to lie on the left from lying flat):
    1. Stand on the patient’s right and stand as close to the patient as possible. Make the bed flat. If the bed may be elevated, raise it to a level that causes minimal back strain for you.
    2. Place both arms around the patient’s shoulders and slightly lift up the patient then pull the patient towards you. Do the same with the patient’s hips so that the patient is now lying on the right side of the bed.
    3. Move to the other side and stand on the patient’s left. Fold both of the patient’s arms across his/her near chest.
    4. Place your left hand on the patient’s shoulder and your other hand on the hip.
    5. Standing with one foot ahead of the other, shift your weight to your front foot as you gently pull the patient’s shoulder toward you. Then shift your weight to your back foot as you gently pull the patient’s hip toward you.
    6. Place a pillow lengthwise under the patient’s back. Gentle pull the patient’s left shoulder towards you so the patient is slightly inclined on his/her back. Place a cushion or pillow between the patient’s knees.
    7. Make sure the patient’s ankles, knees, and elbows are not resting on top of each other. Check that the head and neck are in line with the spine, not stretched forward, back, or to the side.

Kawasaki Disease Care

  • Kawasaki disease (KD) is a rare childhood illness that affects the blood vessels. The symptoms can be severe for several days and can look scary to parents. But then most children return to normal activities.
  • KD is a systemic inflammatory disease, meaning that it is not localized to any particular organ but may have an inflammatory response involving anywhere with blood vessels, including the arteries of the heart.
  • The most serious complications happen when the coronary arteries (arteries that carry blood to the heart) is involved, which may include heart failure, arrhythmia, or even sudden death. Infants are most susceptible to long term sequelae. However, most children who are treated recover from the disease without long-term problems. Continue to follow-up for a few weeks to a few months after treatment.
  • The disease is most common in children under 5 years old. It is not contagious. Its etiology remains unknown.
  • KD is also called mucocutaneous lymph node syndrome. Diagnosis is based upon evidence of systemic inflammation (fever) in association with any four of the following symptoms:
    1. Fever over 39 ºC for over 5 days
    2. Red eyes
    3. Swollen, red skin on the palms of the hands and soles of the feet
    4. Skin rash, often starting in the genital area. It can also be on the back, chest, belly, arms, and legs
    5. Cracked, red lips and tongue
    6. Swollen lymph nodes in the neck
  • Fever management:
    1. Fever is when armpit temperature is over 37.5ºC or anal, forehead, or temporal temperature is over 38ºC.
    2. When your child has chills, keep him/her warm by adding another blanket or elevating the thermostat temperature. Do not give him/her an ice pillow.
    3. If your child has fever but the limbs are warm, give him/her a warm bath (water temperature 26~36ºC).
    4. Encourage your child to drink plenty of water to prevent dehydration. Dry off the sweat immediately. Do not wear too many layers of clothes or use too many blankets.
    5. Fever medication (antipyretics) may be given when the child’s temperature is above 38.5℃. Repeat if necessary with at least 4 to 6 hours between the antipyretics. If your child has a history of febrile convulsion, use antipyretics at a lower temperature to help prevent convulsion.
    6. Antipyretics usually need around 30 minutes to work. You may check your child’s body temperature every hour until the fever has reduced.
  • IV (intravenous therapy) and IV pump care:
    1. Keep the dressing and injection cannula (the small plastic tube which is inserted into the vein) clean and dry.
    2. Periodically check that the the distal extremities (far end of the limb with the injection; ie. fingers or toes) that they are warm and pink.
    3. Keep the injected limb lowered to avoid IV fluid or blood refluxing into the tubes.
    4. Do not adjust the IV rate or touch the buttons of the pump by yourself. Inform the staff if you think adjustment is needed.
    5. The IV pump has a rechargeable battery. You may remove the electric the charging cable when walking around. Please keep the cable plugged in when possible.
    6. Gently compress the injection site for 1~3 minutes with a sterile cotton ball after the cannula has been removed. Remove the cotton balls if there is no more bleeding.
    7. If any of the following conditions occur, please inform the nursing staff:
    (1) Pain, swelling, redness, or wetness at the injection site.
    (2) Painful or reddening of the skin after the cannula was removed.
    (3) You heard the sound of pump alarm.
    (4) Your child needs a shower or change the clothes.
  • Oral ulcer management:
    1. Make observation of the changes of the oral ulcers at least once everyday.
    2. Practice good oral hygiene. Use a soft toothbrush or a gauze wrapped on a popsicle stick and clean the mouth and teeth with normal saline or boiled water. This will help promote wound healing and prevent bad breath from bacterial growth.
    3. Drink or gurgle directly from a cup instead of a straw to avoid contact pain from the straw or wound irritation from sucking motion.
    4. Cool soft diet will reduce the painful sensation during swallowing. Try ice cream, yogurt, jelly, cold milk, or flan.
    5. Try lip balms or vaseline to moisten the lips.
    6. Eat frequent small meals. Do not force feed.
    7. Always practice good hygiene. Gently wipe off drool with wet towelette. Always wash your hands before and after touching your child.
  • Avoid scratching or manipulating the skin rash to prevent secondary infection. Try gentle lotion on dry itchy skin.
  • Inform our medical staff immediately if there are the following symptoms:
    1. Chest pain
    2. Shortness of breath
    3. Abnormal breathing sounds or signs of difficulty breathing
    4. Vomiting
    5. Skin turning blue or gray
    6. Abnormal irritability or odd behaviours
    7. Convulsion
    8. Loss or change of consciousness
  • Follow-up regularly with your pediatrician or a pediatric cardiologist.
  • Aspirin may be prescribed for blood-thinning and anti-inflammation. It should not be discontinued or changed without the doctor’s orders. Continue to follow-up regularly when taking aspirin. If your child contracts the flu or chickenpox during aspirin treatment course, stop the medication and see your pediatrician as soon as possible.

Chickenpox Management

  • Chickenpox (varicella) is a virus that causes an itchy rash and red spots or blisters (pox) all over the body. Although usually isn’t a serious problem in healthy children, it is highly contagious. An infected person can spread it onto others when sneezing, coughing, or sharing food or drinks. The fluid from a broken chickenpox blister is also contagious. A person who has chickenpox can spread the virus even before he or she has any symptoms. For most people, getting chickenpox provides immunity for life. At the same time, those who have never had the illness and have not had the chickenpox vaccine are at risk for chickenpox.
  • The varicella-zoster virus is usually more active during late winter and early spring. It starts with fever, chills, poor appetite, sore throat, cough, muscle and joint soreness, and develops a blister-like rash with itching in 1-2 days. The rash starts from the trunk and the face, and can spread over the entire body. It usually takes about 1 or 2 days for the spot to go through all its stages: blistering, bursting, drying, and crusting over. New red spots will appear every day for up to 5 to 7 days. The first symptoms of chickenpox usually develop about 14 to 16 days after contact with a person infected with the virus.
  • A person with chickenpox can spread the disease as soon as they have any symptoms, the 1 to 2 days before the rash have begun. They remain contagious until all their chickenpox blisters have scabbed, usually 5~10 days. After this, then the person with chickenpox can return to day care, school, or work.
  • Chickenpox can be serious, especially in babies, people with weakened immune systems, and pregnant women. The best way to prevent chickenpox is to get the chickenpox vaccine.
  • Fever management:
    1. Fever when armpit temperature is over 37.5ºC or anal, forehead, or temporal temperature is over 38ºC.
    2. When your child has chills, keep him/her warm by adding another blanket or elevating the thermostat temperature. Do not give him/her an ice pillow.
    3. If your child has fever but the limbs are warm, give him/her a warm bath (water temperature 26~36ºC).
    4. Encourage your child to drink plenty of water to prevent dehydration. Dry off the sweat immediately. Do not wear too many layers of clothes or use too many blankets.
    5. Fever medication (antipyretics) may be given when the child’s temperature is above 38.5℃. Repeat if necessary with at least 4 to 6 hours between the antipyretics. If your child has a history of febrile convulsion, use antipyretics at a lower temperature to help prevent convulsion.
    6. Antipyretics usually need around 30 minutes to work. You may check your child’s body temperature every hour until the fever has reduced.
    7. Take antipyretics as instructed. Do not take aspirin.
  • IV (intravenous therapy) and IV pump care:
    1. Keep the dressing and injection cannula (the small plastic tube which is inserted into the vein) clean and dry.
    2. Periodically check that the the distal extremities (far end of the limb with the injection; ie. fingers or toes) that they are warm and pink.
    3. Keep the injected limb lowered to avoid IV fluid or blood refluxing into the tubes.
    4. Do not adjust the IV rate or touch the buttons of the pump by yourself. Inform the staff if you think adjustment is needed.
    5. The IV pump has a rechargeable battery. You may remove the electric the charging cable when walking around. Please keep the cable plugged in when possible.
    6. Gently compress the injection site for 1~3 minutes with a sterile cotton ball after the cannula has been removed. Remove the cotton balls if there is no more bleeding.
    7. If any of the following conditions occur, please inform the nursing staff:
    (1) Pain, swelling, redness, or wetness at the injection site.
    (2) Painful or reddening of the skin after the cannula was removed.
    (3) You heard the sound of pump alarm.
    (4) Your child needs a shower or change the clothes.
  • Rash care:
    1. Clothing, bedding, towels, wound dressings, toys, utensils, or anything that might have come in contact with the patient’s body fluid should be cleaned separately. Do not share them with others.
    2. Wear loose clothing and keep the body clean and dry. Cool ambient temperature can help reduce the itching sensation.
    3. Do not break blisters as this may lead to infection and scarring.
    4. Keep the hands clean and trim nails regularly. Before going to bed, wear cotton gloves and socks to avoid scratching.
    5. Try skin calming lotion for the itch.
  • Patients should stay at home and avoid public places. Do not come in contact with pregnant women or infants who have never had chickenpox.
  • Infants should get a varicella vaccine once they are 12 months old.
  • Please go to the hospital as soon as possible if there are following symptoms:
    1. Persistent vomiting or severe headache
    2. Difficulty walking or unsteady gait
    3. Severe coughing
    4. Difficulty breathing
    5. Chest pain
    6. Severe abdominal pain
    7. Fever over 39 degree Celsius or fever lasting longer than 24 hours
    8. Confusion, agitation, drowsiness, coma
    9. Stiff neck and back pain
    10. Signs of wound infection (skin redness, pain, swelling, pus)
    11. Evident new blister formation after 7 days or rash that lasts for over 2 weeks
    12. Chickenpox on the eyeball

Urinary Tract Infection Management in Children

  • Urinary tract infection (UTI) is the infection of the urinary system (kidneys, ureters, bladder and urethra). It can cause symptoms of fever, abdominal pain, vomiting, painful or burning sensation during urination, frequent bathroom calls with only small amount of urine, difficulty holding urine, foul stench of urine, flank pain, back pain or even blood in the urine. If not treated immediately, UTI can have serious complications including sepsis, seizure, and kidney or bladder damage. Urinary tract infections are common in infants and children. 3~5% of girls and 1% of boys under 2 years old with unexplained fever have UTI.
  • Fever management:
    1. Fever is when armpit temperature is over 37.5ºC or anal, forehead, or temporal temperature is over 38ºC.
    2. When your child has chills, keep him/her warm by adding another blanket or elevating the thermostat temperature. Do not give him/her an ice pillow.
    3. If your child has fever but the limbs are warm, give him/her a warm bath (water temperature 26~36ºC).
    4. Encourage your child to drink plenty of water to prevent dehydration. Dry off the sweat immediately. Do not wear too many layers of clothes or use too many blankets.
    5. Fever medication (antipyretics) may be given when the child’s temperature is above 38.5℃. Repeat if necessary with at least 4 to 6 hours between the antipyretics. If your child has a history of febrile convulsion, use antipyretics at a lower temperature to help prevent convulsion.
    6. Antipyretics usually need around 30 minutes to work. You may check your child’s body temperature every hour until the fever has reduced.
    7. Take antipyretics as instructed. Do not take aspirin.
  • IV (intravenous therapy) and IV pump care:
    1. Keep the dressing and injection cannula (the small plastic tube which is inserted into the vein) clean and dry.
    2. Periodically check that the the distal extremities (far end of the limb with the injection; ie. fingers or toes) that they are warm and pink.
    3. Keep the injected limb lowered to avoid IV fluid or blood refluxing into the tubes.
    4. Do not adjust the IV rate or touch the buttons of the pump by yourself. Inform the staff if you think adjustment is needed.
    5. The IV pump has a rechargeable battery. You may remove the electric the charging cable when walking around. Please keep the cable plugged in when possible.
    6. Gently compress the injection site for 1~3 minutes with a sterile cotton ball after the cannula has been removed. Remove the cotton balls if there is no more bleeding.
    7. If any of the following conditions occur, please inform the nursing staff:
    (1) Pain, swelling, redness, or wetness at the injection site.
    (2) Painful or reddening of the skin after the cannula was removed.
    (3) You heard the sound of pump alarm.
    (4) Your child needs a shower or change the clothes.
  • Avoid putting on diapers too tightly. Change diapers at least every two hours, as urine and feces that have been sitting too long may breed bacteria which may increase the risk of urinary tract infection.
  • Older children should wear underwear with 100% cotton material. To reduce bacteria growth, underwear should also be changed when damp from water or sweat.
  • Encouraged your child to drink plenty of water. 100% juice without sugar additives such as cranberry, citrus juice, or guava juice are also recommended.
  • Do not hold the urge of urination. Remind your child to the go to the toilet between play time. Tell your child to not rush during voiding to allow complete emptying of the bladder.
  • Cleaning up and hygiene:
    1. Girls should wipe from front to back (ie. from the urethra towards the anus)
    2. Boys should gently push the foreskin down to wash the glans everyday.
    3. Take showers instead of baths.
  • Call your pediatrician or go to the emergency department if there are following symptoms:
    1. Fever over 38 ℃ with poor appetite (anorexia) or decreased activity.
    2. Voiding difficulty or pain causing your child to cry or scream.
    3. Decreased urine amount or foul smelling urine.
    4. Purulent secretions on diapers.

Hand Foot Mouth Disease (HFMD) and Herpangina Management

  • HFMD and herpangina are infections of the enterovirus which usually occur during the summer (May~June) and autumn (Septmber~October) periods. It is highly contagious and often breaks out within a community.
  • Enterovirus is transmitted from person to person via the fecal-oral route; that is, when the caretaker changes a diaper without washing his/her hands afterwards or when a young child gets stool on his/her hands and then touches objects that other children put in their mouths. The virus also spreads easily through direct contact with oral and respiratory secretions such as droplets from coughing and sneezing, as well as touching the vesicle fluids in HFMD.
  • Enteroviral infection often causes fever, sores in or on the mouth, and skin rash. In some cases, there are no symptoms at all or the symptoms are very mild that parents also catch the disease without any realization. Symptoms usually occur 3~6 days after being exposed to the virus.
  • The most commonly occurring types in Taiwan are herpangina and HFMD which in addition to the aforementioned symptoms, results in sores or vesicles usually 1~5mm in diameter on the hands, soles of the feet, knees, buttocks or legs. The sores may be painful. Infected children often complain of mouth or throat pain, and in children who have yet to speak often show refusal to eat. There may also be unexplainable fussiness, abdominal pain, vomiting, and diarrhea.
  • The illness usually doesn’t last more than a week or so. At first your child may feel tired, get a sore throat, or have a fever of around 38~39°C. Then in a day or two, sores or blisters may appear and they quickly rupture and crust over.
  • Enterovirus is infamous and often feared by parents because of how quickly and easily it spreads and its potential serious complications. Type A71 enterovirus has been associated with complications of the central nervous system (encephalitis, paralysis, meningitis), lung edema and hemorrhage, and heart failure.
  • There are more than 60 types of viruses in the group of enteroviruses. There is long-lasting immunity once infected, but only for that specific type of enterovirus. As there are so many types of enterovirus, it is possible to contract enterovirus again in the same year or possibly even the same season. Different types of enterovirus may cause similar symptoms. Therefore, the same patient may seem like he/she has gotten hand-foot-and-mouth disease or herpangina more than once. There is no specific antiviral therapy available for the treatment of the enteroviruses nor is there vaccines. Management is symptom relief, and most patients will be fully recovered within one week. However, children with complications may require hospitalization.
  • Fever management:
    1. Fever is when armpit temperature is over 37.5ºC or anal, forehead, or temporal temperature is over 38ºC.
    2. When your child has chills, keep him/her warm by adding another blanket or elevating the thermostat temperature. Do not give him/her an ice pillow.
    3. If your child has fever but the limbs are warm, give him/her a warm bath (water temperature 26~36ºC).
    4. Encourage your child to drink plenty of water to prevent dehydration. Dry off the sweat immediately. Do not wear too many layers of clothes or use too many blankets.
    5. Fever medication (antipyretics) may be given when the child’s temperature is above 38.5℃. Repeat if necessary with at least 4 to 6 hours between the antipyretics. If your child has a history of febrile convulsion, use antipyretics at a lower temperature to help prevent convulsion.
    6. Antipyretics usually need around 30 minutes to work. You may check your child’s body temperature every hour until the fever has reduced.
    7. Take antipyretics as instructed. Do not take aspirin.
  • IV (intravenous therapy) and IV pump care:
    1. Keep the dressing and injection cannula (the small plastic tube which is inserted into the vein) clean and dry.
    2. Periodically check that the the distal extremities (far end of the limb with the injection; ie. fingers or toes) that they are warm and pink.
    3. Keep the injected limb lowered to avoid IV fluid or blood refluxing into the tubes.
    4. Do not adjust the IV rate or touch the buttons of the pump by yourself. Inform the staff if you think adjustment is needed.
    5. The IV pump has a rechargeable battery. You may remove the electric the charging cable when walking around. Please keep the cable plugged in when possible.
    6. Gently compress the injection site for 1~3 minutes with a sterile cotton ball after the cannula has been removed. Remove the cotton balls if there is no more bleeding.
    7. If any of the following conditions occur, please inform the nursing staff:
    (1) Pain, swelling, redness, or wetness at the injection site.
    (2) Painful or reddening of the skin after the cannula was removed.
    (3) You heard the sound of pump alarm.
    (4) Your child needs a shower or change the clothes.
  • Oral ulcer management:
    1. Make observation of the changes of the oral ulcers at least once everyday.
    2. Practice good oral hygiene. Use a soft toothbrush or a gauze wrapped on a popsicle stick and clean the mouth and teeth with normal saline or boiled water. This will help promote wound healing and prevent bad breath from bacterial growth.
    3. Drink or gurgle directly from a cup instead of a straw to avoid contact pain from the straw or wound irritation from sucking motion.
    4. Cool soft diet will reduce the painful sensation during swallowing. Try ice cream, yogurt, jelly, cold milk, or flan.
    5. Try lip balms or vaseline to moisten the lips.
    6. Eat frequent small meals. Do not force feed.
    7. Always practice good hygiene. Gently wipe off drool with wet towelette. Always wash your hands before and after touching your child.
  • Avoid scratching or manipulating the skin rash to prevent secondary infection. Try gentle lotion on dry itchy skin.
  • Personal hygiene is the most important factor in disease prevention and outbreak control. Children younger than 3 years old are at most risk for complications and should be encouraged and helped with practicing good hand washing technique.
  • How should you wash your hands:
    1. Wet your hands with clean, running water (warm or cold), turn off the tap, and apply soap.
    2. Lather your hands by rubbing them together with the soap. Be sure to lather the backs of your hands, between your fingers, and under your nails.
    3. Scrub your hands for at least 20 seconds. Need a timer? Hum the “Happy Birthday” song from beginning to end twice.
    4. Rinse your hands well under clean, running water.
    5. Dry your hands using a clean towel or air dry them.
  • When to wash your hands:
    1. Before, during, and after preparing food
    2. Before eating food
    3. Before and after caring for someone who is sick or going to the hospital
    4. Before and after treating a cut or wound
    5. Before touching or making direct contact with a child
    6. After using the toilet
    7. After changing diapers or cleaning up a child who has used the toilet
    8. After blowing your nose, coughing, or sneezing
    9. After touching an animal, animal feed, or animal waste
    10. After handling pet food or pet treats
    11. After touching garbage
  • Disinfect common areas. Get in the habit of cleaning high-traffic areas and surfaces first with soap and water, then with a diluted solution of chlorine bleach and water. Child care centers should follow a strict schedule of cleaning and disinfecting all common areas, including shared items such as toys, as the virus can live on these objects for days. Clean your baby’s pacifiers often.
  • Children are most likely to spread the disease during the first week of the illness. But the virus can stay in the stool for several months and may spread to others. To help prevent the disease from spreading, isolate infected children at home, avoid close contact with other children including siblings, and don’t let your child share toys or give kisses.
  • Always have a balanced diet, regular exercise, and adequate sleep to help boost immunity.
  • Go to a hospital or inform our medical staff immediately if there are the following symptoms:
    1. Extreme sleepiness
    2. Myoclonic jerks (repeated jerk-like movements similar to a startling response involving muscle contractions of the whole body)
    3. Persistent vomiting
    4. Persistent fever
    5. Decreased activity or generalized weakness
    6. Irritable behaviour or crying
    7. Loss or change of consciousness
    8. Neck stiffness
    9. Paralysis
    10. Shortness of breath
    11. Increased heart rate or irregular pulse
    *special attention should be paid to young infants within the first 5 days of illness.
  • Sterilizing at home:
    1.Aldehydes and halogen-based disinfectants (such as commercially available chlorine bleach) can deactivate enterovirus activity. Try adding bleach into your laundry loads.
    2. Making disinfecting spray:
    mix 1 tbsp / 15~20mL household bleach (usually sold in 6% to 7% concentrations) in 5 L tap water and divide into appropriate size spray bottles
    3. Dry heat weakens and shortens the lifespan of the virus. Cook food thoroughly. Wash clothes with hot water and put the dryer on highest heat setting.
    4. UV (ultraviolet) light diminishes viral activity. Try drying cleaned objects in the sun.

Cellulitis Care in Children

  • Cellulitis is a common but potentially serious bacterial infection of the skin and the deeper tissues beneath. It is most common in the lower legs although it can occur anywhere on the body or the face. It may also extend directly from a wound or somewhere near a wound.
  • Cellulitis appears as a swollen, red area of skin that feels hot and tender. Sometimes, pus or blisters may develop causing localize pain. It might cause fever, chills, malaise, or joint pain. Left untreated, the spreading infection can rapidly turn life-threatening.
  • Fever management:
    1. Fever when armpit temperature is over 37.5ºC or anal, forehead, or temporal temperature is over 38ºC.
    2. When your child has chills, keep him/her warm by adding another blanket or elevating the thermostat temperature. Do not give him/her an ice pillow.
    3. If your child has fever but the limbs are warm, give him/her a warm bath (water temperature 26~36ºC).
    4. Encourage your child to drink plenty of water to prevent dehydration. Dry off the sweat immediately. Do not wear too many layers of clothes or use too many blankets.
    5. Fever medication (antipyretics) may be given when the child’s temperature is above 38.5℃. Repeat if necessary with at least 4 to 6 hours between the antipyretics. If your child has a history of febrile convulsion, use antipyretics at a lower temperature to help prevent convulsion.
    6. Antipyretics usually need around 30 minutes to work. You may check your child’s body temperature every hour until the fever has reduced.
    7. Take antipyretics as instructed. Do not take aspirin.
  • IV (intravenous therapy) and IV pump care:
    1. Keep the dressing and injection cannula (the small plastic tube which is inserted into the vein) clean and dry.
    2. Periodically check that the the distal extremities (far end of the limb with the injection; ie. fingers or toes) that they are warm and pink.
    3. Keep the injected limb lowered to avoid IV fluid or blood refluxing into the tubes.
    4. Do not adjust the IV rate or touch the buttons of the pump by yourself. Inform the staff if you think adjustment is needed.
    5. The IV pump has a rechargeable battery. You may remove the electric the charging cable when walking around. Please keep the cable plugged in when possible.
    6. Gently compress the injection site for 1~3 minutes with a sterile cotton ball after the cannula has been removed. Remove the cotton balls if there is no more bleeding.
    7. If any of the following conditions occur, please inform the nursing staff:
    (1)Pain, swelling, redness, or wetness at the injection site.
    (2)Painful or reddening of the skin after the cannula was removed.
    (3)You heard the sound of pump alarm.
    (4)Your child needs a shower or change the clothes.
  • Always wash your hands before and after touching a sick child to prevent spreading the disease.
  • Keep the infected limb elevated to help reduce swelling.
  • Ice packing the site may mediate the pain and swelling.
  • Check the infected area for changes in wound healing, redness, swelling, or discharge.
  • Wound Care:
    1. In a circular motion starting from the center working outwards, clean the wound with a swab soaked with sterilized saline or water to remove any debris or discharge.
    2. Using a different swab, apply non-alcoholic Betadine over the wound in the same motion; wait about 30 seconds to dry and disinfect.
    3. Use a different swab again soaked in in sterilized saline to remove the Betadine.
    4. Cover the wound with sterile gauze.
  • Take a sponge baths to avoid getting the wound wet.
  • Practice good personal hygiene to prevent further damage to the skin. Avoid scratching which may cause skin breaks furthering skin infection.
  • All wounds no matter how small may lead to infection if not treated properly.
  • If no restrictions, consider a high protein diet to improve immunity and promote wound healing.
  • See a doctor as soon as possible if there is persistent high fever, progressive swelling of the infected area, or appearance of purulent secretions.

Managing Febrile Convulsion in Children

  • A febrile seizure or febrile convulsion, is a seizure associated with fever which occur in children between the ages of 6 months and 5 years. The seizure may be over the whole body or may be only on a single limb and the child loses awareness during the episode. Most seizures occurs within 24 hours of the fever, are less than five minutes in duration, and the child is completely back to normal within sixty minutes of the event.
  • Febrile convulsion seldom result in any short or long term neurological problems or epilepsy. Parents or caretakers should not panic during an episode. Place the child in a safe place (bed or on flat ground) and rotate the child onto his/her side. Clear out his/her mouth if there is vomiting. Do NOT put anything in the child’s mouth. Give rectal suppository fever medications.
  • Seek immediate medical if there is the following conditions:
    1. Seizure continues for more than 5 minutes
    2. Patient remains unarousable for a long time after seizure subsides
    3. Persistent vomiting
    4. Complaints of severe headache
    5. Neck stiffness
    6. Fever unresponsive to medications
    7. Weakness or numbness of a limb after seizure episode

Acute Gastroenteritis (Stomach Flu) Management in Children

  • Reduce food intake during acute stage (the first few days of the illness when symptoms are prominent) but do allow your child to eat in small frequent meals as long as symptoms are not worsening.
  • Withhold antidiarrheal medications when diarrhea subsides.
  • Make sure your child is taking enough fluids. Give water, sports drinks, or clear broths. Juice and soft drinks should be avoided.
  • Avoid drinking milk and soy product. Stay away from fried, greasy, or strong flavored foods.
  • The best foods for your child are easily digestible foods, such as rice cereal, pasta, breads, cooked beans, mashed potatoes, cooked carrots, applesauce, and bananas.
  • Stop feeding if there is vomiting. Rest for a few hours then try again.
  • To prevent catching or spreading the virus, always wash hands thoroughly especially when eating and handling food, use separate personal items around your home, disinfect hard surfaces such as counters, doorknobs, faucets, separate raw food and from, practice good kitchen hygiene and separate raw from cooked food.
  • Mild diarrhea may persist for a few days. Allow your child rest and continue to observe for symptom changes. Please return to the hospital as soon as possible if there are following symptoms:
    1. Worsening vomiting or diarrhea
    2. Signs of dehydration (e.g. decreased urine output, dry sticky tongue)
    3. Shock or loss of consioucness
    4. Persistent abdominal pain
    5. Irritable unconsolable crying
    6. Abdominal pain shifting to the right lower abdomen
    7. Decreased activity, very poor appetite, or complaints of weakness and fatigue

Managing Children with Colds

  • More than 200 different viruses can cause this infection, but the rhinovirus is the most common culprit. Antibiotics, which fight bacteria, won’t treat your child’s cold. Except in newborns, colds in healthy children aren’t dangerous. They usually go away in 4 to 10 days without treatment.
  • Sometimes, there may be intermittent fever for 3-5 days. Try an ice pillow when the temperature is over 38℃ and there is no chills. You may give fever medications when the temperature is over 38.5℃.
  • Drink lots of warm water. Avoid eating iced, cold or sweet food and beverages. Hold off oranges and grapefruit temporarily.
  • Wear masks that cover the nose and mouth area to prevent spreading the disease and also to help minimize symptom exacerbation from cold air, dust, or cigarette smoke.
  • To allow your child’s immune system to fight off the virus, let your child get plenty of rest and give him/her more vegetables and fruits for a vitamin boost.
  • Call your pediatrician if your child doesn’t get better after a few days. Follow-up at the outpatient clinic.
  • Please call or return to the hospital as soon as possible if there are following symptoms:
    1. Persistent high fever
    2. Poor activity or extreme fatigue or poor appetite
    3. Hacking cough
    4. Too much thick yellow or green sputum

Oral Ulcer Management in Children

  • Oral ulcers may occur at all ages, and there are multitudes of causes:oral trauma, recurrent stomatitis, vesicular stomatitis, chickenpox, hand foot and mouth disease (enterovirus), bacteria, fungi, gastrointestinal diseases, autoimmune disease, etc… Oral ulcers may easily relapse but will usually heal within 5-10 days without leaving a scar.
  • Oral ulcer care:
    1. Make observation of the changes of the oral ulcers at least once everyday.
    2. Practice good oral hygiene. Use a soft toothbrush or a gauze wrapped on a popsicle stick and clean the mouth and teeth with normal saline or boiled water. This will help promote wound healing and prevent bad breath from bacterial growth.
    3. Drink or gurgle directly from a cup instead of a straw to avoid contact pain from the straw or wound irritation from sucking motion.
    4. Cool soft diet will reduce the painful sensation during swallowing. Try ice cream, yogurt, jelly, cold milk, or flan. Avoid strong flavored or stimulating foods that are sour, spicy, bitter, or too sweet.
    5. Try lip balms or vaseline to moisten the lips.
    6. Eat frequent small meals. Do not force feed.
    7. Always practice good hygiene. Gently wipe off drool with wet towelette. Always wash your hands before and after touching your child.
  • Oral drug application:
    1. If prescribed, use the oral anti-inflammatory spray 30 minutes before eating.
    2. When applying oral cream, gently dab a small amount of the cream with a small spatula or Q-tip on the affected areas. Do not rub as it may cause painful irritation.

Managing Cough in Children

  • Drink warm water to help relieve itchy throat. Take small slow sips to avoid coughing.
  • Avoid eating iced, cold or sweet food and beverages. Hold off oranges and grapefruit temporarily.
  • Wear masks that cover the nose and mouth area to prevent spreading the disease and also to help minimize symptom exacerbation from cold air, dust, or cigarette smoke.
  • Take medicine as instructed and follow up at the outpatient department as scheduled.
  • See a doctor as soon as possible if there are the following symptoms:
    1. High or persistent fever unresponsive to medication
    2. Wheezing
    3. Large amounts of purulent yellowish sputums
    4. Severe dry cough
    5. Lips or nails turning blue or gray
    6. Coughing blood
    7. Coughing with diarrhea
    8. Traveling to areas with known active epidemics
    9. Symptoms continues to worsen despite having seen a doctor

Croup Management

  • Croup is a common respiratory problem in young children. It usually occurs a few days after the start of a cold and is usually caused by the same viruses that cause the common cold.
  • Your child may have symptoms of a hoarse voice, a harsh bark-like cough, and possibly wheezing upon inhaling or even appears to have some difficulty breathing. The symptoms are caused by the swelling and narrowing of the voice box, windpipe, and breathing tubes that lead to the lungs filled with mucous, compressing the air current resulting in the scary breathing sounds.
  • Croup mostly occur during the winter season and may suddenly attack at night causing poor sleep, barking cough, hoarse voice and wheezing.
  • In addition to medicines, inhaling cold damp air will help open up the breathing tubes. Try letting your child breathe in a face steamer or running a hot shower to create steam and let the bathroom fill with steam then have your child breathe in the moist air for 10 to 15 minutes.
  • Try to stay calm during an attack, and soothe your child. Your child’s crying can make the swelling in the windpipe worse and make it even harder to breathe.
  • If your child continues to have difficulty breathing or the symptoms have not improved 30 minutes after an attack, go to the emergency room immediately.

Asthma Management in Children

  • To prevent asthma attacks, take medication regularly and avoid contact with allergens such as cigarette, pollen, cold air, dust, and pets.
  • On days when there is a large temperature difference, wearing masks and scarves will help prevent asthma attacks.
  • During flu season, avoid public or crowded places with poor ventilation.
  • Exercise regularly and eat a balanced diet.
  • Always carry your asthma medications with you at all times in case of exacerbation. Take the medications according to doctor’s instructions.
  • If there is sustained high fever, cough, yellowish sputum, difficulty breathing, or when the inhalor cannot effectively relieve the symptoms, return to the hospital as soon as possible.

Fever Management in Children

  • Let your child rest. Give him/her plenty of water, juice, or sports beverages.
  • Dry off the sweat immediately. Do not wear too many layers of clothes or use too many blankets.
  • Adjust the thermostat to a comfortable temperature. Take medicine as instructed and prescribed.
  • Take your child’s temperature every 4 hours.
    1. If the ear temperature is above 39ºC but there is no chills, try using an ice pillow or draw a warm bath (water temperature 30-34ºC).
    2. If the ear temperature is above 38ºC, consider taking oral fever drugs (antipyretics) if instructed by the doctor.
    3. If the ear temperature is above 38.5ºC, consider using an anal suppositories antipyretic. Suppositories should only be used every 4-6 hours. Keep them suppositories stored in the refrigerator.
    4. If your child has a history of febrile convulsion, use antipyretics at a lower temperature to prevent convulsion.
  • Antipyretics usually need around 30 minutes to work. You may check your child’s body temperature every hour until the fever has reduced.
  • Do not give aspirin to a child under 18 years of age because of the risk of Reye’s syndrome, a dangerous brain disease.
  • Please remain clam when your child has a fever. Be aware of your child’s activity and appetite. When in doubt, call the hospital for further information or whether your child may need to be brought to the the emergency department. Otherwise, follow up at the pediatrics department.
  • Bring your child to the hospital as soon as possible if there are the following symptoms:
    1. Persistent high fever unresponsive to antipyretics
    2. Headache or neck stiffness
    3. Difficulty breathing
    4. Large amount of yellow sputum
    5. Loss of appetite or barely eating
    6. Intense fatigue or poor activity

Abdominal Pain Care in Children

  • Take your child to the emergency department if there are the following symptoms:
    1. Sudden onset of severe unrelenting abdominal pain
    2. Your baby cries upon being touched on his/her abdomen
    3. There is a mass in your child’s inguinal area
    4. Persistent abdominal pain with an evidently worse pain over his/her right lower abdominal area
    5. Severe pain with nausea or vomiting
    6. A stiff tense abdomen
    7. Bloody diarrhea with nausea and vomiting
  • Take medication as instructed.
  • Eating small meals. Do not eat strong flavored or stimulating foods such as spicy, sour, or deep-fried foods.
  • When there is severe nausea/vomiting or abdominal pain, temporarily hold off any eating or drinking until the symptoms have improved.

Self Care with the Flu (Influenza)

  • The flu is caused by influenza viruses A and B. There are different strains of the flu virus every year. The flu causes a fever, body aches, a headache, a dry cough, and a sore or dry throat. You will probably feel tired and less hungry than usual. The symptoms usually are the worst for the first 3 or 4 days. But it can take 1 to 2 weeks to get completely better.
  • Most people get better without problems. But sometimes the flu can lead to a bacterial infection, such as an ear infection, a sinus infection, or bronchitis. Less often, the flu may cause a more serious problem, such as pneumonia. Certain people are at higher risk of problems from the flu. They include young children, pregnant women, older adults, and people with long-term illnesses or with impaired immune systems that make it hard to fight infection.
  • After being diagnosed with the flu but have no complications necessary for admission, return home and rest, drink plenty of fluids, and take medicine to lower your fever. Wear a surgical mask as soon as your diagnosis is confirmed to help prevent spreading the virus.
  • During this period, avoid going to public areas with large crowds or using the mass transport system. Avoid close contact with others including your family or those living with you. Maintain a distance of at least 1 meter if possible when talking to others. Let those who have close contact with you aware of flu symptoms so that they may seek medical help when necessary.
  • All patients and family members should practice proper personal hygiene even more frequently, especially in terms of hand washing and personal respiratory tract protection:
    1. Wear masks if you have cough or other respiratory symptoms. Change your mask frequently and throw out the old one as soon as it is contaminated with your oral and nasal secretion.
    2. Wash your hands immediately and thoroughly if there is any possible contact with your respiratory secretion.
    3. Use a facial tissue or handkerchief to cover your nose and mouth when sneezing. You may use your sleeves as cover if there is no available tissue of handkerchief. Change into clean clothes at least once a day.
  • Return to the hospital as soon as possible if there are the following symptoms:
    1. Feeling out of breath (during exercise or even at rest)
    2. Difficulty in breathing
    3. Cyanotic change (hypoxia: turning purple or blue around the mouth)
    4. Coughing blood
    5. Chest pain
    6. Abnormal or loss of consciousness
    7. Persistent high fever for more than 3 days despite fever medication
    8. Shock or low blood pressure
  • In addition to the above symptoms, bring your child to the hospital as soon as possible if there is also any of the following symptoms:
    1. You have difficulty waking your child
    2. Decreased activity or motivation to play
    3. Poor appetite and decreased urine output
  • The sensitivity of the influenza rapid test in our hospital is approximately 69%. However, the test result is only a reference and the choice of treatment should still depend on the physician and the clinical presentation and condition of the patient.
  • Patterns and epidemic of the influenza virus changes seasonally. For more updated information, please visit the global information network of the center for disease control at http://www.cdc.gov.tw/.
  • Some antiviral medicines reduce the severity and shorten the duration of flu symptoms by 1 to 1½ days if given within 48 hours of the first symptoms. These medicines are not intended to substitute for getting a flu vaccine each year.
  • For patients taking Oseltamivir
    1. Take the appropriate dosage correctly and completely to prevent developing drug resistance and ineffective or incomplete treatment effect.
    (1) Adults:twice a day, one capsule a time (75mg capsule) everyday for 5 days straight.
    (2) Children:dosage will depend on the child’s body weight but should also be taken everyday for 5 days straight.
    2. Possible adverse reactions and should be brought back to the hospital immediately:
    (1) Severe nausea or vomiting
    (2) There have been reports found in teenagers and adults in Japan where there were temporary psychotic behaviors like self-harm or delirium after taking oseltamivir.
    3. Please read the instructions and information provided in the medication box.
  • For patients taking Relenza
    1. Take the appropriate dosage correctly and completely to prevent developing drug resistance and ineffective or incomplete treatment effect.
    (1) Twice a day, 2 inhalations each time (2x5mg), with a total daily inhalation dose of 20mg, everyday for 5 days straight.
    2. Possible adverse reactions and should be brought back to the hospital immediately:
    (1) Patients with any history of chronic respiratory diseases should be more aware for any symptoms of bronchus spasm or difficulty in breathing.
    (2) There have been reports found in teenagers and children in Japan where there were temporary psychotic behaviors like self-harm or delirium after taking relenza.
    3. Please read the instructions and information provided in the medication box.

Understanding and Handling Dengue Fever

  • Dengue fever, also known as Breakbone fever, Dandy fever, Duengero, or Seven Day Fever Dengue Type, is an acute viral infection spread by mosquitoes. If the illness develops into severe complications, it is called Dengue Hemorrhagic Fever or Dengue Shock Syndrome.
  • Dengue Fever in Taiwan, caused by the dengue virus, are carried by the mosquito species Aedes aegypti and Aedes albopictus (also called the Asian tiger mosquito). There are 4 different serotypes of dengue virus, type I, II, III, and IV.
  • The primary form of Dengue Fever is characterized by a skin rash and a high fever (≧ 38 ℃) with severe pain in the head, the eye sockets, the muscles, the bones and joints. Other symptoms may include shaking chills, diarrhea, and vomiting. Bouts of extreme exhaustion may last for months after the initial symptoms.
  • The secondary from of Dengue Fever is the Dengue Hemorrhagic Fever or Dengue Shock Syndrome which happens when people with weakened immune systems as well as those with a second or subsequent dengue infection are believed to be at greater risk for developing dengue hemorrhagic fever. Warning signs include abdominal pain or tenderness upon touch, persistent vomiting, drowsiness or irritability, bleeding (e.g. bleeding gums, nosebleeds, vomiting blood, black or bloody stools), patches of unknown cause of skin bruising, or low blood pressure and shock.
  • After being bitten by a dengue virus carrying mosquito, a patient may remain asymptomatic for 3 to 8 days (up to 14 days). The patient becomes contagious from 1 day prior to symptom onset up to 5 days after symptoms have developed. Thus during this time, if the patient gets bitten by a Aedes aegypti or Aedes albopictus mosquito, the mosquito will carry the virus in a transmissible state and pass to others when bitten.
  • Protect yourself and make efforts to keep the mosquito population down:
    1. Home:
    (1) Install screen doors
    (2) Use mosquito coils or mosquito lamp
    (3) Put up mosquito nets around the bed
    (4) Clear vector breeding sources (ie. any stasis water pools including pans under pots, old tires, buckets left out, etc…) and practice “scan, empty, clean, brush” frequently by looking for possible breeding grounds and emptying the water and cleaning and brushing out the
    2. When going out, wear light-colored long-sleeved clothing and apply insect repellents to any exposed parts of the body.
    3. Patients with dengue fever should be extra cautious within the first 5 days after symptom onset of preventing any more mosquito bites.
  • Patients who are confirmed or suspected to have been infected by the Dengue virus but do not need to be admitted must follow-up at the Infectious Diseases Outpatient department as scheduled.
  • Please return to the hospital if there are the following symptoms (possible development into complicated Dengue Hemorrhagic Fever):
    1. Symptoms worsening
    2. Persistent worsening symptoms even after fever subsided
    3. Severe abdominal pain
    4. Persistent vomiting
    5. Cold clammy extremities
    6. Extreme fatigue
    7. Irritability and restlessness
    8. Spontaneous bleeding (such as bloody stool or brown vomit)
    9. No urination for more than 4 to 6 hours

※Please call the 24-hour toll-free Infectious Disease Prevention hotline 1922 or a local department of health for any questions or more information.

Understanding Avian Flu H7N9

  • Avian flu or bird flu is caused by a type of influenza virus that rarely infects humans. More than a dozen types of bird flu virus have been identified, including the two strains that have most recently infected humans — H5N1 and H7N9.
  • Bird flu occurs naturally in wild waterfowl and can spread into domestic poultry, such as chickens, turkeys, ducks and geese. The disease is transmitted via contacting with or inhaling an infected bird’s feces, or secretions from its nose, mouth or eyes.
  • The virus can be dormant in an infected person for up to 10 days with a median of 6 days. Afterwards, symptoms of common flu may occur including fever, cough, sore throat, and muscle aches.
  • How bird flu is treated depends on what the virus is doing to your body. In some cases, antiviral medicines may help you feel better. In such cases, antiviral drugs such as oseltamivir (Tamiflu) and zanamivir (Relenza) may be prescribed.
  • In a few cases, bird flu was passed from one person to another person, not from a bird to a person. But this was very rare. Experts also worry because the bird flu virus is so different from other flu viruses that our bodies do not have immunity against it.
  • Practice good hygiene and common sense as dealing with any type of contagious diseases.
    1. Wash your hands. This is one of the simplest and best ways to prevent infections of all kinds. Use an alcohol-based hand sanitizer containing at least 60 percent alcohol when you travel.
    2. Cover your mouth and nose when you cough or sneeze. If flu symptoms occur, wear a mask and get plenty of rest. Call or go to the hospital if there are any concerns.
    3. Avoid cross-contamination when in the kitchen. Use hot, soapy water to wash cutting boards, utensils and all surfaces that have come into contact with raw poultry. Wash your hands immediately afterwards.
    4. Cook food thoroughly. Cook chicken until the juices run clear, and it reaches a minimum internal temperature of 74℃.
    Steer clear of raw eggs. Because eggshells are often contaminated with bird droppings, avoid foods containing raw or undercooked eggs.
    5. Maintain proper personal hygiene habits, balanced diet, adequate exercise and rest.
  • In areas or countries with known or suspected bird flu:
    1. Avoid contact with birds and their secretions. Do not buy from unknown sources or breeding or smuggled birds.
    2. Avoid poultry farms, poultry-processing factories or plants, open-air markets, and close contact with chickens, turkeys, or ducks.
    3. Stay away from open-air markets where live birds are sold.
    4. If you’re traveling to Southeast Asia or to any region with bird flu outbreaks, practice self isolation for 10 days. Check your body temperature everyday in the morning and the afternoon for at least 10 days. Go to the hospital as soon as possible if there are any flu symptoms and mention your travel history promptly.
    5. If there is known contact with birds or traveling to areas with bird flu outbreaks, seek medical treatment if there is any fever, sore throat, cough, conjunctivitis or other symptoms. Wear a mask and take the initiative to inform the medical staff of related contact history, job content or any relevant information.
  • If you have been diagnosed with bird flu but do not need admission, return home immediately and practice self isolation. Take medicine as prescribed and do not stop medication unless instructed, especially if there are antiviral drugs.
    If symptoms progress or worsen (e.g. chest tightness, difficulty breathing, conscious change), go to the hospital right away.
  • Avoid visitors during hospitalization.

Underage Pregnancy Advisement

  • If there is any questions or in case of emergencies, please call the Underage Pregnancy Hotline at 0800-25-7085.
  • Under the regulations of Taiwan Ministry of Health and Welfare, hospitals are required to report to the ministry of any teenage pregnancy. Thus, if you are unwilling to accept on the behalf of the hospital to fax or fill this form, you may take home this form own for future reference when you seek further assistance.
  • For more information, please visit the Health Promotion Administration, Ministry of Health and Welfare website (http://www.bhp.doh.gov.tw)

Seizure Management

  • During the seizure, help the patient to lie down with his/her head turned to one side to prevent choking in case of vomiting.
  • Do not try to pry open the patient’s mouth if his/her jaws are locked even if the patient is biting his/her tongue. Do not try to put something in the patient’s mouth as you might get bitten in the process, break the patient’s teeth, or the object may break then cause the patient to choke or aspirate.
  • Do not try to hold the patient down or try to restrain the patient. Help the patient sit or lie down in a safe are on the floor and remove any dangerous materials or furniture that may be dangerous to the patient.
  • Observe and record the time of onset of the seizure, the seizure behaviour (e.g. shaking or flexing over which leg/arm, eyes rolling back, drooling, head cocked to one side, urination, etc…), and the duration of the episode to help the physician understand the patient’s condition and facilitate treatment and diagnosis.
  • Bring the patient to the hospital immediately or call the emergency medical service for assistance.
  • Patients with prior seizure history should take medication as prescribed and instructed. Practice good self care to avoid infections and fever. Avoid intense sound and light. Avoid drinking alcohol and have a balanced diet and adequate sleep. Follow-up at the neurology out-patient department regularly.

Allergy Home Care

  • Rest. Adjust the room to a comfortable cool temperature.
  • Avoid known and possible allergens.
  • If there is no more edema, drink more water to help metabolize the histamine in your system. Take medicine as instructed.
  • Keep your skin clean by only using lukewarm water. Avoid hot water and fragrant soap with lots of additives. Use gentle mild soap.
  • If there is itching, ice packing may help relieve symptoms. Do not scratch your skin which may cause secondary in faction from skin abrasion and small wounds. Wear loose-fitting lightweight clothes.
  • Call or go to the hospital if there are the following symptoms:
    1. Dizziness
    2. Wheezing
    3. Trouble breathing
    4. Tightness in the chest
    5. Swelling of the tongue, lips, or face