Intraosseous route as alternative access for infusion therapy.

The safe and effective use of intraosseous (IO) access is evolving from its historical use only for emergent access for pediatric patients to use in adult trauma patients and, more recently, for adult inpatients. Current data and research support the use of IO route for infusion in patients of any age as a safe, rapid, and equally effective alternative to intravenous access. The article provides an overview of IO access indications, care, and management; describes therapies administered via IO access; and discusses the expanding use of IO access into areas within hospitals during nonemergent clinical situations.

Prune belly syndrome. A focused physical assessment.

Prune belly syndrome, a rare congenital anomaly, exists almost exclusively in males and consists of genital and urinary abnormalities with partial or complete absence of abdominal wall musculature. The syndrome, caused by urethral obstruction early in development, is the result of massive bladder distention and urinary ascites, leading to degeneration of the abdominal wall musculature and failure of testicular descent. The impaired elimination of urine from the bladder leads to oligohydramnios, pulmonary hypoplasia, and Potter's facies. The syndrome has a broad spectrum of affected anatomy with different levels of severity. The exact etiology of prune belly syndrome is unknown, although several embryologic theories attempt to explain the anomaly. With advances in prenatal screening techniques, the diagnosis and possible treatment of prune belly syndrome can occur before birth, although controversy exists on the proper management of prune belly syndrome. This article explores the theories behind the pathophysiology and embryology of prune belly syndrome and its multisystemic effects on the newborn infant. Specific attention is paid to presentation, clinical features, head-to-toe physical assessment, family support, and nursing care of infants with prune belly syndrome.