Coronary angioplasty is a medical surgery used to treat coronary heart disease. During the surgery, a stent is placed inside patient’s coronary artery in order to stretch the artery open, thus improving blood flow. However, post angioplasty procedure may leads to other postoperative complications which requires critical care. Some examples of postoperative complications are haematoma, bleeding and occlusion of vessel or thrombus. Management of complications involves several nursing assessments such as, vital signs, neurovascular observation, pain and puncture site assessment (Rassaf, Steiner, & Kelm, 2013, p. 75). Hence, it is important to check up on patient routinely to avoid complication and prioritised care when necessary. In the simulation, …show more content…
His blood glucose level indicated 10mmol/L. Mr Harry Bright was evaluated with PQRST assessment and was administered sublingual nitro-glycerine spray and morphine for his chest pain. The quality of his pain is in his chest and the region of pain was radiating down his arm and jaws. The pain started at 4 or 5 minutes after the nursing handover and the severity of the pain was 6 out of 10. During his episode of chest pain, the medical officer was contacted to inform his chest pain and to confirm his medication prescribed. Then, the patient mentioned pain in his right groin where neurovascular observation was performed. The affect limb appeared pallor, polar, paraesthesia, and pulselessness and the patient stated numb, pin and needle sensation. The patient was repositioned with his head of bed elevation below 30 degrees due to discomfort and his metformin tablet was not administered. His puncture site have only minimal amount of oozing, no swelling or haematoma. My only concerns is that he may have an occlusion vessel in his limb based on the observation and assessment
Firstly, we have to understand the primary roles of an ODP which is to plan, assess, and deliver patient care along with an evaluation of the patient throughout the procedure. One of the main stage to always look out for is patient care based on both sides anaesthetic and surgical in order for this a satisfactory level of knowledge and understanding is required to work in a Peri-operative environment. All aspects of patient care starts directly from when they first arrive to the reception until the hand over care of the patient to the designated healthcare professional. Preparation of
The staff believed the patient’s altered behavior was due to the possible drug withdrawals. While the symptoms are similar, there are distinct differences between hypovolemic shock- secondary to blood loss, and acute opiate withdrawals. With a thorough exam, the staff should have been able to recognize this difference. The Clinical Opiate Withdrawal Scale, (Wesson, D. R., & Ling, W., 2003) would have been the proper objective measurement tool to be able accurately, assess the patient. Another breach of duty was not getting the CT scan down in an appropriate amount of time. The physician had a high index of suspicion that the patient was bleeding internally, yet the CT was not completed until the following morning. Lastly, the patient admitted to a substance abuse problem, yet a drug screen was not ordered. If it had been, they would have seen there were no opiates in his system and he was positive for alcohol and benzodiazepines.
During my morning rounds I began my assessment of Mrs. M., and I noted that she had shortness of breath and she was making gurgling sounds. I immediately auscultated her lungs and noted bilateral wheezing throughout all fields, her heart was irregular and rapid and she had 2plus pitting pedal edema. I noticed she had an IV running at 125ml/hr, which I quickly stopped. The patient did not have orders for IV fluid there was only an order to KVO. I raised the head of the bed and paged respiratory to the floor.
What? The patient is 65-year-old man Mr. John Douglas who is suffering from dysphagia and have been admitted to the surgical ward for insertion of a percutaneous endoscopic gastrostomy (PEG). Apart from that, he is a Type 1 diabetes patient and has weakness in his right leg and arm because of right-sided hemiplegia. He is thin in appearance and has stage 1 pressure sore on his right heel.
On admission, a complete physical assessment was performed along with a blood and metabolic panel. The assessment revealed many positive and negative findings. J.P. was positive for dyspnea and a productive cough. She also was positive for dysuria and hematuria, but negative for flank pain. After close examination of her integumentary and musculoskeletal system, the examiner discovered a shiny firm shin on the right lower extremity with +2 edema complemented by severe pain. A set of baseline vitals were also performed revealing a blood pressure of 124/80, pulse of 87 beats per minute, oxygen saturation of 99%, temperature of 97.3 degrees Fahrenheit, and respiration of 12 breaths per minute. The blood and metabolic panel exposed several abnormal labs. A red blood cell count of 3.99, white blood cell count of 22.5, hemoglobin of 10.9, hematocrit of 33.7%, sodium level of 13, potassium level of 3.1, carbon dioxide level of 10, creatinine level of 3.24, glucose level of 200, and a BUN level of 33 were the abnormal labs.
In the medical profession, personnel are asked to make judgments or draw conclusions based on measureable results. Physical assessments, vitals, CT scan, MRI, biopsy are all activities engaged in to prove abnormalities and make decisions as to the way forward. So having hunches are not considered reliable and rightly so. To decide to give a particular medication because of a mere hunch can lead to serious errors. However, pain which is now considered a part of the vital signs is based on the patients’ philosophy or view point and we (nurses) are told not to ignore but respond. This is highly subjective. It’s viewed how the patient sees it and not as tangible or measurable as the other ways of proving when something is abnormal. The situation to be presented will disclose a patient’s ordeal due to a nurse’s approach to or understanding of pain management. It will also assess whether the nurse responded in accordance to protocol.
The patient is a 75-year-old gentleman who presents to the ED with complaints of weakness in the left upper extremity. The symptoms began the day of presentation about 5 hours before he presented. It is continuous. He was brought in by his friend. The patient was playing cards and then felt that he was losing the cards out of his hand and he could not hold onto them. His initial examination in the ED showed that he has dysmetria as noted on the left side the mild pronator drift of the left upper extremity. His motor strength is 4/5 in the left arm. There were no other neurologic deficits. He underwent a noncontrast CT of the head the telemedicine neuroradiologist reviewed it and the determination was made to not to administer TPA.
Because I provide the surgeon with medications, hemostatic agents and irrigation solutions it is crucial to know the proper usage of each, along with the side effects, patient's allergies, and contradictions of certain medications and their reactive
Outcome measures were in the three major categories: Complications following orthopedic procedures, rate of Healthcare- Associated Infections (HAIs), and Mortality complications and process- related metrics following heart bypass. Process indicators were not used in any of published cohorts. However, a process measure related to cardiac surgical technique was used in the CABG methodology. Four structural indicators (Nurse Staffing, Nurse Magnet Recognition, Staff Intensivist, Cardiac Intensive Care Unit were employed along with a measure of Volume of Operation performed.
This 70-year-old patient who presented after what appeared to be a syncopal episode. According to her grandson the patient had a change in mental status at home she was cooking, felt dizzy, went down to sit down and slumped over. It was estimated that she was out with loss of consciousness for about 15 minutes. She was subquently brought to the emergency room. When she did awake she was somewhat confused. She has a prior history of a stroke in 2014, dyslipidemia and hypertension. Initial evaluation her blood pressure was 135/96. Her heart rate was 60. Her EKG had sinus rhythm with no significant abnormalities. Her CT of her head showed no acute mass or infarct. There was also suspicion of urinary tract infection and the patient was
Good morning, my future career will be in the medical field specifically a cardiovascular surgeon. My senior project consisted of me taking pictures and videos for the school at school events ranging from sporting events to extra curricular activities that are done at school. One must wonder how and why does photography/videography play a role in the career of a cardiovascular surgeon? Every year surgeons around the country hold conferences, and Cleveland Clinic where I would like to work is no exception, they hold these conferences to “address clinical challenges facing surgeons in the operating room, including new, innovative minimally invasive procedures, devices and techniques” (Innovations in Surgery.). Taking photos and recording surgery
In situ simulation is an efficient method to gain new technical skills and to identify and address latent safety threats in the hospital. The benefits of in situ simulation training may include lowering the cost of education, facilitate access for a greater number of health worker, and enhance patient safety (F8). Despite of extensive literature searches according to our past knowledge, little is known about influence of in situ simulation for detection of systems failures and individual related problems in Saudi Arabia. We aim to to use the already familiar environment to induce a simulated situation that might reveal systems failures such as: (delayed blood
...osition patient for venipuncture. Then check arms for suitable venipuncture site, applies tourniquet, select vein, palpates and traces path with index finger, properly clean venipuncture site with alcohol prep, anchors vein and smoothly inserts needle with the bevel up. Trying to smoothly push tube into holder without changing needle position, adjust needle if necessary to obtain flow, change tubes without changing needle position, fills tubes in correct order and level. Finally release the tourniquet before withdrawing needle, withdraw needle from arm smoothly, applies pressure to site after withdrawing needle, dispose of needle properly and carefully, check site to ascertain bleeding has stopped, label all tubes at the bedside and leave the patient courteously. Once the new hire has completed the following evaluation and passes, the person will be hires for the job.
As a medical surgical nurse you work with your patients before, during, and after surgery. Before surgery you want to explain the procedure to them and help prepare...
Time out was done by the anesthesiologist, the circulating nurse, the surgeon, and the scrub tech all pausing before the surgery and verifying the patient’s name and date of birth, the procedure being done, the site and location on the body in which the procedure was being done, and documented the count of all the equipment the scrub nurse had before surgery to compare to after surgery. 5. The patient’s privacy was protected and respected throughout the whole surgical procedure. The staff was very professional and I felt I learned a lot from them during my OR experience. 6. A sponge count is when the scrub nurse counts the sponges that are unused before the surgery she relays this to the circulating nurse and it is documented. After the surgery the count is redone to make sure that there are no sponges left in the patient. 7. The circulating nurse documents the information and signs the chart in the operating room. From pre-op to the operating room the nurses in pre-op gave off report to the circulating nurse by SBAR. From the operating room to PACU the anesthesiologist went with the patient and handed off the patient’s condition and information to the nurse in there. 8. There were no ethical or legal issues that were raised during my observation in the whole surgical process. 9. I learned how the whole operating procedure works from start to finish, all the legal paperwork involved, and how the team interacts and helps each other out to give the patient a safe and