Meghan Cantrell
07/06/2016
NUR 105
Case Study
1. NPO status ensures that the stomach as minimal volume of gastric secretions. NPO status decreases the risk of aspiration. ALL same day surgery patients must receive written and oral instructions about when to begin NPO status. ASA recommends 6 or more hours for solid food and 2 hours for clear liquids. ( Ignatavicius, 2013, pg 228)
2. The patient has a history of Type 2 Diabetes that is controlled by 5 mg Metformin twice daily. Metformin should be stopped 24 hours before surgery and restarted only after kidney function is normal. Patient last dose was @ 1800 previous evening. Patient blood glucose level was 280 this morning. Surgeon needs to be notified of patients medical history and glucose reading.
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Surgery can also cause a stress response in the body causing counter regulatory hormones to elevate blood glucose. Stress hormones suppress insulin action which increases risk for Ketoacidosis. ( Ignatavicius, 2013, pg 1324)
3. The patient is going to undergoing an urgent surgery. The patient should understand the surgical procedure explained by the surgeon. The patient should be able to : explain the purpose and expected outcome of the procedures in his/her own words, asking questions when terms or procedures are not understood, adhere to NPO requirements, state an understanding of preoperative preparation, and demonstrate post op exercises. The nurse should make sure the informed consent is signed with the client understand the reason for surgery, who will be preforming it, and risk associated with the surgery. The nurse should not provide detail information about the surgical procedure but can clarify facts and expel myths. The patient should be informed of all drains, tubes, and vascular access. A Foley may be inserted to keep the bladder empty before and after surgery. Drains may be inserted during
2013). Inappropriate use of urinary catheter in patients as stated by the CDC includes patients with incontinence, obtaining urine for culture, or other diagnostic tests when the patient can voluntarily void, and prolonged use after surgery without proper indications. Strategies used focused on initiating restrictions on catheter placement. Development of protocols that restrict catheter placement can serve as a constant reminder for providers about the correct use of catheters and provide alternatives to indwelling catheter use (Meddings et al. 2013). Alternatives to indwelling catheter includes condom catheter, or intermittent straight catheterization. One of the protocols used in this study are urinary retention protocols. This protocol integrates the use of a portable bladder ultrasound to verify urinary retention prior to catheterization. In addition, it recommends using intermittent catheterization to solve temporary issues rather than using indwelling catheters. Indwelling catheters are usually in for a longer period. As a result of that, patients are more at risk of developing infections. Use of portable bladder ultrasound will help to prevent unnecessary use of indwelling catheters; therefore, preventing
5), many hospitals in conjunction with the Joint Commission's 2012 National Patient Safety Goals has been rallying for hospitals to use evidenced-based practices (EBP) to the prevention of CAUTIs because evidence is growing showing that many are avoidable. Such practices such as utilizing a nurse-driven protocol to assess and evaluate the appropriateness and use of urethral catheter to determine how long a patient should have an indwelling catheter and when to discontinue it. Several factors have been identified that pose as risk factors to CAUTI which include but not limited to drainage bag not being below the level of the bladder, healthcare personnel not practicing standard precautions and utilizing aseptic techniques during insertion of catheters, unsterile equipment, and unnecessary placement of urinary
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Metformin is the generic name of a medication used in the management of diabetes mellitus type 2. Various trade names of this drug include Riomet, Glucophage XR, Carbophage SR, Obimet, Siofor, Fortamet, Glucophage, and Glumetza. The chemical name is 1,1-Dimethylbiguanide monohydrochloride. Doses up to 2000 mg per day may be given twice daily. The circulation of metformin is that the drug’s steady state of concentration within the blood is reached in 24-48 hours and the half life is approximately 6-1/2 hours. The nonabsorbed fraction of the dru...
If there is any pre-op for this minor surgery there really isn’t any for the patient and for the medical assistant would be to get the exam room ready and to have all of the supplies and equipment ready for the physician.
... glucose measurements. Continuation into the immediate postoperative period remains important as well. Once in a steady state, treatment ought to be converted to a subcutaneous BBI regimen. For conversion from intravenous to subcutaneous insulin, a transition protocol should be employed 124.
I noticed that Mr. X was still on normal saline 0.9% on flow, and his report from this morning showed sodium at the higher end. Since increased sodium post operative would have an impact on his blood pressure and urine output. So, I stopped the flow and informed his doctor about the fluid and discussed if we could switch it with any other fluid. He then, said to keep it in hold, and he would decide when he comes for the round by checking at his total intake output chart and his lab values if to continue or to stop. I followed his order and explained to the patient. Since, it was day 3 (usually in the day, three patients would be mobilized on a chair) so I explained to him that he would be ambulated out of bed today to make him aware of the plan and to give him time to prepare him for the upcoming plan. As first-time mobilization could be stressful for the patient and some needs more time to get themselves ready for it. I explained him that it would be done with the doctor around. As i left the patient, I made sure to keep the nurses call bell near and told him that I would be back to check on
According to the National council of state board of nursing (2005), the task should be performed if it can be performed with a predictable outcome and does not endanger a client’s life or well-being. For example, the nurse can delegate to the nursing assistant to collect and measure urine output and report it to the RN. This is a non-invasive task and would not harm the patient. However, if the patient were requiring straight catherization to collect a urine specimen, it would be delegated to the LVN since this is an invasive procedure that requires skills and knowledge of performing this procedure. Right circumstance is the next right of delegation. Even though the RN can delegate to nursing assistant to have the patient ambulate, if the patient is recovering from hip surgery and had issues with bleeding during surgery, it would not be appropriate for the nursing assistant to do. The RN should do this task, since the patient is at a risk of being unstable (NCSBN, 2005). The third right of delegation is the right person. After determining what is the task or assignment that needs to be completed, the nurse should decide who would be the best person to do it. Factors that influence the RN’s decision are the knowledge and skill of the person who is performing the task (NCSBN, 2005). Most facilities check skills at the
Neu, A; Hofer, S.E., MD; Karges, Beate; Oeverink, Rudolf; Rosenbauer, J; Holl, R.W., MD. (Sept. 2009). Ketoacidosis at Diabetes Onset Is Still Frequent in Children and Adolescents: A multicenter analysis of 14,664 patients from 106 institutions. Diabetes Care, 32(9) 1647-8. Scholarly Journals. Retrieved from ProQuest Research Library.
Additionally, the LPN cannot push medications into a peripheral intravenous line if the patient “weighs less than 80 lbs, is prenatal, pediatric, or antepartum”, although given that the situation is on a general med-surg floor it is unlikely these patients would be under Sarah’s care at this time. (Rules and Regulations of Practical Nurses. 2015) Sarah can delegate the postoperative patients who need dressing changes and ambulating them to the LPN, but Sarah should assess the wounds for complications initially and serve as resource to the LPN if she has questions about the wounds. Additionally, she could help the nursing assistant with answering calls and serve as a reference for the nursing assistant to ask questions or help with tasks if Sarah is not available. With regards to supervision, the LPN would need continuous supervision given that the working relationship is new. (Cherry and Jacob, 2014) Sarah should be available and willing to answer any questions or address any concerns the LPN
Introduction The College of Nurses of Ontario (CNO) is the governing body of all registered nurses in Ontario and is regulated. The CNO provides expectations and guidelines to follow, which need to be met by each Registered Practical Nurse (RPN) individually. As a nursing student, I am taught about the CNO and the importance of referring back to the guidelines while caring for patients. While gaining experience in the nursing field through my clinical settings, I have realized as a nursing student there are areas I need further development in. In this paper, I will address two of my learning needs and my goals for each.
Diabetic Ketoacidosis (DKA) is a serious disease with complications that may have fatal results in some cases. DKA is defined as an insulin deficiency that occurs when glucose fails to enter insulin into muscles such as: liver and adipose tissue. When there is an accumulation of ketones, it leads to metabolic acidosis which causes nausea and vomiting, as a result fluid and electrolytes are lost (Gibbs). There are many complications of diabetic ketoacidosis, some of the most prevalent are: Cerebral Edema, Hypoglycemia, and Acute Pancreatitis.
middle of paper ... ... The priority for this patient was to establish that she was fully aware of what the procedure involved and the possible risks and complications. I feel that the pre-assessment form used within the unit is far too fundamental, if elements of the roper et al activities of daily living were to be incorporated this would help in achieving a much more in-depth holistic nursing assessment enabling for the best quality and level of care to be given to all patients arriving in the unit. Whilst I feel a full nursing assessment is not fully necessary for a day case unit, as previously stated I feel that the communication element is an excellent way of ensuring a better holistic approach is achieved, it will also help to achieve better documentation and communication between all staff members.
The intervention refers to the treatment provided to the population of the study (Riva et all 2012). In this case, the intervention is the suggested compliance of the entire WHO Surgical Safety Checklist versus noncompliance or lack of completing the full checklist. Full surgical team compliance of the checklist provides safety for patients undergoing surgical procedures, appropriate team communication, and beneficial results for patients and staff. It would be advantageous, especially in emergency situations, to implement an assigned RN to be responsible for the checklist to minimize the risk of any mistakes made by the operative staff. Regardless of the severity of the emergency situation, the checklist should be evaluated in order to prevent any further complications or mistakes and to provide accurate team
The role of the nurse in the preoperative area is to determine the patient’s psychological status to help with the use of coping during the surgery process. Determine physiologic factors directly or indirectly related to the surgical procedure that may cause operative risk factors. Establish baseline data for comparison in the intraoperative and postoperative period. Participate in the identification and documentation of the surgical site and or side of body on which the procedure is to be performed. Identify prescription drugs, over the counter, and herbal supplements that are taken by the patient that may interact and affect the surgical outcome. Document the results of all preoperative laboratory and diagnostic tests in the patient’s record