Introduction: Pulmonary embolism is the most common preventable cause of hospital death and is the number one strategy to improve patient safety in hospital (Geerts et al., 2004). VTE is common among hospital inpatients and is encountered at least as frequently among medical as surgical patients (Bergmann and Kher 2005). Few studies had reported frequency of VTE in medical patients especially in ICU, although approximately 75% of fatal VTE occur among acutely ill non surgical patients (Bosker 2001, and Leizorovicz et al., 2004). VTE is contributing to approximately 10% of all hospital deaths and there is a varying reports of fatal VTE events in hospital ranging from 5-10% to 12-25% (Simonneau et al., 1997, Heit et al., 1999, and Cohen and Alikhan, 2001). Absolute DVT risk in hospitalized patients was 10-20% in medical patients and 10-80% in critical case patients (Greets et al ., 2004). In a review of 1231 patients treated for VTE, 96% had at least one recognized risk factor. Risk increased in proportion to the number of predisposing factors (Anderson and Spencer 2003). In ICU patients, risk factors for VTE include among others, illness requiring ICU, immobilization for at least three days, previous VTE, old age, cancer, CHF, and indwelling vascular catheters. All of these risk factors are present in acutely decompensated COPD patients (Leizorovicz and Mismetti 2004). There is a notable absence of guidelines for the prevention of VTE in such critically ill patients (Greets and Selby 2003). Many reports documented that thromboprophylaxis is underemployed in critically medical patients, in contrast to its practice among surgical wards (Campbell et al., 2001, Rahim et al., 2003 and Stark and Kilzer 2004). The importance o... ... middle of paper ... ...d patients compared to naïve group. There was non significant difference as regard duration of mechanical ventilation. Inhospital death rate was significantly lower in enoxaparin treated groups (tables 2, 3, 4 and 5). Bosson et al, 2003 found that thromboprophylaxis decreased significantly hospitalization period and in hospital death. They reported mortality rate to be 3.8% in patients with DVT and 38.9% in those with PE. In contrary death rate was non significantly different between patients with thromboprophylaxis and whose without difference in LOS (Gardund, 1996 and Bergmann and Kher 2005). From the previous results; it can be concluded that, thromboprophylaxis in acutely decompensated COPD patients admitted to ICU with standard prophylactic dose of enoxaparin is extremely advisable, screening for DVT using DUS is essential in such circumstances, and the fear
VAP develops in a patient after 48 hours or more of endotracheal intubation. According to a study by Relio et al. (as citied in Fields, L.B., 2008, Journal of Neuroscience Nursing, 40(5), 291-8) VAP adds an additional cost of $29,000-$40,000 per patient and increases the morality rate by 40-80%. Mechanically ventilated patients are at an increased risk in developing VAP due to factors such as circumvention of body’s own natural defense mechanisms in the upper respiratory tract (the filtering and protective properties of nasal mucosa and cilia), dry open mouth, and aspiration of oral secretions, altered consciousness, immobility, and possible immunosuppression. Furthermore, the accumulation of plaque in the oral cavity creates a biofilm that allows the patient’s mouth to become colonized with bacteria.
Introduction BiPAP is a form of noninvasive mechanical ventilation used in patients with acute respiratory failure. Many of these patients go on noninvasive ventilation due to COPD exacerbations that are infectious, with congestive heart failure, and ventilator parameters based on their clinical assessment and changes in arterial blood gases. Two different studies were conducted on COPD patients, using a BiPAP machine to improve exacerbations and their activities of daily living. There are many positive outcomes for using these noninvasive ventilators, however when used incorrectly, negative outcomes or no changes at all are always possible. Positive Use for COPD Exacerbations
On May 20th, the patient, Mr. Ard, experienced nausea, shortness of breath, and pain while being treated in the hospital (Pozgar, 2014). The patient’s wife, Mrs. Ard, attempted many times to reach a nurse by pressing the nurse call button (Pozgar, 2014). Once the nurse finally responded, anti-nausea medication was administered (Pozgar, 2014). Mrs. Ard continued to monitor her husband’s situation, and felt as if the nausea and shortness of breath were getting worse (Pozgar, 2014). Mrs. Ard continued to ring the nurse call button for approximately 1.25 hours prior to a response from a nurse (Pozgar, 2014). A code was called, and Mr. Ard did not survive (Pozgar, 2014).
Introduction : Mrs Dorothy Beecham has been admitted to hospital with community –acquired pneumonia and query DVT. She is currently on waiting list of total knee replacement. Her past medical history including cardiovascular disease, COPD, osteoporosis, varicose vein and recurrent DVT in the past two years. A blood test has been done and result is available. DVT on her right calf is also confirmed by Doppler ultrasound. This article is going to explain the future risk of how recurrent DVT going to impact on her health by use literature and relevant pathophysiology knowledge. At the same time, a patient education plan will be established for supporting care needs. This care plan including the symptoms of recurrent DVT and when to seek for medical advice after Dorothy after her discharge from hospital.
Featherstone, P., Prytherch, D., Schmidt, P., Smith, G. (2010). ViEWS: towards a national early warning score for detecting adult inpatient deterioration. Resuscitation, 81(8), 932-937.
potentially an avoidable condition presenting most often in high risk patients such as elderly and those with physical impairments, therefore carrying out risk assessments could potentially prevent them, the a...
Within the intensive care population, the use of prophylactic treatment is used to prevent the risk of venous thrombosis. These patients in particular are at a greater risk for developing thromboembolism due to heightened immobility. The increased risk of venous thrombosis occurs in this population due to the use of mechanical ventilation, sedation and paralytics (Cook & Crowther, 2010). Venous thrombosis can significantly increase the risk of a patient developing a pulmonary embolism. Additionally, it can create long term impacts such as post-thrombotic syndrome. This syndrome occurs twenty to fifty percent after the development of the thrombosis. This can have momentous impacts on individual’s ability
Ventilator-associated pneumonia (VAP) is one of the most common nosocomial infection associated with increased morbidity and mortality. It is recognized that 36-60% of all health associated infection-related deaths are attributable to VAP (Gupta et al, 2016). Ventilator-associated pneumonia is a lung infection that develops in a person who is on a ventilator for more than 48 hours, usually patients in the intensive care unit (ICU) at a hospital. A ventilator is a machine that is used to help a patient breathe by giving oxygen through a tube placed in a patient’s mouth or nose, or
Each year this panel of experts put a microscope on patient safety across the board. They decide where upmost attention needs to be paid. Sometimes items leave the list because there are been strides take to improve in that area and sometimes it continues to stay on the list because they believe the relevance and importance is growing. Healthcare is evolving b...
In septic patients, increased levels of PAI-1 inhibit plasminogen activator (t-PA), which converts plasminogen to plasmin. Release of fibrin inhibits fibrinolysis by activation of thrombin-activatable fibrinolysis inhibitor (TAFI). In addition, the release of PAF causes platelet aggregation. This combination of inhibition of fibrinolysis, fibrin strand production and platelet aggregation contribute to a state of coagulopathy. This can lead to microcirculatory dysfunction with isolated or multiple organ dysfunction and cell death. Mr Hertz’s coagulation profile showed a fibrinogen level of 5.6 g/L, indicating that coagulopathies were underway in his system.
Ventilator-associated pneumonia is the most common and deadly healthcare associated infection, affecting up to 28 percent of ventilated patients. VAP is estimated to occur is 9-27 percent of all mechanically ventilated patients, with the highest risk being early in the course of hospitalization. VAP rates range from1.2 to 8.5 per 1000 ventilator days and are reliant on the definition used for diagnosis. Early onset VAP is defined as pneumonia that occurs within four days and this is
With patient safety always being the number one priority FTR is the worst case scenario for the hospitalized patient. In an article titled “Failure to Rescue: The Nurse’s Impact” from the Medsurg Nursing Journal author Garvey explains ways FTR can occur “including organizational failure, provider lack of knowledge and failure to realize clinical injury, lack of supervision, and failure to get advice.” Nurses are problem solvers by nature, they heal the sick and help save lives. FTR is a tragic experience for everyone involved. The recent surge in this happening across the country has given FTR cases widespread media coverage. Hospitals are trying to figure out what the root cause is and how they can be prevented. Fortunately, with the advancement of technology and extensive research many hospitals have developed action plans and procedures to help prevent the early warning signs from being
Sepsis is defined as a systemic inflammatory response caused by an infective process such as viral, bacterial or fungal (Holling, 2011). Assessment on a patient and starting treatment for sepsis is based on identifying several factors including the infective source, antibiotic administration and fluid replacement (Bailey, 2013). Because time is critical any delay in identifying patients with sepsis will have a negatively affect the patients’ outcome. Many studies have concluded every hour in delay of treatment mortality is increased by 7% (Bailey, 2013). Within this assignment I will briefly discuss the previous practice and the recent practice including the study based on sepsis. I will show what enabled practice to change and I will use the two comparisons of current practice and best practice.
Hinkle, Janice, and Kerry Cheever. “Management of Patients with Chronic Pulmonary Disease." Textbook of Medical-Surgical Nursing, 13th Ed. Philadelphia: Lisa McAllister, 2013. 619-630. Print.
Patient safety must be the first priority in the health care system, and it is widely accepta-ble that unnecessary harm to a patient must be controlled.Two million babies and mother die due to preventable medical errors annually worldwide due to pregnancy related complications and there is worldwide increase in nosocomial infections, which is almost equal to 5-10% of total admissions occurring in the hospitals. (WHO Patient Safety Research, 2009). Total 1.4 million patients are victims of hospital-acquired infection. (WHO Patient Safety Research, 2009). Unsafe infection practice leads to 1.3 million death word wide and loss of 26 millions of life while ad-verse drug events are increasing in health care and 10% of total admitted patients are facing ad-verse drug events. (WHO Patient Safety Re...