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…
Mr Harry Bright is a 65-year-old male patient who had undergo an angioplasty surgery for his right coronary artery. He is allocated to back to the ward and require critical postoperative care and assessments. During the postoperative care, the participants managed performed the correct procedure and prioritised care when necessary whilst communicated effective throughout the situation. At the start of simulation, the participants performed vital sign and puncture site assessment on Mr. Bright. Vital sign assessment is a fundamental skill for nursing care and is essential in identifying clinical deterioration. Similarity, the vital sign is important in post-angioplasty care for early detection in bleeding and other possible complications. According to Mert, et al. (2012, p. 53), post-angioplasty patients require freqent observation to detect any arterial puncture-related complications and systemic or disease –related events. An example of the complication in angioplasty is haemorrhage or haematoma at punture site, this can leads to abnomal vital sign assessment data. Haemorrhage is potientially catastrophic due to the excessive bleeding and the general theory is tachycardia, blood volume depletion and flucturing blood pressure response. However, this may be a misleading conventional wisdom because some patient may not presented the symptom of tachycardiac due to difference in individual phycological respsonses (Schultz & McConachie, 2015, p. 89). Furthermore, studies indicated patient’s vital sign did not fluctuate much during the episode of bleeding and that 59 percent of the cases with haemorrhage was dicovered through assess puncture site (Mert, et al., 2012, p. 53). Puncture site assessment is used to assess any bleeding or haematoma and other complications. It is vital to check for oozing or bleeding in pressure dressing from puncture site and assess site for redness, swelling and pain in the events of bleeding or haematoma. Hence, vital sign can be an early indication of systemic complications and site assess is necessary for checking any oozing or changes at puncture site. As a result, both assessment is critical in postoperative care in order to prevent further deterioation. During the postoperative care Mr Bright also experience groin pain, diminished pulse, and a numb, pins and needle sensation. These symptoms may be caused by localised haematoma, ischaemia and impaired tissue perfusion. The participants manage to think critically and prioritised care through proceeding neurovascular observation on patient’s leg but forgot to perform pain assessment for his groin pain. Haematoma is injury of vessel wall during catheterization and caused pooling of blood outside blood vessel (Tavris, et al., 2012, p. 7). There are different types of haematoma complication in relation to angioplasty and each complication present its own symptoms. In the event of puncture site haematoma, patient may experience pain in groin due to inflammation and swelling. Whereas, retroperitoneal haematoma can cause back or abdominal pain due to the accumulation of blood in the retroperitoneal space. These complications develop an increase in level of pain that requires pain scale assessment to make clinical decision and proceed to management. Numeric rating scale is an appropriate implementation to precisely describe, assess and document the patient’s pain. This tool can assist health practitioners with further management, reassessment and individualise the treatment, thus improved survival for patients (Wu, Dai, Kao, Chang, & Lou, 2015, p. 1). Pain scale is a valuable tool in determine the level of pain and in return health professionals can make judgements based on the data. Inadequate management of pain can result in adverse physical and psychological patient outcome. Furthermore, immune system can be suppressed by continuous unrelieved pain that result in poor wound healing, postsurgical infection. Similarly, untreated pain can further deteriorates the patient’s wound and nursing-patient relationship due to distrust, and insufficient blood flow and oxygen (Eriksson, Wikström, Årestedt, Fridlund, & Broström, 2014, p. 41). Therefore, it is important to evaluate the patient then prioritise care based on patient’s condition. In the presence of a blood clot formation at vessel access site, the affect limb will appear pallor, polar, paraesthesia, and pulselessness due to lack of blood supply and perfusion deficits. Neurovascular observation is performed to evaluate peripheral circulation, motor function and sensory. The participants assess the patient’s limb using the colour, warmth, sensation, movement, pulse strength and pain. This tool is essential in early detection of haematoma and vessel occlusion (Schreiber, 2016, p. 55). In order to prevent poor patient outcomes, judicious observations, timely identification, reporting and appropriate intervention in the event of compromise will help reduce complications. In conculsion, each assessment is designed to prevent further deterioration, helps to evaluates patient’s condition and making clinical decisions. However, it is also important to think critcally, analyse patient’s condition and sitiuation and prioritise care before applying nursing interventions in which the participant manage to achieve this and established a good communication. Introduction Hi, I’m Chia-Ying and I’m a student nursing from Queensland University of Technology. I’m currently admitted to the surgical ward and Mr Harry Bright is my patient who is a 65-year-old male. Situation I’m calling in regarding Mr Harry Bright’s situation. Mr Harry Bright had developed another episode of chest pain and abnormal finding in his neurovascular observation during his stay at surgical ward. He was given sublingual nitro-glycerine spray to resolve his chest pain and morphine relieve the pain. Background Mr Bright is a 65-year-old male with a history of hypertension and DMII – usually reasonably well controlled with medications and diet. He is also a smoker of 20 cigarettes per day. The patient is admitted to the hospital for percutaneous coronary intervention and had a drug eluting stent placed in his right coronary artery with 10 percent residual stenosis at the site. He had a minor myocardial ischaemia during the operation and developed some chest pain in recovery but was resolve with sublingual nitro-glycerine spray. He is transferred back to the surgical ward for post-operative care. Assessment Mr Harry Bright’s vital sign shows a heart rate of 119 beats/minutes, blood pressure of 138/86, oxygen saturation rate is greater than 90 percent, respiratory rate is 26 and his temperature is within the normal range.
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
data. Recommendation Mr Black, I would need a management for this patient and would you be able to review Mr Harry Bright regarding his limb.
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
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.
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
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.
Client Profile: Lane Bronson is a 55 year old male with a history of angina, hypertension, Type 2 diabetes, COPD, and sleep apnea. He comes to the physican’s office complaining of worsening shortness of breath. His skin tone is grey, and his angina is worsening. Previously stable, he now does not get relief from rest or nitroglycerin. The physician called 911 and had Mr. Bronson directly admitted to the hospital.
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.
History of present illness: The patient is a 71 year old male of the Veteran Association. His past medical history includes coronary artery disease and chronic obstructive pulmonary disease. The patient was involved in a contraindication at home where he was thrown into a dresser and hit his lower back. Shortly following the incident the police were contacted. During this time the patient consequently began to develop some substernal chest pain with a radiation to the left arm; the patient also became diaphoretic and somewhat out of breath. Emergency medical services (EMS) were contacted. EMS gave the patient aspirin and nitroglycerin and started a saline lock. EMS brought the patient to the emergency department. The patient had
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.
Mr. GB is a 78 year old white male admitted to Bay Pines VAMC on 6/18/96. for " atypical chest pain and hemoptysis". V/S BP 114/51, P 84, R 24, T 97.4. He seems alert and oriented x 3 and cheerful. Bowel sounds present x 4. Pt. has a red area on his coccyx. Silvadene treatments have been started. Pt. Has a fungal lung infection with a pleural suction drainage tube inserted in his chest . Pt is extremely thin with poor skin turgor with a diagnosis of cachexia ( wasting) secondary to malnutrition and infection. Patient is no known allergies to drugs but is allergic to aerosol sprays disinfectants and dust.. Advanced directives on chart. Code status DNR. Primary physician Dr. R, Thoracic surgeon Dr. L. Psychology Dr.W. There is PT, OT Dietary and Infectious Disease consults when necessary. He lives with his wife who he has been married to for 56 years. His son and his daughter come to visit him. He does not smoke. He wears dentures but did not bring them. He dose not use a hearing aid but he does have a hearing deficit.
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.
...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.
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.
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
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