Initial Discussion Post
Week one
NURS6521, N-17
As a post-anesthesia care unit (PACU) Registered Nurse (RN), I care for patients of all races, ages, gender and ethnic backgrounds. However, a majority of the people I care for are of advanced age. Therefore, one must be aware of changes in the body related to aging. The purpose of this discussion is to present a case that addresses the considerations and issues of the perioperative care of an elderly patient.
Case Description
Due to the changes in the body related to aging, pain control in older patients is somewhat difficult. The case I chose is one of a 78-year-old male undergoing femoral popliteal bypass surgery. M.M. is a 78-year-old non-smoker with hypertension, hyperlipidemia, and peripheral artery disease. As a PACU nurse, one can work with the entire perioperative team in the decision-making process concerning all aspects
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of patient care. Factors Influencing Pharmacokinetic and Pharmacodynamic Processes As a person ages, the body goes through several pharmacokinetic changes.
Pharmacokinetic relates to how the body absorbs, distributes, and eliminates medications. Also referred to as what the body does to the drug. Some of the changes are decreased blood flow, decreased albumin, lean body mass, and total body water, liver blood flow and mass, enzymatic activity, glomerular filtration, and secretion. Also, aging increases gastric PH, body fat, and delays gastric emptying (Arcangelo & Peterson, 2013, pp. 66-67). Changes in the peripheral nervous system (PNS) and central nervous system (CNS) include peripheral nerve deterioration, mild motor and discriminatory sensory changes in the feet, changes in the senses, and memory deterioration. An increase in the sympathetic nervous systems (SNS) causes organ-specific changes that target the gastrointestinal system and skeletal muscles affecting responses to stress and pain (Halaszynski, T., 2013). According to Hilmer, McLachlan, & LeCouteur (2007), there is an increase in adverse drug reactions, which are more severe in the
elderly. Pharmacodynamics is what the drug does to the body. Due to either decreased capacity to respond to a drug or increased sensitivity of the receptor to the drug, the elderly are more sensitive to drug-receptor interactions. Also, the sedative effects of drugs are exaggerated in the elderly due to changes in the CNS (Arcangelo & Peterson, 2013, pp. 67-68). Plan of Care Therefore, the anesthesiologists and the perioperative team made the decision to use a regional anesthesia (RA), specifically a neuraxial or spinal anesthesia without intubation. The utilization of intraoperative intravenous narcotic occurs throughout the surgery. This type of strategy is a multimodal drug approach. A multimodal approach is advantageous because the different drugs target different pathways and receptors. Therefore, analgesia efficacy is optimal, thereby decreasing the need for high doses of narcotics for pain control. The lower doses of opioids prevent the possibility of adverse events (AE). RA without intubation preserves pulmonary function, improves patient outcomes, decreases negative pathophysiologic events, and produces adequate pain control (Halaszynski, T., 2013). The patient came to PACU alert and oriented times three with adequate pain control, and in good respiratory status. The multimodal use of pain control decreased M.M.s pain while preserving respiratory function, and preventing the chance of cognitive disorders post-operatively. Conclusion In conclusion, it is imperative that the team of caregivers knows the effects of medications on the elderly population. The changes in the body due to aging must be addressed to provide patient-centered care and avoid any adverse events. Knowing the pharmacokinetic and pharmacodynamic changes as one increases in age is an intricate aspect of creating an individualized plan of care.
The role of nurse practitioner in the Canadian healthcare system is relatively new compared to the traditional roles of doctors and registered nurses, and as with any new role, there are people who oppose the changes and others who appreciate them. Some members of the public and the healthcare system believe that the addition of the nurse practitioner (NP) role is an unnecessary change and liability to the system because it blurs the line between a doctor and a nurse; this is because nurse practitioners are registered nurses with additional training (usually a masters degree) that allows them to expand their scope of practice into some areas which can be treated by doctors. Other people feel that nurse practitioners can help provide additional primary care services, while bridging communication between nurses and doctors. There are always legitimate challenges to be overcome when changing a system as complicated as healthcare,
1. What is the difference between a. and a. Which K, S, and A pertain to the care you provided to the patient you have chosen? Why do you need to be a member? K- Describe the limits and boundaries of therapeutic patient-centered care. S- Assess levels of physical and emotional comfort.
The practice of patient-controlled analgesia (PCA) has been around for approximately four decades now. During this time there have been improvements to the technology and the understanding of how to use this form of patient pain control; however, there continues to be concern related to the safety and efficacy of PCA. As this analysis proceeds it will briefly explain what PCA is and how it is used, then delve into the benefits and the safety issues surrounding PCA use as it pertains to the patient and the nurse. Some of the benefits of PCA include improved pain management, improved use of nursing resources, increased patient satisfaction, and reduced pulmonary issues (Hicks, Sikirica, Nelson, Schein & Cousins, 2008). Some of the safety issues surrounding PCA use include infusion pump programing errors, basal infusion dosing, and proxy errors when using PCA by proxy (Ladak, Chan, Easty, & Chagpar, 2007). Therefore, the purpose of this report is to examine the benefits and risks of patient-controlled analgesia and how it relates to nursing practice.
Hinkle, J., Cheever, K., & , (2012). Textbook of medical-surgical nursing. (13 ed., pp. 586-588). Philadelphia: Wolters Kluwer Health
Stomberg, M., Sjöström, B., & Haljamäe, H. (2003). The Role of the Nurse Anesthetist in the Planning of Postoperative Pain Management. AANA Journal, 71(3), 197.
American Association of Nurse Anesthetists. Professional Aspects of Nurse Anesthesia Practice. Philadelphia: F. A. Davis Company, 1994. Print.
A registered nurse (RN) is someone that went through a university or college and studied nursing; and then passed the national licensing exam to obtain a license to practice nursing. The degree earned by an RN at the need of the program is deemed a professional nursing degree. The RN top nursing staff and they usually works independently. On the hand, an LPN only earns a practical nursing degree after completion of the program. LPNs are mostly recognized only in USA and Canada; they are also named as License Vocational Nurse (LVN) in the state of California and Texas. LPN work under the supervisor of an RN or a physician.
Pain Management Nursing, 10(2), 76-84.
The nurse is creating a four-column plan of care for a client. For which areas should the nurse prepare to document when creating this care plan?
The modern nurse has much to be thankful for because of some of the early pioneers of nursing, such as Florence Nightingale and Jensey Snow. However, the scope and influence of professional nursing, as well as the individual nurse, has seen more exponential growth and change in North America since the establishment of the first professional organization for nursing, the Nurses Associated Alumnae of the United States and Canada, which in 1911 came to be known as the American Nurses Association.
Volles, D. F. (2011, April 11). University of Virginia Health System Adult and Geriatric Sedation/Analgesia for Diagnostic and Therapeutic Procedures. Retrieved May 12, 2011, from University of Virgina Health System: University of Virginia Health System Adult and Geriatric Sedation/Analgesia for Diagnostic and Therapeutic Procedures
Smeltzer, S. C., Bare, B. G., Hinkle, J. L., & Cheever, K. H. (2010). Brunner & Suddarth’s textbook of medical-surgical nursing (12th ed.). Philadelphia, PA: Lippincott Williams & Wilkins.
Kick, Ella. "Overview: Health Care and the Aging Population: What Are Today's Challenges?" The Online Journal of Issues in Nursing. N.p., n.d. Web.
Westhead, C. (2007). Perioperative Nursing Management of the Elderly Patient. Canadian Operating Room Nursing Journal, 25(3), 34-41. Retrieved from http://gateway.library.qut.edu.au/login?url=http://search.proquest.com.ezp01.library.qut.edu.au/docview/274594603?accountid=13380.
Five levels are used to describe the progression of nursing expertise in a clinical setting: novice, advanced beginner, competent, proficient, and expert (4). In the novice stage nurses lack experience and confidence to perform actions independent of guidelines and rules (Benner,p. 403). A novice nurse, without asking if the patient is in pain, may not acknowledge that a postsurgical patient in the recovery room has pain if the patient is laying quietly in bed although their blood pressure and heart rate have increased from preoperative levels. The advanced beginner, having had more experience with postsurgical patients may notice the patient's blood pressure and heart rate changes and believe the patient is in pain however, the nurse may conference with other nursing staff to confirm the assumption. Competent nurses begin to predict situations and patterns from previous experience and use time management skills more effectively (4, 124).