The Postoperative Setting: A Case Study

b. What will its future value be if the CD pays 5 percent interest? If it pays 15 percent interest?

Mr BW was a 74-year-old man who had a fall due to a new onset of seizures, which resulted, to a direct impact of his head on the ground while at home. While at the hospital, MR BW underwent a CT and MRI brain scan and showed a haematoma, which resulted to commencing of the patient on Keppra and Bezodiapenes. Moreover, Mr BW also developed a sudden onset of pleuretic chest pain, which was confirmed by CTPA as a small pleural effusion on the left lungs; while there was also pulmonary embolism on both upper and lower lobes of the left lung. Due to the development of a provoked pulmonary embolism, patient commenced on Clexane injection. In September 2015, an elective open abdominoperineal resection was performed on Mr BW, which resulted to prolonged stay in the hospital due to delayed wound healing.

Pulmonary embolism resulting from deep vein thrombosis is the most common preventable cause of hospital death (Maynard, 2015). Consequently, the Surgeon General has called to action to prevent deep vein thrombosis. Deep vein thrombosis in the healthcare setting can be reduced through

Pain is the way the body communicates and lets us know that there is something wrong that needs attention. The brain processes that sensation into information and that leads us to take action. If it is a natural part of our beings and is necessary then why do we do all we can to suppress it? There is a fine line between pain that is needed to help with function and pain that is there that disturbs homeostasis. There is also a question of is pain real or is it all in the mind. Pain and being able to manage it, is a very big component in the perioperative setting. It is triggered differently and is unique to each person this make treating pain just as unique. This paper will discuss pain management in the pre-operative, intra-operative and post- operative settings.

This patient is an 80 year old female who required inpatient hospitalization due to: She was brought by the ambulance to the Emergency Department with complaint of chest pain for the past week, worsening over the past 2 days. She also had non-productive cough, nausea, diaphoresis, shortness of breath, and bilateral inspiratory crackles with mild expiratory wheezing in her lungs, as well as one plus pitting edema on the lower extremities. Her medical histories were significant for diabetes mellitus type 2, hypertension, hyponatremia, status post for PCI or coronary artery bypass graft with pacemaker, and a recent hip fracture status post left hip replacement. In the Emergency Department, her vital signs included a blood pressure of 150/78mmhg, and a respiratory rate of 24 breaths per minute, with an oxygen saturation of 95 % on 3 Liters of oxygen per minute. She had a troponin I of 227 and BNP level of 1539 (noted as elevated). At that time, she was given aspirin to chew, sublingual nitroglycerin , 40 mg of IV Lasix, morphine, was placed on oxygen which helped with her breathing , telemetry monitoring, and EKG was done.

Over a seven hour period including set up and breakdown of the clinic process on any given day the team can see up to 100 patients. The team will see all patients that have registered at the beginning of the day. The clinic is a process where a patient is registered on arrival, waits in the designated area, is allocated seen and seen by a clinician, assessed by clinician, given either education or medication or both, a health plan and discharged. If need be the patient can be admitted into the LTL patient portal for follow up if team wants to continue care post clinic. The product that is output by the process is healthcare.

In 2003 during the last semester of nursing school, my life was devastated as my ex-husband was arrested as a serial rapist. This was overbearing and I thought this as being impossible to recover from. A breaking point came as I approached a red light deciding whether to deliberately run my minivan into oncoming traffic with my two young children to end our lives. Only days later, I once again felt that I was at the lowest point in my life as the reality of this event truly hit during a medical-surgical examination.

The vision of The Evansville Surgery Center is commitment. The ESC promotes patient centered care as well as delivering quality surgical care, according to their website. The ESC also has been recognized as “one of the 100 Best Places to Work in Healthcare” (ESC, 2015). Some of the benefits provided to employees of the ESC are tuition reimbursement, certification opportunities, day care, and health care insurance. CNA job responsibilities are not for the faint of heart, it requires self-discipline and commitment in order to provide the best health care for the patient. I believe that The Evansville Surgery Center is the ideal facility to launch my medical

Have there been any recent advances in the post-operative management of the selected procedure? Why?

As the third most common reason of cardiovascular death after myocardial ischemia and stroke, pulmonary embolism (PE) is a conceivably fatal condition connected with significant morbidity and mortality (Araoz et al., 2007).

Specific perioperative risk factors include greater intraoperative blood loss, more postoperative transfusions, and postoperative haematocrit of 30%.Severe acute pain regardless of the method of analgesia (opioid type, method, and dose) is associated with post-operative delirium (Fong et al.,2006).

Postoperative pain is the most undesired sequence of surgery, and if not treated properly, can lead to increased hospital stay and delayed return to daily activities (10).

As Jane was presenting with a symptom of a life threatening event it was important that treatment was immediate. Priority was initially made from assessment of the airways, breathing and circulation, level of consciousness and pain. Jane’s respirations on admission were recorded at a rate of 28 breaths per minute, she looked cyanosed. Jane’s other clinical observations recorded a heart rate of 105 beats per minute (sinus tachycardia), blood pressure (BP) of 140/85 and oxygen saturation (SPO2) on room air 87%. It is important to establish a base line so that the nurse is altered to sudden deterioration in the patient’s clinical condition. Jane’s PEWS score (Physiological Early Warning Score) was 4 and indicated a need for urgent medical attention (BTS 2006). Breathing was the most obvious issue and was the immediate priority.

A systematic review undertaken by Smetana (2009) identifies postoperative respiratory failure as an example of cascade iatrogenesis i.e. serial development of multiple medical complications that can be set in motion by a seemingly innocuous first event. In this case, Mrs Hilton’s open cholecystectomy is that first event. Smetana (2009) points out that: when an older patient with postoperative pain is over-sedated, a decline in respiratory function occurs, that if not recognized, can result in respiratory failure that requires mechanical ventilation, that again, if not managed properly can culminate in ventilator-associated pneumonia and even sepsis and death (p.1529). After her upper abdominal surgery Mrs Hilton may have difficulty with deep breathing and coughing due to pain however both are essential interventions for prevention and treatment of respiratory infections and complications. Brown et al. (2008) recommend that when Mrs Hilton is awake, turning, coughing and deep breathing should be encouraged every one to two hours as this aids in the removal of secretions and prevents mucous plugs. They also encourage mobility when possible to increase respiratory excursion. Moreover, as Mrs Hilton

Risk for infection related to surgical wound on her left upper back and drainage tube in left lung. I chose this as the second nursing diagnosis and would also rate this high priority. The patient did not have a