2. The fact that she has been kept almost totally stationery for 3 days following surgery, when she should have been exercising her limb
3. The small urine output that may signal post-operation infection.
4. Her living quarters -- in a trailer that provide plenty of opportunity for falling and re-fracturing of limb.
5. Her age which again places her at greater risk for falling.
6. Mrs. Well's desire to return to her housework. "Only very light work should be performed post-surgery of the hip with no bending, twisting, or crossing the legs at the hip joint, or at the ankles"(Queen Elizabeth Hospital Birmingham). Similarly, Mrs. Wells lives in a rural area- she should avoid gardening. Only light housework should be engaged in.
7. Mrs. Wells needs someone to help her do routine tasks such as bathing and dressing. She only has a son who lives with her, and she is poor. This may indicate…...
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References
Queen Elizabeth Hospital Birmingham. Information for patients about precautions following Hemiarthroplasty surgery Hemiarthroplasty.pdf www.ofc-oregon.com Complications of orthopedic surgery http://www.ofcoregon.com/assets_ofc/COMPLICATIONS_OF_ORTHOPEDIC_SURGERY.pdfhttp://www.ihb.nhs.ik/pdf/Pifollowing
Antiemetic Efficacy of Ipa Inhalation
Post-Operative Nausea and Vomiting
Antiemetic Efficacy of IPA Inhalation in High-isk PONV Patients
Antiemetic Efficacy of IPA Inhalation in High-isk PONV Patients
Post-operative nausea and vomiting (PONV) is considered a significant enough threat to patient health that surgical patients are often treated prophylactically to prevent its occurrence (reviewed by Murphy, Hooper, Sullivan, Clifford, and Apfel, 2006). PONV has been defined as an episode of nausea, vomiting, or retching (non-productive vomiting) that occurs within 24 hours following surgery, which can cause patient distress, post-operative complications, prolonged recovery times, and increase the cost of post-surgical care. The prevalence of PONV for the average surgical patient is estimated to be between 20 and 30%, but high-risk patients may have up to an 80% or higher chance of experiencing this condition. The high variability in PONV risk precludes standard prophylactic treatment, due to the cost and the increased risk to patient health that…...
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References
Apfel, Christian C. (2005). PONV: A problem of inhalational anaesthesia? Best Practice & Research Clinical Anaesthesiology, 19(3), 485-500.
Cullen, Karen A., Hall, Margaret J., and Golosinskiy, Aleksandr. (2009). Ambulatory surgery in the United States, 2006. National Health Statistics Reports, 11, 1-28. Retrieved 9 Oct. 2012 from http://www.cdc.gov/nchs/data/nhsr/nhsr011.pdf .
It was noted that factors affecting the removal of third molars vary from country to country depending on the stakeholders (Esposito, 2005).
In this section, we discussed the origins of third molars, as well as the different types of impaction that can occur. The effects of the type of impaction were found to be a factor in the ease if removal and the complications that may occur. Understanding types of impactions and the affect that they can have on the potential for complications is an important step in preventing complications before and after surgery. The following section will discuss the surgical procedures for removal of mandibular impactions.
Surgical Extraction of Impacted Mandibular Third Molars
Surgical extraction of third molars is performed for a number of reasons. They are sometimes performed to prevent surgery in older patients, although this reasoning is questionable (Valiati, Ibrahim, & Poli, et al., 2009). It can be performed…...
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References
Al-Asfour, a. (2009). Postoperative Infection After Surgical Removal of Impacted Mandibular
Third Molars: An Analysis of 110 Consecutive Procedures. Med Princ Pract 18:48-52.
Bernard, G. & Mintz, V. (2003), Evidence-based means of avoiding Lingual Nerve Injury
following Mandibular Third Molar Extractions. Brazilian Journal of Oral Science. 2 (5):
(Sussman and Bates-Jensen, 2007)
Assessment data is reported to enable the clear communication among clinicians about the wound and in making the provision for "continuity in the plan of care" as well as allowing for "evaluation of treatment modalities." (Sussman and Bates-Jensen, 2007) Wounds that are classified as red, yellow and black are those that require examination of deep tissue involvement. (Sussman and Bates-Jensen, 2007) The wound must be monitored during the healing process since monitoring provides the means of "checking the wound on a regular and frequent basis for "signs and symptoms that should trigger a full reassessment, such as increased wound exudate or bruising of the adjacent or periwound skin. Included in monitoring is the "gross evaluation for signs and symptoms of wound complications, such as erthema (change in color) or periwound skin and pus, which is indicative of infection." (Sussman and Bates-Jensen, 2007) Included as well should…...
Khan, Y. And Fitzgerald, P. And Walton, M. (1997) Assessment of the postoperative visit after routine inguinal hernia repair: A prospective randomized trial. Journal of Pediatric Surgery. Vol. 32, Issue 6. June 1997. Online available at: http://www.jpedsurg.org/article/S0022-3468%2897%2990644-8/abstract
In this case, that power dynamic was only exacerbated by the fact that the entire MSICU nursing team had never received training in management of the type of clinical issues presented and by the fact that they were excluded from any consultation in connection with a post-operative management plan.
Therefore, it is recommended that the institution immediately implement a policy of "see something, say something" according to which all members of healthcare teams are encouraged to speak up irrespective of power differentials. Furthermore, that protocol must include a statement of policy insulating any member of a healthcare team who does voice a legitimate concern in good faith from any retaliation or other negative response that could conceivably deter such diligence. Finally, the record of this case also indicates the immediate need for protocols requiring all members of the healthcare team to identify themselves to other members of the team, especially…...
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References
Bosk, Charles L. (2003). Forgive and Remember: Managing Medical Failure.
Gawande, Atul. (2008). Better: A Surgeon's Notes on Performance.
Groopman, Jerome. (2008). How Doctors Think.
Timmermans, Stefan. (2003). The Gold Standard: The Challenge of Evidence-Based
NICE has developed a set of guidelines and standards to help minimize the risk of VTE and ensure healthcare protocols are in place to educate patients about the risks of VTE. The purpose of this literature review is to examine a tool to access a Hospital Trust compliance with the National Institute of Clinical Excellence (NICE) published standards on Venous thromboembolism (VTE) prevention. The tool will have the capability to monitor, report, and disseminate relevant information.
National Institute for Clinical Excellence
The National Institute for Health and Clinical Excellence, or NICE, is an institution whose goals including providing clinical quality guidelines and standards to help manage a nationwide database. The purpose of this database includes help improve total healthcare at multiple levels, including at the cardiovascular, vascular, mental, neurological at other levels of health (NICE, 2011). The goals of NICE include prevention of disease, treating disease, and monitoring…...
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References:
Department of Health (DH). (2010 March). "Venous Thromboembolism (VTE) Risk
Assessment." Department of Health. Retrieved July 23, 2011: Publications PolicyAndGuidance
NHS Evidence. (2011). NHS Evidence: Evidence in Health and Social Care. NHS Evidence,
Aortic dissection is a disease of the wall of the aorta in which the aortic blood bursts into the muscular layer of the great artery, thus forming a blood filled channel along the planes of the muscularis layer. This false lumen can re-rupture back into the true lumen, through a second distal intimal tear, creating a biluminal or double barrelled aorta. Due to weakened walls, there is threat of rupture into the surrounding tissue with fatal consequences. (Boon, , Colledge, Walker, & Hunter, 2010)
The pathophysiology behind the condition is often a spontaneous or iatrogenic tear in the intima. However, in about five to ten percent of patients, these tears are absent. An intimal tear can occur anywhere along the aorta, although a vast majority of tears are found within ten centimeters of the aortic valve. The dissection may extend towards the heart, affecting the coronary arteries, or it may rupture…...
Boulton, Martha (2005) Exploring alexithymia, depression, and binge eating in self-reported eating disorders in women. Perspectives in Psychiatric Care
Dahm, Lori (2005) Obesity update: are we getting any thinner?(Special Report)
Private Label Buyer
Merrick, Joav (2005) Psychosomatic reasons for chronic pains.(Editorial)
Southern Medical Journal
____(2006) Obese people may be more sensitive to pain.(NEWS Breaks)(Brief article) Nutrition oday
PORER, LAWRENCE C. WAMPLER, RICHARD S (2000) Adjustment to Rapid Weight Loss. Families, Systems & Health
Rubin, Jay J. (2005) Psychosomatic pain: new insights and management strategies.(CME opic: Psychosomatic Pain) Southern Medical Journal
ucker, Miriam E. (2005) Depression tied to poor adherence to cardiac Rx: results of two studies show that use of aspirin and [beta]-blockers was lower in depressed patients.(Psychosomatic Medicine) Clinical Psychiatry News
MEHODOLOGY
his study will seek to determine whether or not obese post operative patients have a higher incidence of psychosomatic disorders and illnesses than non-obese post op patients have.
Need for study
he need for this study is evidenced in…...
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The need for this study is evident. The cost factor of psychosomatic illnesses may be reduced if it can be determined whether or not the obese patient population has a higher incidence of psychosomatic illness in post op. If it does then future steps can be taken to better prepare the obese patient population for surgery to reduce the incidence of post op psychometric illness.
REFERENCE
Tucker, Miriam E. (2005) Depression tied to poor adherence to cardiac Rx: results of two studies show that use of aspirin and [beta]-blockers was lower in depressed patients.(Psychosomatic Medicine) Clinical Psychiatry News
Mrs. Mansfield is being handed over to care from the operating theatre nurse. We would require an update chart information. She has had an ovary removal (bilateral salpingo-oophrectomy) and is currently on an IV infusion of .8% Normal Saline. In order to continue her care, we would need previous vitals, lab work, and any details on her condition. We know she has a bellovac drain insitu and a PCA along with O2 via nasal prongs. We would need the orders on the PCA and the physician's assessment of pain medications. There would likely be instructions on wound draining, as well as potential additional fluids and/or blood transfusion information (part of vitals in chart). Post-operative care instructions would be mandatory -- including diet, hourly rounding instructions and additional materials to assist with her post-operative care condition (Fogel & Woods, 2008 p. 428).
Q2 -- esearch shows that unrelieved pain has a detrimental…...
Music and Pain
The use of music in relation to relaxation and pain control is universal in application. Many cultures use music, tones, chanting, drums, or other forms of biofeedback to treat patients in acute pain, women in labor, recovery, and now, most recently, in pre- and post-operative care. In fact, the therapeutic value of music has been recognized as vital and powerful since Ancient Times; archaeological evidence shows flutes carved from bone in pictures of physicians healing patients, Greek physicians used music and vibration to heal, aid in digestion and induce sleep; the Early Egyptians used musical incantations to help with the healing process; and certainly, numerous native tribes use singing and chanting as part of their healing rituals (Nilsson, 2008).
Further, most postoperative patients have pain, despite the use of analgesia. Nurses are constantly trying to be more effective in delivering pain medication. One study showed that patients who were…...
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WORKS CITED
Ghetti, C. (2011). Active music engagement with emotional-approach coping to improve well being in liver and kidney translplant recipients. Journal of Music Therapy. 48 (4): 463-85.
Good, M., et.al. (2010). Supplementing Relaxation and Music for Pain After Surgery. Nursing Research. 59 (4): 259-69.
Goodwin C.J. (2010). Research in Psychology: Methods and Design. New York: John
The brain while expanding pushes the skull outward in the same perpendicular to the closed structure. This will be marked by the occurrence of 'papilledema' 'pseudoproptosis' as also 'optic atrophy.' (39) This results in the orbital socket being smaller and the eyes getting 'protoposed'. The intercranial pressure is bound to be high. The symptoms in such cases will be optic atrophy, head ache and papilledema. Or in the case of 'Crouzon's disease' where occurs a marked hooked nose and a frontal lobe which makes the disease also called the parrot head disease. Surgery in both these types of situations become mandatory as the result of the cranial pressure could result in death. (39)
egarding the facial surgery discussions always centre on perfecting features and cosmetic changes. The debate must rather be on the goals of the surgery and the overall benefits that can accrue to the patient in terms of…...
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References
1. Buncke HJ. Facial Paralysis - Reanimation. California Pacific Medical Center. [online]. 2007 [cited 2008 Feb 16]. Available from: URL:
Alcohol use has been linked with liver disease mortality and increased social and economic costs (NCI, 2014; ruha et al., 2009). Most recent statistics say that disorders in alcohol consumption afflict millions of people worldwide. The incidence has been increasing along with increasing alcohol consumption. Alcohol liver disease takes the form of acute alcoholic hepatitis and chronic liver disease, such as steatosis, steatohepatitis, fibrosis and cirrhosis. Seriousness and prognosis depend on the amount consumed, the pattern of drinking and the length of time of consumption, the presence of liver inflammation, diet and nutritional and genetic disposition. While steatosis is virtually benign, morbidity and mortality are both high in liver cirrhosis. Survival rate for advanced cirrhosis is 1 to 2 years and 50% mortality risk for those with severe acute alcoholic hepatitis have as much as 50% mortality (NCI, 2014). Long-term intake of…...
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BIBLIOGRAPHY
Bruha, R., et al. (2009). Alcoholic liver disease. Vol. 110 # 3m Prague Medical Report:
People die each year of cardiac related health problems. Some die of heart attacks and others of congestive heart failure and so forth. This research proposal highlights five peer reviewed journal articles that show how to improve, step-by-step, the infrastructure of a hospital cardiac program. Quantitative data from the studies along with in-hospital data will reveal the need for quality improvement as well as how successful certain methods are when implemented among specific populations. Information was gathered through the search engine Google Scholar and PubMed. All articles are less than four years old and reveal ways to not just improve the safety and care of patient's but also how to improve surgical outcomes and enhance IT infrastructure, all of which are essential to running a great hospital cardiac program.
Introduction
Several patients in (Hospital Name) have come in complaining of cardiac related health problems. Some have had issues with cardiothoracic surgery from…...
Grace, S.L., Poirier, P., Norris, C.M., Oakes, G.H., Somanader, D.S., & Suskin, N. (2014). Pan-Canadian Development of Cardiac Rehabilitation and Secondary Prevention Quality Indicators Endorsed by the Canadian Association of Cardiac Rehabilitation. Canadian Journal of Cardiology, 30(8), 945-948. Retrieved from http://www.sciencedirect.com/science/article/pii/S0828282X14002335
Guillamondegui, O.D., Gunter, O.L., Hines, L., Martin, B.J., Gibson, W., Clarke, C., Cecil, W.T. (2012). Using the National Surgical Quality Improvement Program and the Tennessee Surgical Quality Collaborative to Improve Surgical Outcomes. Journal of the American College of Surgeons, 214(4), 709-714. Retrieved from http://www.sciencedirect.com/science/article/pii/S1072751511013287
IEEE Conference on Software Engineering Education and Training, & IEEE Computer Society. (2011). Educating software engineers of the future: Software quality research through problem-based learning. In CSEE&T 2011: Proceedings (pp. 91-100). Los Alamitos, California: IEEE.
Improving Surgical Outcomes Using the Perioperative Dialogue Model
The estimated $8.5 to $17 billion lost to surgical errors in 1999 was not primarily due to individual incompetence, but to the failure of perioperative systems to operate seamlessly (reviewed by Plasters, Seagull, and Xiao, 2003). The successful management of an operating-room depends heavily on effective communications, but in the absence of a foolproof system for keeping abreast of changes in patient status or surgery schedules, miscommunication is not as rare as it should be.
An important component of the perioperative surgical team is the duties performed by the perioperative nurse (PN), who typically functions as a patient advocate before and during surgery (reviewed by Lee, Kerridge, Chui, Chiu, and Gin, 2011). In Sweden, surgical nursing care has begun to emphasize the importance of a perioperative dialogue between the patient and the PN (eviewed by Lindwall and von Post, 2008). Under the perioperative dialogue…...
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References
Kehlet, Henrik and Wilmore, Douglas W. (2002). Multimodal strategies to improve surgical outcome. American Journal of Surgery, 183, 630-641.
Lee, Anna, Kerridge, Ross K., Chui, Po Tong, Chiu, Chun Hung, and Gin, Tony. (2011). Perioperative systems as a quality model of perioperative medicine and surgical care. Health Policy, 102, 214-222.
Lindwall, Lillemor and von Post, Irene. (2009). Continuity created by nurses in the perioperative dialogue -- a literature review. Scandinavian Journal of Caring Sciences, 23, 395-401.
Plasters, Cheryl L., Seagull, F. Jacob, and Xiao, Yan. (2003). Coordination challenges in operating-room management: An in-depth field study. AMIA Annual Symposium Proceedings, 524-528.
Temporomandibular Joint Surgery: A Comparison
Between Arthrocentesis And Arthroscopic Approaches
Background and Historical Perspective:
Temporomandibular Syndrome is a somewhat general descriptive term comprising several distinct pathologies, all related to the various structures of the temporomandibular joint. TMJ symptomatology ranges from general myofascial discomfort which can often be addressed by conservative (non-invasive) approaches to profoundly pathological interarticular mechanical malfunctions requiring extensive surgical repairs.
In general, the vast majority of TMJ symptoms are temporary in duration and resolve either spontaneously, or with conservative treatment consisting of rest, anti- inflammatory agents, muscle relaxants, physical therapy, dental devices and/or bite adjustments, behavior modification and external application of thermal compresses.
A comprehensive evaluation is essential to accurate diagnosis, particularly since stress management problems and repressed aggression sometimes manifest as myofascial pain.
Surgical intervention should therefore always be considered as a last resort and limited to intracapsular pathology associated with significant pain and mechanical malfunction. Where surgery is indicated, the traditional choices…...
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9. Sanders B: Arthroscopic management of internal derangements of the temporomandibular joint. Oral Maxillofacial Surgical Clinic North America 1994; 6:259-269
10. Sanders B: Arthroscopic management of internal derangements of the temporomandibular joint. Oral Maxillofacial Surgical Clinic North America 1994; 6:259-269
11. Kuwahara T, Bessette RW, Maruyama T (1994). A retrospective study on the clinical results of temporomandibular joint surgery. Cranio 12:179-183
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