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21 Cards in this Set
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•Complete blood count related to surgery
From Week 5 Kelly lecture |
Again the anesthesiologist is looking for elevated WBC that might tip us off to infection or a low hemoglobin and hematocrit that might make his recovery from anesthesia complicated. Also a low hemoglobin could cause Mr. Ball to have a peri operative heart attack.
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•Electrolyte levels r/t surgery
From Week 5 Kelly lecture |
A low or high potassium could cause dysrrhythmias. Also Mr. Ball should not go to surgery if he is severely dehydrated. Renal indices are very important. An elevated serum creatinine or a GFR (glomerular filtration rate) that is less than 60 could indicate thea Mr. Ball is likely to suffer acute renal failure.
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•Urinalysis r/t surgery
From Week 5 Kelly lecture |
since we will most likely place a foley catheter, we will want to know that Mr. Ball does not have a UTI. Also renal function is important for clearing the anesthesia. Protein in the urine, might indicate a potential for renal failure.
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•X-ray left lower extremity r/t surgery
From Week 5 Kelly lecture |
Limbs that are poorly perfused often get severe infections that do not respond to antibiotics. If that infection spreads to the bone, that is osteomyelitis. This is a severe infection that the surgeon will want to know about prior to the surgery. The x ray of the extremity will allow the surgeon to rule out this complication.
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http://www.jointcommission.org :
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This is a website that discusses the importance of medication reconciliation among other things. One can check the SCIP (surgical care improvement program) to see how hospitals are implementing this process.
– The joint commission is a component of the American Medical Association and surveys hospitals for compliance to Joint Commission Standards. Any hospital that accepts Medicare payments must be accredited by the Joint Commission or JCAHO. |
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What must the patient consent to for the surgical procedure to be done?
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3 requirements:
• Adequate disclosure of diagnosis-purpose, risks, and consequences of treatment, probability of success, prognosis if not instituted • Understanding & comprehension -patient must be drug free prior to signing consent • Consent given voluntarily -patient must not be persuaded or coerced to undergo the procedure |
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Information that should be provided to the pre-op patient includes:
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-Description of procedure and alternative therapies
-Underlying disease process and its natural course -Name and qualifications of person performing procedure -Explanation of risks and how often they occur -Explanation that patient has the right to refuse treatment or withdraw consent |
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The legalities of pre-op consents includes:
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•Patient must be 18 years old to sign own consent or be an emancipated minor
•Parent signs for dependent children as legally responsible •Patient must be deemed competent to sign own consent •Patient must be alert & oriented; Consent may not be signed by patient after receiving narcotics or sedatives (The message here is do not give the pre op medications prior to the patient signing the consent!!!) •Not necessary if threat to life and patient or legally authorized person unavailable |
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latex allergy or sensitivity.
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•At Risk:
•Genetic predisposition •Children with spina bifida •Urogenital abnormalities •Spinal cord injuries •Hx of multiple surgeries •Health care professionals •Allergies to avocado, tomato, banana |
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•Signs and symptoms of allergic reaction to latex
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–Urticaria
–Rhinorrhea –Bronchospasm –Compromised respiratory status –Circulatory collapse & Death |
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Nine Patient Safety Solutions
From Joint Commission Website 1. through 3. |
1. Look-Alike, Sound-Alike Medication Names (PDF)
Confusing drug names is one of the most common causes of medication errors and is a worldwide concern. With tens of thousands of drugs currently on the market, the potential for error created by confusing brand or generic drug names and packaging is significant. 2. Patient Identification (PDF) The widespread and continuing failures to correctly identify patients often leads to medication, transfusion and testing errors; wrong person procedures; and the discharge of infants to the wrong families. 3. Communication During Patient Hand-Overs (PDF) Gaps in hand-over (or hand-off) communication between patient care units, and between and among care teams, can cause serious breakdowns in the continuity of care, inappropriate treatment, and potential harm for the patient. |
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Nine Patient Safety Solutions
From Joint Commission Website 4. through 6. |
4. Performance of Correct Procedure at Correct Body Site (PDF)
Considered totally preventable, cases of wrong procedure or wrong site surgery are largely the result of miscommunication and unavailable, or incorrect, information. A major contributing factor to these types of errors is the lack of a standardized preoperative process. 5. Control of Concentrated Electrolyte Solutions (PDF) While all drugs, biologics, vaccines and contrast media have a defined risk profile, concentrated electrolyte solutions that are used for injection are especially dangerous. 6. Assuring Medication Accuracy at Transitions in Care (PDF) Medication errors occur most commonly at transitions. Medication reconciliation is a process designed to prevent medication errors at patient transition points. |
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Nine Patient Safety Solutions
From Joint Commission Website 7. through 9. |
7. Avoiding Catheter and Tubing Mis-Connections (PDF)
The design of tubing, catheters, and syringes currently in use is such that it is possible to inadvertently cause patient harm through connecting the wrong syringes and tubing and then delivering medication or fluids through an unintended wrong route. 8. Single Use of Injection Devices (PDF) One of the biggest global concerns is the spread of Human Immunodeficiency Virus (HIV), the Hepatitis B Virus (HBV), and the Hepatitis C Virus (HCV) because of the reuse of injection needles. 9. Improved Hand Hygiene to Prevent Health Care-Associated Infection (HAI) (PDF) It is estimated that at any point in time more than 1.4 million people worldwide are suffering from infections acquired in hospitals. Effective hand hygiene is the primary preventive measure for avoiding this problem. |
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•On the morning of the surgery, the OR calls for Mr. Ball to be brought to the OR holding room. What are the responsibilities of the nurse caring for Mr. Ball at this time?
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•Accurate Identification of Mr. Ball
•2 patient identifiers •Known last meal for patient •Safe transport to OR via stretcher with side rails up •Psychosocial support for Mr. Ball and his family •Patent IV with D5.45NS infusing at 50cc/hr •Mr. Ball voids before pre-operative medications |
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•On the morning of the surgery, the OR calls for Mr. Ball to be brought to the OR holding room. What are the responsibilities of the nurse caring for Mr. Ball at this time?
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(cont.)
•Pre-operative dose of Ativan 0.5 mg IV given once on stretcher •Signed consent form is in the chart •OR Checklist completed and on the front of the chart •Accurate identification of patient, surgical procedure & site •Done in holding room with physician present •All pertinent labs and diagnostics (CXR, ECG) are on the chart with appropriate interpretations. Review labs once more to make sure there are no abnormalities that will cause problems during the intra operative and post operative periods. |
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Stages of wound healing:
Inflammatory stage |
first 3 days after initial trauma. Attempts are made at the site to:
-Control bleeding with clot formation -Deliver oxygen, WBC's and nutrients to the area via blood supply |
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Stages of wound healing:
Proliferative Stage |
Lasts the next 3-24 days. Effects to the wound include:
-Replacing lost tissue w/CT or granulated tissue -Contracting the wound's edges -resurfacing of new epithelial cells |
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Stages of wound healing::
Maturation or remodeling stage |
involves the strengthening of the collagen scar and the restoration of a more normal appearance.
-it can take more than 1 year to complete depending on the extent of the original wound. |
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Healing Processes:
Primary Intention |
Characteristics:
-Little or no tissue loss -Edges are approximated, as with a surgical incision. Wound Type -Heals rapidly -Low risk of infection -No or minimal scarring |
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Healing Processes:
Secondary Intention |
Characteristics:
-Loss of tissue -Wound edges widely separated (pressure ulcers, stab wounds) Wound Type -Longer healing time -Increased risk of infection -Scarring |
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Healing Processess:
Tertiary intention |
Characteristics:
-Widely separated -Deep -Spontaneous opening of a previously closed wound -Risk of infection Wound Type -Extensive drainage and tissue debris -Closed later -Long healing time |
