Outline of Case and Objectives
43 year old male
Previous laparotomy about 10 years ago due to gunshot abdomen
Presenting now with a single stab wound to the right epigastric region, pericardial effusion confirmed by ultrasound. Explorative laparotomy done- patient has right ventricular injury and right sided diaphragmatic injury
The patient was intubated and ventilated
The patient had the following devices in place:
o Right Intercostal Chest Drain (ICD) for a haemothorax which drained 150ml.
o Right sided mediastinal drain
o Left sided pericardial drain
o Left sided peripheral intravenous (IV) line
o Right sided central venous line
o Right radial Arterial line (A. line)
Before this case I had not previously come across an A. line in hospital or prehospitally which is why I will be focusing on arterial line care and maintenance during interhospital transfers. I have extended my search to in hospital care as there is very little literature focusing specifically on prehospital care of A. lines.
As an Emergency Care Practitioner (ECP) you are often required to do interfacility transfers of critically ill patients. These patients oftentimes have devices in place that an ECP would not routinely come…
the crash course on how to read EKGs was very helpful.
During my second shift in the SINU, one of my patients was intubated and communicated to me by writing notes on a clipboard. I discontinued the arterial line and two infiltrated IV catheters on this patient. I also established an IV access on the first attempt. I had the opportunity to observe this patient’s extubation; I was surprised how quick this process was. My other patient had a fungal infection covering the entire body. I…
tear of the bladder neck, rectum or vagina;
Extravasation at injury site ± blood in the vaginal introitus.
Extravasation at bladder neck during suprapubic cystography ± rectal or vaginal ﬁlling with contrast.
Table 8: European Association of Urology (EAU) Classification of urethral injury (Martinez-Pineiro et al, 2010)
IV.e. Urethral Stricture Characteristics and Etiology:
Most urethral strictures were idiopathic (34%), iatrogenic (32%), inflammatory (20%) or traumatic (14%). Iatrogenic…
it to do over? (Consider this as you plan for tomorrow).
I am a firm believer in growth; I retain a belief that no matter an individual’s level of education or training, he or she could always improve. Learning does not impede. Every clinical day I uncover a task that I wish I could have completed better, and this week, that wish came in the form of catheters, feeding tubes, and IV pumps. Throughout my time at this clinical facility, I never retained an opportunity to witness a nurse implement,…
It drains the bladder and is removed after being used. An indwelling catheter stays in the bladder. Most of them are inserted through the urethra and into the bladder as well. Urine is constantly draining into a drainage bag. A balloon near the tip of the catheter is inflated after it is inserted – this balloon prevents the catheter from falling out of the bladder. A suprapubic catheter is surgically inserted through the abdomen above the pubic bone and into the bladder. It is also left in the…
URINARY CATHETER USE DURING LABOR
An indwelling urinary catheter is a device that is typically placed into the bladder through the urethra. It is anchored in the bladder with a balloon and remains in the bladder until removed. Its purpose is to facilitate continuous removal of urine from the bladder through a closed system. Despite the system being closed it does not necessarily protect the patient from infection. Infection can stem from either endogenous or exogenous sources. Endogenous…
on insertion technique, catheter management, and removal. The plan is to only insert urinary catheters only when needed, and remove them when not needed as well as main unobstructed urine flow along with other interventions such as hand hygiene, education, and outcome and process surveillance of CAUTI. The article reported that there has been evidences that the preventative efforts are successful according to the INCC member hospital feedback even in countries with limited resources. The use of…
1. Acknowledging the prevalence of CAUTI as an issue and surveying staff members’ understanding problem. In addition, questions pertaining to the nursing interventions on ways to decrease CAUTI can be asked to assess such as the amount of times per the month that they initiated Foley removals. This lets staff members take credit for their outstanding work in proactive care. The surveys can also let staff understand the importance of work accountability and assess catheter insertion…
Research Question: How will education on the importance and use of the nurse-driven indwelling urinary catheter removal protocol affect knowledge of nurses taking care of patients with urinary catheters and the CAUTI rates in an acute care hospital in North Carolina ?
Project Significance: An indwelling catheter removal protocol is a recommended tool and is part of a bundle used to prevent CAUTI. The lack of knowledge of its use and its importance may be directly related to high CAUTI…
Patient-Focused Concept Map
M.P. is a 42-year-old male patient admitted on 2/22/2016 for infected stage IV decubitus ulcers, and penile deformity caused by urethral erosion from indwelling catheter. Patient is also anemic, and is on isolation precaution due to MRSA, staphylococcus aureus, and Escherichia coli infections. M.P. is a homeless paraplegic with double above the knee amputations (due to a motor vehicle accident in 2013) with an opiate addiction suffering from severe…