...Initiative. Venous Thromboembolism in ICU Patients Introduction Most patients admitted to the ICU are unable to move about and are at high risk for developing venous thromboembolism in the form of deep vein thrombosis (DVT) or pulmonary emboli (PE). This paper is about an ongoing effort in the writer’s facility’s ICU to prevent occurrences of venous thromboembolism. Compliance with proper use of mechanical thrombo-prophylaxis, staff education and compliance played a major role in the decrease of DVT at this facility. This facility’s quality initiative and DVT/PE eradication program was towards prevention of these vulnerable at risk patients. Venous thromboembolism (VTE), manifested as either DVT or PE, is the most common preventable cause of hospital death. (SOURCE)? This paper focuses on the role the ICU nurses are playing to help track and prevent at risk patients from developing DVT/PE. Adherence to prophylaxis guidelines supported with regular interactive education, preprinted order sets, reminders, and computer support systems were significant. Literature Review Although there is substantial evidence that primary preventive therapy effectively reduces the risk of VTE, under-treatment, it remains a problem (Cohen et al, cited in Duggan-Keen, 2010). For patients at risk for VTE in the acute hospital care setting, studies showed that approximately 40% of at risk surgical patients and approximately 60% of at risk medical patients did not receive appropriate VTE prophylaxis...
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...What is Deep Vein Thrombophlebitis/Thrombosis (DVT)? It is categorized as peripheral neurovascular dysfunction. DVT generates from a thrombus, a blood clot that can result from an injury to the tissues or in a patient that has quick- clotting factors in their blood. When a thrombus is present, the body replies with an inflammatory response. The response mechanism is called thrombophlebitis. DVT occurs deeper in the veins and can be serious, potentially causing a life-threatening condition called a Pulmonary Embolus (PE). DVT prophylaxis etiology The etiology for DVT prophylaxis is typically high-risk patients, to include those who have had hip surgery, knee arthroscopy or open prostatectomy. However, other risk factors such as prolonged periods...
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...Post Op DVT Patient Initials: Z, Z A 35 y/o male was admitted via the Emergency Department for a fractured left femur. He was parasurfing and lost control, slamming into some rocks off shore. He was taken to the operating room the day after admission for an open reduction and internal fixation (ORIF) of his left femur. You are assigned to care for him on postoperative day two. He is not married but lives with his girlfriend of 5 years in a two story home. He is athletic and exercises 5 times a week. He is a construction worker and is in good health. His parents are alive and healthy. Healthcare Provider’s Orders: O2 2LPM nasal cannula to keep O2 sat >92% Activity as tolerated Regular diet Saline Lock Antiembolic knee-high stockings Alprazolam 0.5mg PO HS prn for anxiety or insomnia Ampicillin 3g in 100ml 0.9% NS IVPB q12h Hydromorphone 1mg IV q4h prn for severe pain Hydrocodone 5mg/acetaminophen325mg 1 tab PO q4h prn Diphenhydramine 25mg PO q4h prn for pruritus Ondansetron 4mg IV q6h for nausea Acetaminophen 650mg PO q4h prn for Temp greater than 38°C Docusate sodium 100mg PO BID (discontinue for loose stools) Questions to Prepare: 1. Describe the nursing management of the orthopedic postoperative patient. Include in this discussion potential complications, the risk factors and what is done to prevent these. 2. What is the pathophysiology of deep vein thrombosis (DVT)? 3. What is the medical and nursing management of the patient with a DVT...
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...ABTRACT Pulmonary embolism (PE) caused by blockage of one of the arteries of lungs. Usually caused by deep vein thrombosis (DVT) from upper or lower extremities. The classical clinical presentation of PE is sudden onset of pleuritic chest pain, hypoxemia, and shortness of breath. Most often patient does not display any classic symptoms. PE is one of the major concerns of short-term mortality and long-term morbidity after aesthetic surgery. The present case report describes a 42-year-old female who survived after an episode of bilateral PE after undergoing an elective abdominoplasty. A literature review was conducted to explore the prevalence, pathophysiological presentation and use of prophylactic practice among plastic surgery patient to prevent...
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...Case Study 8 1. List 6 risk factors for DVT. Inheriting a blood clot disorder Prolonged bed rest, such as long hospital stay Injury or surgery Pregnancy Birth control pills or hormone replacement Being overweight or obese 2. Identify at least 5 problems from L.J.’s history that represent his personal risk factors. Smoking history Personal history of DVT Prolonged bed rest Age of above 60 years old Sitting for long period of times (Bus Driving) 3. Something is missing from the scenario. Based on his history, L.J. should have been taking an important medication. What is it, and why should he be taking it? He should have been taking a blood thinner. This will decrease the blood’s ability to clot. This keeps the existing clots from getting larger and new clots from forming. 4. Keeping in mind L.J.’s health history and admitting diagnoses, what are the most important assessments you will make during your physical examination and assessment? I will continually assess for peripheral circulation and monitor for pain associated with his right leg DVT. I would also monitor for swelling, redness, excess warmth, and discoloration in comparison with unaffected limb. 5. What is the most serious complication of DVT? Most serious complication is that a thrombus becomes mobile changing its status as an embolus. An embolus has a high likelihood of reaching the lungs and which can potentially become fatal as a pulmonary embolism. 6. List at least 8 assessment findings...
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...opportunity to stay on this patient’s care team despite the change in preceptors/hospitalists. Since I continued to stay on her care team, I became the source of information for the patient’s previous status, current condition, and future planned treatments for the oncoming hospitalists. However, due to a communication error, I relayed incorrect information to the hospitalist coming on service, leading to additional unnecessary hospital stay for the patient. Initially, the cardiologist had planned a right heart catheterization for the patient on Monday. He had a conversation with the admitting hospitalist about his plan. He told the hospitalist that after reading the patient’s echocardiography, he believed that the patient’s right ventricle was in bad...
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...and symptoms of bleeding, pain assessment, restlessness, irritability, confusion, somnolence, tachypnea, dyspnea, significant decrease in oximetry results, decreased PaO2 and/or increased PaCO2, central cyanosis | #3 Nursing Diagnosis:Impaired physical mobility Supportive Data:R/T left lower extremity clot and right lower extremity edema and pain AEB c/o pain with ambulation and ROM of lower extremities | Relationship of Diagnoses BRIEFLY explain the relationship (causative or resultant) between your selected nursing diagnoses. If the diagnoses are unrelated, state that. The impaired gas exchange and impaired physical mobility are directly related to the patient’s diagnosis of DVT and PE. The risk for bleeding is correlated because of the heparin drip needed for the treatment of PE and DVT. | Priority Nursing Diagnosis: Goal, Outcomes, Interventions and Responses Priority Nursing Diagnosis Impaired gas exchange r/t decreased pulmonary perfusion aeb c/o SOB with any exertion, pain with deep breathing, and decreased O2 saturation with ambulation. Expected Outcomes (measurable) INTERVENTIONS | CLIENT RESPONSE TO INTERVENTIONS | INSTRUCTOR FEEDBACK | 1.) Maintain client on bed rest to reduce oxygen demands during acute respiratory distress; increase activity gradually as allowed and tolerated2.) Maintain oxygen therapy as ordered3.) Perform actions to...
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...RTT1 Task 1 Nursing-sensitive indicators reflect the structure, process and outcomes of nursing care. These are measurable indicators of the quality of care provided to patients. Quality and/or quantity of nursing care can and does affect patient outcomes and the understanding of these measurements can assist in the planning and implementation of nursing care so that appropriate, quality health care with positive outcomes can be achieved. Poor performance on these indicators means not only is the quality of the care provided not good enough, but also they lead to longer, much more expensive hospital stays with poorer outcomes for the patient. Use of restraints for safety is, unfortunately, sometimes necessary. Options to explore first should be: Is there a family member that can come and sit with the patient to keep calm and safe? Does the hospital itself provide sitters in the room for safety? Can the patient be moved to a room closer to the nurse’s station so they can be monitored by staff? Does the hospital have a “niche” cart to keep their confused patients busy? When restraints are used, it is of utmost importance to release the restraints every hour for range of motion exercise and to turn the patient hourly to prevent pressure ulcer and DVT occurrence. More importantly, if a pressure ulcer is starting to form, it must be documented per institution protocol and the patient must be turned and kept off the site so the pressure ulcer does not progress. Although not addressed...
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...the organization pieces of nursing care which may include; staffing levels, educational levels, experience level, and staffing mix. The process of nursing sensitive indicators includes; the methods of assessments, type of interventions, and methods of care. The outcomes of nursing sensitive indicators are directly relatable to the qualitative and quantitative nursing measures (Sauls, 2013). Pressure ulcers, infections rates, and patient satisfactions are examples of outcomes. Understanding nursing-sensitive indicators could assist the nurses with measures for prevention that could lead to an improved patient outcome. Nursing-sensitive indicators identify structures of care and care processes, both of which in turn influence care outcomes (Montalvo, 2007). There are several nursing-sensitive processes and outcome indicators in this case which include; an increased risk for pressure ulcers, length of hospital stay, restraint prevalence, risk for falls, and patient satisfaction. The patient is at risk for pressure ulcers due to his decreased mobility from his hip fracture. By understanding this risk, the nurse should be more aware of the need to frequently reposition the patient. Being educated on this risk would also possibly decrease the length of hospital stay. If a pressure ulcer occurs, the patient would need additional treatment which could lengthen his stay. Due to the mild dementia diagnosis and his use of pain medication, the patient is at risk for falls and increased confusion...
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...Critical Care Case Study Crystal Meyer Mohave Community College Nursing 222 Mrs. Michelle Christensen April 1, 2014 Critical Care Case Study ADMISSION TC is a 61-year-old English speaking Caucasian female born on April 29, 1952. She weighs 99.7 Kg and is 5 feet, 5 inches in height with a BMI of 35.84. On March 5, 2014, TC was brought into the emergency department after her daughter-in-law called 911 when she found TC unresponsive at home in her bathroom. When paramedics arrived, she was found to be cool, pale, and diaphoretic with oxygen saturations in the high 70’s. Emergency responders placed a non-rebreather high flow oxygen mask and her oxygenation began to improve with saturations in the low 90’s. Upon arrival to the emergency department, TC’s vital signs were as follows: T 97.4; P 97; BP 120/95 mm Hg; RR 15 per minute; and O2 sats of 98% via NRB oxygen mask on 8L. A chest x-ray (CXR) revealed no abnormality and lungs were determined to be grossly clear. However, TC was checked for a pulmonary embolism via a pulmonary artery angiogram with IV contrast and found to have a large clot burden with a small saddle embolism. TC also complained of right ankle pain. An X-ray of her right ankle revealed a distal tib/fib fracture, which was presumed to be related to her fall during her hypoxic episode. With these findings, TC was admitted to the Intensive Care Unit of Kingman Regional Medical Center and placed on an NPO diet in preparation for placement of an inferior vena...
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...demands for quality patient care on the rise, so will the standard that nurses advance their education. There are three different avenues in becoming a registered nurse: diploma programs and associate degree programs ranging from 2-3 years to complete, and baccalaureate degree programs taking 4 years. According to the American Association of Colleges of Nursing (AACN), baccalaureate-nursing programs include all associate degree curriculums plus a more in-depth focus on physical assessments, social science, research, public and community health, humanities, and nursing leadership (AACN, n.d.). This advancement in education has expanded nurse’s scope of practice, broadened their awareness of cultural, social and economic considerations, and enhanced their critical thinking skills. Thus resulting in better nurses, and better care. This statement seems relatively simple, but ask a seasoned nurse with their associate’s degree for 20 years, if returning to school would increase their quality of care and level of competencies and you may offend them. Ongoing studies and research have shown that quality patient care, lower mortality rates, lower medication errors, and positive patient outcomes were direct results from nurses educated at the baccalaureate and graduate degree levels (AACN, n.d.). In 2003, Dr. Linda Aiken and her colleagues published in the Journal of the American Medical Association results of their study measuring outcomes between surgical patient mortality and failure...
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...RTT1 Organizational Systems Task 2 The purpose of this paper is to analyze the unfortunate sentinel event of Mr. B, a sixty-seven-year-old patient presenting with severe left leg pain at the emergency room. A root cause analysis is necessary to investigate the causative factors that led to the sentinel event. The errors or hazards in care in the Mr. B scenario will be identified. Change theory will be utilized to develop an appropriate improvement plan to decrease the likelihood of a reoccurrence of the outcome of the Mr. B scenario. A Failure Modes and Effects Analysis (FMEA) will be used to project the likelihood that the suggested improvement plan would not fail. Lastly, key roles nurses would play in improving the quality of care in the Mr. B scenario will be discussed. A. Root Cause Analysis A root cause analysis (RCA) is “a process for identifying the basic or causal factors that underlie variation in performance, including the occurrence or possible occurrence of a sentinel event” (Cherry & Jacob, 2011, p. 442). The participants during the root cause analysis would be the emergency room physician (Dr. T.), the Mr. B’s LPN and RN (Nurse J) during the time of the sentinel event, the emergency room nurse manager, and the chief nursing officer (CNO) of the hospital. These members would meet in a root cause analysis meeting to discuss the causative factors that created Mr. B’s sentinel event. The first step in a root cause analysis on the sentinel event that caused...
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...Nursing Theory Plan of Care Nursing Theory Plan of Care Transforming nursing research evidence into practice and policy is essential for the provision of quality care. Research utilization is defined as “the systematic process of transferring research knowledge into practice for the purpose of understanding, validating, enhancing, or changing practice” and has a potential to influence attitudes, beliefs, and behaviors of healthcare providers and recipients, alike (Matthew-Maich, Ploeg, Jack, & Dobbins, 2010). Most practical nursing disciplines create mechanisms of research utilization that, according to MacGuire (2006), can “clearly explicate the essential nature, meanings and components of nursing so that nurse clinicians can use this knowledge in a deliberate and meaningful way.” There are some difficulties with the process of transforming research findings into practice. Nurses may not know about the research finding, or they may find the changes to be disruptive and resist implementing them. They may not have the appropriate training or funding, or simply may not have the autonomy to apply the knowledge into their practice independently (MacGuire, 2006). When successfully implemented, research findings encourage nurses to make thoughtful and informed choices, to avoid automatic reactions based on old assumptions and practices, and to afford them ability to understand and critique research evidence in relation to their practice. Sometimes, a new idea could be rightfully...
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...Nursing Theory Plan of Care Fintan O’Connell NUR/513 May 23, 2012 Francine McDonald Care Plan for Ronald Issler |Nursing Process |Data and Relevant Information | |1. Breathe normally |Complains of shortness of breath, oxygen saturation 88% on room air, | | |heart rate 58, chest x-ray with bilateral lower lobe infiltrates, | | |history of DVT. | |2. Eat and drink adequately |Height 6 ft., weight 147 pounds. BMI 19.7 (lower range of normal). | | |History of congestive heart failure, takes diuretic. Hemoglobin and | | |hematocrit levels low (HGB 10.4 gm/dl, HCT 29.6%) | |3. Elimination of body wastes |History of congestive heart failure (as noted above), elevated | | |creatinine level of 2.0 mg/dl | |4. Move and maintain posture |Increasing weakness...
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...Nurses use research to provide evidence based care that promotes quality health outcomes for the patients, families, communities, and the health care system. Nurses and other healthcare personnel are able to use the skills learned through evidence based research to decrease a patient’s length of stay, decreases morbidity and mortality, and healthcare cost. Nursing research is a scientific process that validates and refines existing knowledge and generates new knowledge that directly and indirectly influences nursing practice (Burns & Grove, 2011). Extensive research is needed to develop sound empirical knowledge for synthesis into the best research evidence needed for practice. This research evidence might be synthesized to develop guidelines, standards, protocols, or policies to direct the implementation of a variety of nursing interventions (Burns & Grove, 2011). One example of nursing research that has improved patient outcomes is through the use of VAP (ventilator associated pneumonia) bundles in an intensive care unit setting for patients that are intubated for more than twenty four hours. VAP is pneumonia that occurs in a patient who was intubated and ventilated at the time of or within 48 hours before the onset of event (Centers for Disease Control and Prevention, n.d.) The Institute of Health Improvement (IHI) developed a ventilator bundle that incorporates several strategies to prevent morbidity associated with being on a ventilator. These strategies included: elevation...
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