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Health, Medicine, Nursing
Case Study
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Patient with Musculoskeletal Limitations Complicated by a Medical Illness (Case Study Sample)


The Surgical Care Improvement Project (SCIP), was implemented as a commitment to improving the safety of surgical patients by reducing post-operative complications. Although some surgical complications are unavoidable, surgical care can be improved through better adherence to evidence based practice.
Case Study: A 60-year old patient with a long standing history of right knee pain has been diagnosed with osteoarthritis, and has been recommended a total left knee arthroscopy to improve chronic discomfort and improve mobility.
The patient’s past medical history includes hypertension and an irregular heart rate. The patient denies any allergies.
The patient reports to the hospital at 1 p.m. for a left knee replacement. A medication reconciliation is completed, and the patient reports taking the following medications with a sip of water at 8:00 p.m.:
• Lisinopril 10 mg PO daily
• Toprol 25 mg PO daily
• Celebrex 200 mg PO daily
While in the pre-operative holding area, vital signs are taken and are within normal limits. No hair removal was performed. The patient was ordered and received Ancef 1 gram IV mini bag, at 2:30 p.m. The patient was transferred to the operating room, where anesthesia monitoring began at 3:00 p.m., a urinary catheter was placed, and a forced air warming device was placed to maintain the patient’s temperature.
After recovering in the post anesthesia care unit (PACU), the patient was transferred to a surgical floor. Post-operative orders included:
• Ancef 1 gram IV mini bag every 8 hours
• Long leg TED hose and sequential compression stockings to right leg while in bed
• Lovenox 30 mg subcutaneously every morning, starting the following morning
• Urinary catheter to be discontinued at 3:00 p.m. on post-operative day 1
The patient progressed well, both with pain control and mobility. TED hose and sequential compression stockings were worn while in bed. On the first post-operative day, the first dose of Lovenox was administered at 1000 a.m. and the last dose of Ancef was received at 2:30 p.m. The patient was able to void after removal of the urinary catheter. The patient progressed well and was discharged home on post- operative day 5.
Evidence shows that more than 45 million operative procedures are performed in the United States each year. Approximately 40% of operative procedures result in a surgical complication. The Surgical Care Improvement Project (SCIP) was implemented to improve quality of care of surgical patients, by reducing surgical complications. Nurses play an important role in this process by following and adhering to evidence based and best practice protocols.
Using evidence based practice from two professional nursing journals, and/or your nursing textbooks, answer the following questions:
1. Explain one of the SCIP core measures, and how it has impacted the prevention of surgical complications. 2. Explain why no hair removal was required for the surgical procedure. If hair removal were ordered, explain the appropriate technique.
3. What methods were used to ensure that the recommended VTE/DVT prophylaxis was implemented, and why is the timing important? Explain your rationale with evidence.
Using APA format, write a two (2) to three (3) page paper (excluding the cover and reference page) that addresses the case study. A minimum of two (2) current professional references must be provided. Current references include professional nursing publications dated within five (5) years, and/or a textbook(s) used for the course that is no more than one (1) edition old. Websites are not to be used as professional resources or references.


Postoperative Complications
Postoperative complications are quite common especially where the best practices are not followed properly. This not only complicates the recovery process but also puts the life and safety of the patient in danger. Postoperative complications tend to result from the primary disease that required the operation, the operation itself and sometimes they result from unrelated factors (Medscape, 2015). The most complex aspect related to the postoperative complications is the fact that, the symptoms are masked in the two health complications and may lead to poor diagnosis and thus wrong treatment as the situation worsens.
It is crucial for the operative surgeon to continuously evaluate the patient for any complications. In report carried out at the institute of medicine, where more than 44,000 operations were assessed between the years 1977 and 1990; the results revealed that, there were more than 5.4% of patients that suffered postoperative, which translated to more than 2400 (Medscape, 2015). More than half of the cases were ironically attributed to human error. In another study carried out in the year 2003, there were more than 22% of deaths which would have been prevented and all of them were associated with postoperative complications (Medscape, 2015). Other than the deaths associated with postoperative complications, millions of additional days on hospital beds have been added on with costs soaring into billions of dollars annually and social implications that have irreparable damage to the families and the society, all of which can be avoided. In an effort to reduce the number of postoperative complications or otherwise called the Surgical Site Infections, a set of compliance measures were developed under the Surgical Care Improvement Project in 2003 (Medscape, 2015).
The Surgical Infection Prevention measures were initiated in the year 2003. Hospitals were then tasked with collecting data in July 1st of the year 2004 (Medscape, 2015). On 1st July the measures transitioned to Surgical Care Improvement Project measures. The partners to the initiative include ten national organizations that are in the steering committee. With a technical expert panel to advice on the target areas, the initiative has been working to align Centers for Medicare and Medicaid Services, relative to the performance measures on surgery (Medscape, 2015).
Of the many measures that have been laid out, is the number one measure, which states that prophylactic antibiotic should be received within one hour prior to surgical incision. The importance of the measure in the surgical procedures cannot be understated relative to the fact that, surgical sites infections are estimated to be around 500,000 on an annual rate (Medscape, 2015). They also account for more than 4 million days extended in hospital, which rounds off to close to $2 billion dollars in costs (Medscape, 2015). The idea behind the administration of the antibiotic is to make sure that there is an effective serum and tissue levels, during the surgery period.
According to data collected from 2847 patients that underwent clean-contaminated or clean surgeries, they showed that receiving the prophylactic antibiotic two hours before their surgery, reduced the rate surgical site infection to less than 0.6 percent (Medscape, 2015). This is a crucial decline considering the figures that have been published before showing more than more than half a million patients are infected during their surgery. However, it is also important to note that, those patients that received the prophylactic antibiotics more than three hours after the surgery had twice the rate surgical site infection (SALKIND & RAO, 2011). Those that received the antibiotic more than two hours before their s...
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