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A Patient with Musculoskeletal Limitations Complicated By a Medical Illness (Essay #2)

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M6A4: A Patient with Musculoskeletal Limitations Complicated by a Medical Illness
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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. our recommended text book for this course is Brunner & suddarth's Text book of medical- surgical Nursing. 13th edition (2014) by Janice L.Hinkle, Kerry H. Cheever. Lippincott Williams & Wilkins ( Please try as much as possible to use this book.}
Compose your work using a word processor (or other software as appropriate) and save it frequently to your computer. Use a 12 font size, double space your work and use APA format for citations, references, and overall format. Information on how to use the Excelsior College Library to help you research and write your paper is available through the Library Help for AD Nursing Courses page. Assistance with APA format, grammar, and avoiding plagiarism is available for free through the Excelsior College Online Writing Lab (OWL). Be sure to check your work and correct any spelling or grammatical errors before you submit your assignment.
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A Patient with Musculoskeletal Limitations Complicated By a Medical Illness
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A Patient with Musculoskeletal Limitations Complicated By a Medical Illness
Introduction
Studies reveal that forty-five million procedures are conducted in the United States of America annually. Further, forty percent of the procedures always result in surgical complications. It is why the Surgical Care Improvement Project (SCIP) was launched, because it improves the quality of care among surgical patients. Critical to the discussion is the fact that a sixty-year-old patient reported to a hospital for a knee surgery. The patient reported history of hypertension and an irregular heart rate. It is crucial to highlight that no hair removal was done prior to the surgery. Additionally, a forced air-warming device was placed to maintain the patient’s temperature. Ultimately, it is crucial to highlight that the surgery was conducted during the day. This paper uses the Surgical Care Improvement Project to analyze the conditions for the case study under discussion.
SCIP Core Measures Used
Clearly, SCIP measures were introduced with an aim of improving the quality of care in patients. It is notable that a forced air-warming device was placed to maintain the patient’s temperature. According In Moore, In Turner, and In Todd (2013), the connection between surgical site infections and hypothermia comprises of the SCIP measures. Specifically, it is the SCIP-Inf 7. Hypothermia is a critical internal body temperature of less than 360 C. It is important to highlight that In Fry (2013) argues that hypothermia is associated with increased risks of post-surgical infections. As evidence, the author cites a meta-analysis by revealing that patients with temperatures that dropped by a mean of 1.50 C had higher risks of developing post-surgical complications. The author further cites a study by arguing that hypothermia may directly impair immune function and promote surgical wound infections.
The fact that a forced air-warming device was placed to maintain the patient’s temperature indicates that SCIP-Inf 7 measure was applied. Critical to the discussion is the fact that the measure prevented post-surgical complications by maintaining the patient’s body temperature. As a result, the measure prevented vasoconstriction and maintained a steady supply of oxygen in the body tissues. Further, maintaining a steady body temperature upheld functions of the neutrophil's phagocytosis and increased the patient’s immunity.
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