Case Study #35 Essay example

There are challenges that Dr. Correia goes through on occasion. One problem he has is working with the patient’s provider and figuring out what exactly the provider wants him to do. Sometimes it’s difficult to figure out what specific tests the provider wants to have Dr. Correia do. Another problem Dr. Correia comes across is when all the tests show nothing wrong so he has to figure out the puzzle of what’s going on with the patient. After figuring out what is wrong with the patient, it also might to difficult to tell the patient if the test results came out bad.

Perioperative pressure area care is an essential part of the health care team’s perioperative management of the surgical patient. Advancements in clinical assessment, surgical positioning equiptment and standards of practice are essential in providing the highest level of patient centred care throughout the patient’s perioperative experience. Understanding and critically evaluating the advancements in current literature and clinical practice provide the perioperative nurse with the knowledge and skills required to provide holistic patient centred care for the surgical patient. This essay looks to explore and evaluate perioperative pressure area management, planning, assessment and prevention by surveying the available current literature and standards of practice.

In transport, patient received O2 at 4 liters via nasal cannula, baseline EKG, Normal Saline IV started in left hand, 325 mg aspirin by mouth (po). Patient complained she was short of breath and experiencing severe pain between her shoulder blades. She stated that she has been feeling nasuseated for the past 3 hours. She states she has a history of stable angina and is currently taking medication as needed. She states she did not take the nitroglycerin because she was not experiencing chest pain, just back pain. She states that her last check-up with the Pulmonologist showed that her EKG did not show any changes since her last visit. She denies episodes of syncope. The patient does report that she tripped over something on the floor, which resulted in her falling and hitting her back on a large table. In addition, she states that her heart rate has been ranging from 130/ 90 to 140/92. Patient states her Primary care physician placed her on blood pressure medication 2 months ago due to the increase.

You graduated 3 months ago and are working with a home care agency. Included in your caseload is J.S., a 60-year-old man suffering from chronic obstructive pulmonary disease (COPD) related to (R/T) cigarette smoking. He has been on home oxygen, 2 L oxygen by nasal cannula (O2/NC), for several years. Approximately 10 months ago, he was started on chronic oral steroid therapy. Medications include ipratropium-albuterol (Combivent) inhaler, formoterol (Foradil) inhaler, dexamethasone (Decadron), digoxin, and furosemide (Lasix). On the way to J.S.’s home, you make a mental note to check him for signs and symptoms (S/S) of Cushing’s syndrome.

Poor work life balance for gen. y – When gen. y can’t work due to their social life outside of work. The gen. y wanted more flexible working hours instead of wanting to only have to work full-time. Francoli gave them the solution to pick between two option which where 1) was to work longer hours four days a week and have the Friday off or 2) employees get to choose when they want to work put to only 8 hours a day.

Martin, a behavior analyst, is working with Sara, a 14-year-old girl with severe developmental delays who exhibits self-injurious behavior (SIB). The self-injurious behaviors included pulling her hair, biting her arm and banging her head against the wall. After conducting a functional analysis, Martin decided to employ an intervention program consisting of differential reinforcement of other (DRO) desired behavior. Martin collected data on Sara's SIB before and during the intervention. Below is a depiction of the data that Martin collected:

In Kindred Rehabilitation, the patient had a total knee replacement due to osteoarthritis. Osteoarthritis causes degenerative changes, within the joints causing bone stiffening and reactive inflammation. My patient was admitted on 10/21/11 with osteoarthritis and a left total knee replacement. Her PT and INR were a concern because she had developed mild thrombocytopenia which resulted in the elevation and potential bleeding. The physician had to take her off of Lovenox and switch her to an oral anti-coagulant Xarelto at 10mg once daily. During her care I was educated by the interdisciplinary teams managing mobility, safety, and the more

MEDICAL UPDATE: Client continues to report arthritis in her left leg and hand, high blood pressure. She also reports she will need surgery but she is waiting to be housed.

According to R.P. she is allergic to sulfa (thrush), eggs, Allegra (cramps) and Penicillin (GI upset. Her past medical history consists of hypothyroidism, chronic sinusitis, endometrial cancer and a mitral valve prolapse. The conditions that required hospitalization was a surgical removal of the ovaries and a hysterectomy in year of 2006. R.P. also had surgery on the right elbow and an appendectomy, but was unable to recall the year. The medications that she is currently taking are levothyroxine, Claritin, Singular, Prilosec and propranolol. R.P. is currently up-to-date with immunizations of Td/Tdap in 2016 and vaccinations of pneumococcal 11/2016. Client refused influenza vaccine.

Patient has a history of a myocardial infarction (MI, or also known as a heart attack) in 2004, she had a hip pinning in 2005, and a traumatic amputation of fingers on her left hand in 1974 from a lawnmower accident.

Enhanced recovery after surgery (ERAS) are a relatively new set of protocols arising in the 1990’s which have since been coined the gold standard in surgical patient care. They have been increasing adopted in because overall research has shown them to be a safe and cost effective way of reducing length of hospital stay and positive patient outcomes. ERAS protocols are threaded throughout the perioperative care, including pre, intra and post-operative phases. I will analysis two research papers which highlight the use of ERAS protocols and define a variety of protocols and focus on four ERAS protocols which are commonly used in surgical nursing.

Acute respiratory distress syndrome (ARDS) occurs when fluid builds up in the tiny, elastic air sacs (alveoli) in your lungs. More fluid in your lungs means less oxygen can reach your bloodstream. This deprives your organs of the oxygen they need to function.

On April 11, 2014, I had the privilege of direct observation of a patient’s orthopedic surgery, from the pre-operative to post-operative setting. The patient with the initials N.R, which we will call Mrs. R, arrived to the hospital just prior to 6:30a.m. As the name implies, Mrs. R was a female patient, 76 years old with an admitting diagnosis of right hip osteoarthritis. Due to arthritis in her hip, Mrs. R’s ability to perform daily activities and participate in hobbies such as dancing has been extremely compromised over the last 2 years. The overall goal of Mrs. R’s surgery

The plan I would need in place would first to address her respiratory status and maintain a patent airway. I would also want to have the patient demonstrate how to splint while deep breathing or coughing. I would ask the Cna to help with position changes every 2 hours or more if needed for comfort for the patient. I would need to do a full assessment at this point if the patient is more stable. By having the patient deep breath will also help her return to consciousness, (Ahmed, Latif and Khan, 2013). I would want to keep her comfortable and in as little pain as possible. I would also want to try to educate her as to when to push for pain medications from her PCA pump. If there were any family I would want to try to get them involved with the education as well. The use of an incentive spirometer should be included in the teaching too. I would keep monitoring the incision site and watching for signs that the patient is in pain. While I was working on patient education with this patient, I would ask the CAN to do vitals on the 2 postop patients every 15 minutes for the first hour, reporting abnormal vital signs to myself or the other R.N. I would also ask the other R.N. if she/ he would do the discharge for that patient, while I remain with this patient and make sure she is going to stay stable.

Question 1. What competences has IBM had to invest in arising from its transformation from a ‘product-centric’ to a ‘service-centric’ organization?