Early Ambulating Summary

This clinical rotation I was assigned to observe at the operating room, where they conduct various surgical procedures. The night prior to the clinical, I have to admit, was every bit unnerving. Especially, the fear of not knowing what to expect was daunting. There must have been a thousand scenario of what to expect or what might possibly go wrong playing through my head that night. However, after being introduced to the nurse I would be following, and meeting the surgeon and the rest of the team; my nerves settled down. The surgery scheduled was for a ventral hernia, which seemed routine, but complicated by a previous bowel realignment previously. The whole operation, from beginning to end, lasted a little over four hours. Although, the procedure lasted that long, it did not bother me even bit. In spite of standing for the whole duration of the observation, I never felt tired nor gotten bored. Notably, watching the surgical team working cohesively is like watching an artists who have

On 01/27/2016, I observed about 22 patients in Postanesthesia Care Unit. Some of the patients were observed after surgeries while others were observed after endoscopy. During my shift, I observed patients awaiting recovery for removal of kidney stones, malignant melanoma (removal of moles), Endometrial Biopsy (EBX), superficial femoral artery (SFA), Hernia repair, Oophorectomy (ovary removal surgery), Cardiorrhaphy (Ventricular repair), Cystolithalopaxy (bladder stone removal), gall stone removal, Ectopic pregnancy surgery, and leg surgery.

The appropriate assessment of patients prior to surgery to identify coexisting medical problems and to plan peri-operative care is of increasing importance. The goals of peri-operative assessment are to identify important medical issues in order to optimise their treatment, inform the patient of the risks associated with surgery, and ensure care is provided in an appropriate environment secondly to identify important social issues which may have a bearing on the planned procedure and the recovery period and to familiarise the patient with the planned procedure and the hospital processes.(American Society of Anaesthesiologists)

The pre-operative stage is an important phase in patient’s surgery process. This is the time where the patients is experiencing a lot of anxiety issues and have questions regarding the impending procedure. To help ensure good patient outcomes, it is imperative to provide complete preoperative instructions and discharge instructions (Allison & George, 2014). It is the nurses’ duty to safe guard and protects the patient’s welfare during the surgical experience. Effective preoperative preparation is known to enhance postoperative pain management and recovery. Health professionals need to be cognizant of the contextual factors that influence patients’ preoperative experiences and give context appropriate care (Aziato & Adejumo, 2014).

The agenda was quite clear that during their observations the recovery showed needs were decreased according to age and BMI. They stated older patients were in need of more assistance and longer stay in the hospital as opposed to younger adults. I found it interesting that they saw patients with bilateral knees had decreased needs and that unilateral were in need of more assistance before discharge. Managing pain was their first priority during research and rehabilitation, followed by instructing care of their own surgical wound. The aim of this study was to actively reinforce assessment and management after this procedure and giving guidance to those in health care.

GDT has been found to be the pillar upon which the Enhanced Recovery after Surgery (ERAS) program is built upon. The downside of this technique is that it does not work well for bedside applications and most specialists do not allow the use of this method on a day-to-day basis. In the past few years, the use of GDT policies has been suggested as an important part of the ERAS package. The main concept of this plan is to have a myriad of solutions that will automatically lead to a better result in magnitude (Trinooson & Gold, 2013). Most of the studies, however have analyzed the effect and impact of implementation of the ERAS program. With regards to this shortcoming, it can be conclusively said that the outcome of using GDT mediation cannot be seen

The results from this study can change how nurses and other health care professionals approach mobilization. Early ambulation is cost-effective, can decrease the risk of postoperative complications to patients and can decrease the hospital stay of these patients (King, 2012). Although there is great importance in early ambulation, nurses need to be aware of the barriers that prevent ambulation and need to work around them or remove the barriers all together. I believe that research is a big part of a nurse’s scope of practice because they are always reading and discovering new interventions that they can apply in the health care setting. To promote the use of evidence based knowledge, the results of the study done by Haines et al. (2013) shows

when pain scores were greater than 5 on a 0-10 pain scale scoring system. In addition to

The study utilized a random design that compared a planned ambulation program to the usual care exhibited over the course of three days (Tedore et al., 2016.)

Postoperative pain is the most undesired sequence of surgery, and if not treated properly, can lead to increased hospital stay and delayed return to daily activities (10).

The second section focused on the act of labor and delivery, including first three hours of infant birth, followed by postpartum care and breastfeeding. The speaker spoke about the current practices that occur within the hospital's labor and delivery department. When speaking about delayed cord clamping, she discussed why this is important and even mentioned the volume of blood an infant lacks when the umbilical cord is clammed or cut too soon after birth. While discussing breastfeeding, she briefly mentioned infant blood glucose screenings, and the evidence that is published regarding encouraging breastfeeding within the first hour of

R. that he needs to continue to be autonomous in hygiene care tasks such as grooming,

In the do phase, the early ambulation project was initiated. The clinicians from the planning phase assisted in getting the word out to clinical staff and implementation was in full swing (Engel, Needham, Morris, & Gropper, 2013). The do phase also contained some compliance measures to ensure the new program was in use and no significant issues to hamper the project were encountered.

My goals for Y.M. included alleviating pain, educating and preventing potential complications. The administration of pain medications at prescribed intervals helped her manage pain. Also, changes in body positioning can assist in relieving pain as well. For patients that undergo appendectomies, the high Fowler’s position is helpful in alleviating pain because it reduces tension on the incision and abdominal organs (Huether & McCance, 2012). So, I ensured that Y.M. was placed in this position to aid in alleviating her pain. Additionally, throughout the shift, I educated Y.M. on the use of the incentive spirometer to promote optimal lung expansion, which is helpful in preventing post-op pulmonary complications. I also ensured that Y.M. was drinking

The need for a perioperative surgical home model stems from healthcare’s transition to a more value-based process of care as opposed to a fee-for-service system. Additionally, patients that are required to undergo surgery are often times separated from their usual medical care. This can result in delays, lapses in care, unnecessary testing, complications, an increase in costs, etc. Therefore, it would be favorable for a new model like the PSH model to be developed because it involves an innovation for care before and throughout the surgery process (asahq).