Nursing: Questions and Answers

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The Question is: You are working on a busy orthopedic ward and notice that many of the patients (mostly women) following Total Hip Replacement (THR) surgery are found to have developed a urinary tract infection when their catheter was removed in the post-operative period. Using the evidence-based approach, my direction would be to use the PICO model (Hoffman et al, 2010) and phrase the question in various ways. I may for instance ask myself the following: Population: How common is CAUTI following total hip replacement (THR) surgery. Are there specific characteristics of this population that make them vulnerable to CAUTI? What are the risk factors that predispose to CAUTI? Intervention: What are the indications for removal of the catheter? What if I try an alternate approach such as condom catheterization for men (Smith PW et al (2008))? Or Suprapubic catheterization? (ibid) Comparison: What if I try Intermittent catheterization on one group and short-term (C-I) or long-term (A-III) indwelling urethral catheterization on two others to compare? (Saint et al, 2008) Outcome: Which interventions would prevent urinary tract? Can the catheter be applied in such a way that urinary tract infection is avoided (such as with meatal cleansing or avoiding catheter irrigation (Hooten et al, 2009)) and routine catheter change)? Would a replacement to catheter need to be found or should modifications in the way catheter is applied be used instead? (Jones et al, 2008). There are two

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