Obstructive Sleep Apnea Syndrome

As a clinical requirement for my Adult 1: Medical-Surgical course, I had the opportunity to observe a patient in the Operating Room and in the Post Anesthesia Unit of Advocate Good Samaritan Hospital. The procedure that I observed was a left total knee replacement. The patient needed this surgery because she was experiencing osteoarthritis, and this surgery could alleviate her pain and discomfort. I was with the patient from the end of her stay in the pre-operative holding area to the Operating Room, and then to the Post Anesthesia Care Unit. This paper will include background inquiry, preoperative and operative

As a provider of care, professional nurses depend on research, theories, and evidence based practice to guide the care they provide to patients. Nurses deliver care to their patients based on information they have learned through many years of school and training. Training for nurses and other providers of care is founded on theories, research, and evidence based practice in the healthcare field. Theories, research, and evidence based practice are all important for providing care to patients and each can be used in a different manner depending on the situation. Clinicians often use research based evidence to design and implement care that is high-quality and cost effective for patients. Evidence based practice can be used to provide care to patients in a steadily changing clinical environment. (PDF page 8-9). Nursing theories are frequently used as frameworks for establishing nursing care interventions and assessing

S.P. should be up out of bed post-op day 1 and wearing TED hose continuously, as well as wearing SCDs overnight in bed. Constipation prevention should e achieved by administering scheduled doses of Colace. Proper nutrition should be encouraged to include plenty of protein to ensure proper wound healing and avoid development of pressure ulcers (Lewis, Dirksen, Heitkemper, Bucher, & Camera, 2011). S.P. should practice coughing and deep breathing throughout her hospital stay to avoid lung congestion and occurrence of pneumonia infection, educating the patient about smoking cessation assistance can be helpful as well.

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)

Itroduction: Evidence-based practice is an approach to medicine that uses scientific evidence to determine the best practice (Beyea & Slattery, 2006). As nurses perform their daily tasks they must continually ask themselves, “What is the evidence for this intervention?”. Nurses are well positioned to question current nursing practices and use evidence to make care more effective. In order to improve patients’ outcomes it is the responsibility of the nurse to transition evidence-based practice into the norm, through application of daily practice (Flynn Makic, Rauen, Watson & Will Poteet, 2014). Continual evaluation of current practice must be performed to ensure the use of evidence-based practice opposed to practice based upon tradition. The implementation of evidence-based practice standardizes healthcare practices and diminishes groundless variations within care. These variations lead to the production of uncertain health outcomes (Stevens, 2013).

Sleep apnea is a common sleeping disorder where a person has experiences of not breathing during sleep. Over 20 million Americans, mostly overweight men, suffer from sleep apnea. Despite these numbers, sleep apnea is often not treated directly because its symptoms are thought to be those of depression, stress, or just loud snoring. There may be a genetic component to this disorder as it often occurs within families.People with sleep apnea stop breathing for at least 10 seconds at a time; these short stops in breathing can happen up to 400 times every night.

The relationship between the perioperative nurse and the patient has suffered a long process of mutation throughout the last decades. If before all the dynamics experienced within an operating theatre were based upon organizational and logistical aspects, these days the focus lies on the patient and all the comfort and security demanded throughout a process that already reveals itself aggressive for the patient. Being the front-line person in this dynamic, the anaesthetic nurse plays a crucial and intense role on the patient’s experience.

The John Hopkins Nursing Evidence-Based Practice Model describes how practice, education and research are the foundation for professional nursing. Practice is first, nurses need to question the basis of their practice and utilize an evidenced based approach to validate or change their current practice. Next is education, nurses’ education is basic in the beginning however with ongoing education nurses are able to gain new knowledge and skills throughout their careers. Finally is research, research generates new information for the nursing profession and allows for improvement of practice based on scientific evidence and research. (Dearholt & Dang 2012, p. 34-40).

Regardless of the number and type of practitioners involved, the MDA retains virtually all responsibility of the patients. The anesthetic management is delegated by the MDA to any of the team members that participate in this model. The CRNA’s role, in this model, would be to implement the concluded plan formulated through collaboration of the team.

Association of perioperative Registered Nurses (AORN) is a nonprofit organization that represents more than 160,000 perioperative nurses by providing nursing education, standards, and clinical practice resources-including the peer-reviewed, monthly publication-AORN Journal-to enable optimal outcomes for patients undergoing operative and other invasive procedures (ARON, 2015). The AORN organization focuses on best practice standards for quality patient care in the operating room. The OR setting is a fast pace environment that requires nurses to keep up on the latest technology, medicine, and positioning devices for the surgical patient. Nurses are advocates for patients during their surgical procedure to ensure safe and quality care. Our mission is to promote safety and optimal outcomes for patients undergoing operative and other invasive procedures by providing practice support and professional development opportunities to perioperative nurses (AORN, 2015).

The AMSU, or pre-operative nurse, is responsible for the pre-operative assessment. In this assessment, the nurse obtains vitals, receives a health history, and documents current medications the patient is taking. In the OR, the nurse is a circulating nurse. The nurse operates outside of the sterile field. They are responsible for charting information during the surgery and ensuring safety precautions are in place. The circulating nurse is responsible for collaborating with all other surgical team members. In the post-anesthesia care unit (PACU), the nurse is responsible for assessing the patient’s condition by taking and recording vital signs. The PACU nurse also helps rouse the patient still recovering from anesthesia and is responsible for reacting

Objective #3. Analyze the collected data to determine the strengths and weakness is the final goal. It appears the pre-anesthesia screener corrects most of the system failures prior to the patient’s scheduled surgery. The pre-anesthesia screener spoke of most of the day dedicated to problem solving and reiterating information with the patient and caregivers prior to surgery. If the pre-operative instructions and education were more transparent, then it may lessen the amount of phone calls and

Nursing care involves a wide range of interventions which are then draw diverse evidence base of knowledge and research of nurses. When providing evidence in practice it is very important that the records are accurately maintained in order for the evidence to be considered. The main reason for research to be evaluated and critiqued is due to evidence based practice. When carrying out Evidence Based Practice it is important to start off with a clear precisely aimed outcome that needs to be achieved. Evidenced based nursing is also the approach that nurses take to provide their patients with the best care that they can. This doesn’t just begin with the patient but stems to the families. The magnet hospital model upholds this to an exceptional level. They make it their goal to provide absolutely best care for their patients and they are awarded for it. Archiebald Cochran was a pioneer in evidenced based nursing. He published “Effectiveness and Efficiency” in 1971 where he criticized the lack of reliability in EBN. He argued the need for evidence in nursing. Being the founder of evidence based nursing his influence and dedication were said to be the key in making well-formed decisions about healthcare. EBN consists of formulating a question, gathering evidence to answer clinical questions, deciding which would be best, assessment of the patient, and evaluation. EBN paved the way for nursing

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.

A surgical nurse is responsible for monitoring and ensuring quality healthcare for a patient following surgery. Assessment, diagnosis, planning, intervention, and outcome evaluation are inherent in the post operative nurse’s role with the aim of a successful recovery for the patient. The appropriate provision of care is integral for prevention of complications that can arise from the anaesthesia or the surgical procedure. Whilst complications are common at least half of all complications are preventable (Haynes et al., 2009). The foundations of Mrs Hilton’s nursing plan are to ensure that any post surgery complications are circumvented. My role as Mrs Hilton’s surgical nurse will involve coupling my knowledge and the professional