Preoperative Glycemic Control : Risk Assessment And Modification Essay

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

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.

On the day of surgery, avoid eating or drinking anything six to 12 hours before the operation. Just take a small sip of water to ingest any medication you are asked to take. Go to the hospital early so you will arrive on time for your 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).

Egi et al. (2016) conducted a level II multicenter, multinational, retrospective observational study to study the impact of pre-morbid glycemic control on the association between acute hypoglycemia in intensive care unit patients and subsequent hospital mortality in critically ill patients. The study took place in hospitals in the United States of America, Japan, and Australia. All adult patients admitted into

During the pre-briefing, the group collectively discussed the patient’s history, presenting issues and other influences to the patient's care. As well, during this time, the group worked to identify role expectations, protocols, timelines and other presenting issues that would require consideration, including impaired circulation/post-op bleeding, mental status or hypoxemia. Decision-making in this aspect was based on the determined role and intended learning outcomes.

Hi Gregory, great information on glucose level before and after surgery. Moreover, I work in the pre and post surgery unit, blood chemistry are checked on each surgical patient. Blood glucose over 200 are treated, became this increase the chances of non- healing wound or infection, and moreover can cause other complications. Education in these patients before and after surgery are important, "the better control of your diabetes, the better your chances of an excellent surgical outcome. Keeping your blood glucose within the parameters your doctor recommends is key. Top-notch nutrition, including high-quality protein, is also essential. Protein is an important component in the healing process and can help contribute to faster wound healing, stronger

The reasons could be a lack of motivation, avoidance of information or the ignorance about the health behavior (Virginia Tech Continuing & Professional Education, n.d.). In this initial stage, the patients are still in the hospital. It is the responsibility of the discharge nurse to emphasize the importance of maintaining the blood glucose (BG) levels within the normal range while educating the patient, to prevent the surgical site infections (SSIs). The nurse should stress the need to check the patient’s BG levels at least two to three times a day and document the results in the BG monitoring chart provided to the patient at

During my rotation in the operating room at Community medical center, I observed the preoperative, intraoperative, and postoperative care for a patient who underwent a laparoscopic hysterectomy. I believe that an appropriate preoperative plan of care for this patient would have included a full physical exam and an interview for patient history, a pelvic exam to look over and understand the nature of the patient’s complications, blood testing including a CBC and WBC to note any signs of infection or contraindications for the procedure, and a urine test to rule out any urinary tract infections or pregnancy. It would be important to interview the patient and ask questions to determine how the patient is feeling about their procedure and to better assist with any anxiety or pain they may be dealing with preoperatively. It is important to consult with the patient well before the procedure to ensure that she knows to refrain from smoking for at least 8 weeks before the procedure because this reduces the risks of complications such as infections, issues with blood pressure, heart rate, blood flow, and respirations when under anesthesia, and promoting overall health and risks associated with smoking after the procedure. (ASAHQ) It is also important to educate the patient to consume no food or drinks after midnight the night before the scheduled procedure. (Health Communities) During my rotation I observed that the patient did indeed have labs drawn and a urine test run. Her lab

Patient G.M. is a four-year-old female from a middle class family living in San Diego. She originally presented with her mother and father to her general practitioner with lethargy and several vomiting episodes in the past few days. Her father stated concern after realizing her frequent urination in the past week. Her vital signs upon initial assessment were HR 140 RR 22 Temperature 102.7 degrees Fahrenheit, BP 70/62, O2 saturation 97%, 32 pounds, and 40 inches tall. Her General practitioner was concerned about type I diabetes and performed a blood sugar check. Upon assessment the monitor read HI, indicating that the level was above 500 and too high for the monitor to read. The doctor informed them she needed immediate treated in the closest pediatric ER due to the potential for diabetic ketoacidosis.

perioperative hypotension is a common problem, incidence is largely unknown. There are evidences suggesting that incidence of myocardial adverse events in the postoperative outcome may be linked to the prolonged episodes of perioperative hypotension. There are few comprehensive resources available in the literature regarding diagnosis and management of these common clinical outcomes, especially in non-cardiac surgery.[1] Perioperative myocardial ischemia is associated with significant morbidity and mortality, 50% of postoperative deaths are due to cardiac complications, the ischema is the major problem amongst.[1] It is an emergency crisis which poses a unique challenge for the anaesthetist in its management. We report a case of Intraoperative myocardial ischemia in an elderly patient with multiple comorbidities who underwent orthopaedic hip surgery . Intraoperative myocardial ischemia was diagnosed on time and was managed successfully.

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

Whilst in-line arterial blood gases(ABG) run constantly, individual samples are taken regularly for calibration (Curle et al., 2007).Thus requiring the aid of either another perfusionist who is not currently running their own bypass or asking a circulating nurse for help if they are not already engaged in another task. The perfusionist is responsible for ensuring that the majority of these parameters are within the correct range, as part of ensuring that the bypass machine is functioning properly in its role of oxygenation and decarbonisation of the blood. One area which the anaesthetist is concerned with in particular during bypass is the blood glucose; as if it rises too high in response to surgical stress it may be necessary to begin an insulin infusion (Cheng and David, 2006).

Physical preparation usually consists of a complete medical history and physical exam, including the patient's surgical background. The patient should inform the nursing staff if he or she has ever had an adverse reaction to anesthesia (such as anaphylactic shock). Laboratory tests may include complete blood count , and urinalysis . The patient may also have an electrocardiogram (EKG) if they are over 50 years of age or if he or she has a history of cardiac disease . A chest x ray may be done if a patient has a history of respiratory disease. Part of the preparation includes assessment for risk factors, such as nutritional deficiencies, steroid , drug or alcohol abuse and metabolic diseases such as diabetes as these may affect healing time. The patient should also provide a list of all medications or food supplements that they use. Supplements are often overlooked, but may cause adverse