Patient with Musculoskeletal Limitations Complicated by Medical Illness
The Surgical Care Improvement Project (SCIP), was implemented as a commitment to improving the safety of surgical patients by reducing post-operative complications. Although some surgical complications are unavoidable, surgical care can be improved through better adherence to evidence based practice.
Case Study: A 60-year old patient with a long standing history of right knee pain has been diagnosed with osteoarthritis, and has been recommended a total left knee arthroscopy to improve chronic discomfort and improve mobility.
The patient’s past medical history includes hypertension and an irregular heart rate. The patient denies any allergies.
The patient reports to the hospital at 1 p.m. for a left knee replacement. A medication reconciliation is completed, and the patient reports taking the following medications with a sip of water at 8:00 p.m.:
• Lisinopril 10 mg PO daily
• Toprol 25 mg PO daily
• Celebrex 200 mg PO daily
While in the pre-operative holding area, vital signs are taken and are within normal limits. No hair removal was performed. The patient was ordered and received Ancef 1 gram IV mini bag, at 2:30 p.m. The patient was transferred to the operating room, where anesthesia monitoring began at 3:00 p.m., a urinary catheter was placed, and a forced air warming device was placed to maintain the patient’s temperature.
After recovering in the post anesthesia care unit (PACU), the patient was transferred to a surgical floor. Post-operative orders included:
• Ancef 1 gram IV mini bag every 8 hours
• Long leg TED hose and sequential compression stockings to right leg while in bed
• Lovenox 30 mg subcutaneously every morning, starting the following morning
• Urinary catheter to be discontinued at 3:00 p.m. on post-operative day 1
The patient progressed well, both with pain control and mobility. TED hose and sequential compression stockings were worn while in bed. On the first post-operative day, the first dose of Lovenox was administered at 1000 a.m. and the last dose of Ancef was received at 2:30 p.m. The patient was able to void after removal of the urinary catheter. The patient progressed well and was discharged home on post- operative day 5.
Evidence shows that more than 45 million operative procedures are performed in the United States each year. Approximately 40% of operative procedures result in a surgical complication. The Surgical Care Improvement Project (SCIP) was implemented to improve quality of care of surgical patients, by reducing surgical complications. Nurses play an important role in this process by following and adhering to evidence based and best practice protocols.
Using evidence based practice from two professional nursing journals, and/or your nursing textbooks, answer the following questions:
1. Explain one of the SCIP core measures, and how it has impacted the prevention of surgical complications. 2. Explain why no hair removal was required for the surgical procedure. If hair removal were ordered, explain the appropriate technique.
3. What methods were used to ensure that the recommended VTE/DVT prophylaxis was implemented, and why is the timing important? Explain your rationale with evidence.
Using APA format, write a two (2) to three (3) page paper (excluding the cover and reference page) that addresses the case study. A minimum of two (2) current professional references must be provided. Current references include professional nursing publications dated within five (5) years, and/or a textbook(s) used for the course that is no more than one (1) edition old. Websites are not to be used as professional resources or references.
Compose your work using a word processor (or other software as appropriate) and save it frequently to your computer. Use a 12 font size, double space your work and use APA format for citations, references, and overall format. Information on how to use the Excelsior College Library to help you research and write your paper is available through the Library Help for AD Nursing Courses page. Assistance with APA format, grammar, and avoiding plagiarism is available for free through the Excelsior College Online Writing Lab (OWL). Be sure to check your work and correct any spelling or grammatical errors before you submit your assignment.
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Patient with Musculoskeletal Limitations Complicated by Medical Illness
Name;
Institutional Affiliation;
Date
Introduction
The common complications that result after a surgery include the postoperative sepsis, surgical infection site infection, thromboembolic complications, cardiovascular complications and respiratory complications. Through a Surgical Infection Prevention approach, the mortality and morbidity that are associated with postoperative surgical site infections can be managed(Berenguer, Ochsner, Lord,& Senkowski, 2010). This paper, therefore, seeks to determine the core measures of Surgical Care Improvement Project (SCIP) and how this approach has wedged the inhibition of surgical complications. The paper will also address the measures implemented in recommending the VTE/DVT prophylaxis.
The Core Measures of SCIP and It’s Impacted on the Prevention of Surgical Complications
The core goal of the SCIP project primarily lies in decreasing the mortality and morbidity that are associated with postoperative surgical site infections by promoting the appropriate approaches to timing and selection of the prophylactic antimicrobials(Berenguer, et.al). It is, therefore, essential to determine that the timing and choice of an appropriate antimicrobial prophylaxis are associated mainly with the promotion of bacterial resistance.
According to sources, the first approach in the treatment of the SSIs is ensuring that a patient is prevented from surgical complications (Munday, Deveaux, Roberts, Fry, & Polk, 2014). This requires that the patient undergoes an operative technique, administered under an appropriate preoperative antibiotic including other preventive measures geared towards neutralizing the bacteria that would cause a threat, fungal and viral contamination that may be posed by an operative staff, the patient’s endogenous skin and the operating room environment.
The Surgical Procedure with No Hair Removal
In accordance to the numerous trials examined, the approach of preoperative hair removal is related to operative site infection. Hair is believed to lack some aspect of cleanliness, a fact that typically explains the reason why its removal may result in an infection prophylaxis (Munday, et.al). It is, therefore, evident to determine that shaving the skin is an approach through which an increase in the rate of SSI can be seen. This primarily lies in the fact that shaving may result in microscopic abrasions and cuts, a factor that would lead to a disruption of the skins ability to defend itself from microorganism colonization.
In as much as shaving may increase the risk of a patient in getting a postoperative infection, even when the shaving is done during the time of the surgery or a day prior to the surgery has no difference in terms of the rate of getting the infections (Myles, 2012). In this aspect, the CDC recommends that hair should not be removed unless it covers the area of operation.
In any case, the hair should be eliminated, and then this should be done before the operation through the use of electric clippers rather than through a shave. The patients who would want to shave before the surgery are advised to clip rather than shave with this done either in the morning of the surgical day or pri...