...Peri operative nursing care includes nursing care given before (preoperative), during (intraoperative) and after surgery (post operative) (Crisp J &Taylor C 2005:1660). Peri operative nursing is a fast paced, changing and challenging field. Skin preparation is one of the important peri operative procedures. Evidence based practice provides a helpful framework for health care providers in peri operative settings to use research in practice settings (Beyea S 2004:97). In this essay exploration of research evidence around skin care preparation will be discussed. Based on the findings from the research material, conclusion will be drawn. Surgical site infections are reported to be the third most frequently occurring nosocomial infection among hospitals patients. It can increase the length of stay up to 7.3 days, and increase the cost by prolonged postoperative stay as well as increase morbidity & mortality ( The impact of Preoperative 2003:1). SSIs can occur both peri and postoperatively, and skin is a potential source of microbial contamination. Therefore, it is important to prepare peri operative skin preparation. Skin preparation is a pre-operative procedure, which is performed to reduce the risk of postoperative wound infection and to prepare patient for surgery by removing soil and transient microorganisms from the skin. Peri operative skin preparation involves two processes- the first is physical cleansing, the physical removal of bacteria and dirt by washing with soap, detergent...
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...Web Search Assignment #1 (Quantitative Research) Kayla Tranbarger Tabor College Wichita Instructor: Marlene Pietrocola NUR 410: Evidence Based Nursing Practice January 25, 2015 I chose the article titled “The effect of nurse-performed preoperative skin preparation on post-operative surgical site infections in abdominal surgery”. This quantitative research article is an experimental study to determine the effect of preoperative skin preparation procedures by nurses on post-surgical site infections in abdominal surgeries. The research question that the authors Dizer et. al are asking is if pre-operative skin preparation will decrease the risk of post-operative skin infections in abdominal surgeries. This study was based on previous research done that states pre-surgical skin cleansing with antibacterial agents greatly reduce the risk of infections. This study is to provide more evidence to support its use into nursing practice. The research design was experimental in that there was an intervention; preoperative skin preparation, a sample group that received the intervention and a control group to compare the sample group to. The methods used to answer the question were that the experimental subjects of the study were 272 patients that had been hospitalized and underwent abdominal surgery during a specified time period. The population of patients that made up the two groups met certain criteria for the study, and then were randomly separated into the sample and control...
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...Governor’s University Procedure, basis for practice, rationale and explanation The procedure for the use of povidone-iodine for surgical cite antisepsis is: skin preparation for surgery includes the use of sterile drapes to drape the patient and square off surgical area with sterile towels to absorb excess solution. The incision site is where the prep begins and proceeds outward from that point. Iodine soap or scrub, wet the skin with sterile water the iodine scrub will be added to the point of lather, the site is to be scrubbed for 5 minutes. Excess solution is to be blotted with sterile towels or sterile gauze. When iodine paint is used the iodine paint will be applied and allowed to dry before first incision. This practice of surgical skin preparation has been a standard for many years. At this facility povidone-iodine is used predominantly however a few surgeons do use chlorhexidine, it has typically been surgeon choice for skin preparation. Studies have shown that Chlorhexidine-alcohol is a superior product to povidone-iodine to reduce skin colonization and reduce surgical site infection, (Darouiche, Wall, Itani, Otterson, Webb, Carrick, & ... Berger, 2010). No specific use for either product was found in the policy and procedures for the hospital on the hospital web site. There were no available protocols involving the products that were found. It is not apparent that there has been any evidenced based practice involved. Recent changes in hospital...
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...The role of preoperative Chlorhexidine as an antiseptic solution to reduce the risk of postoperative surgical site infection C1369366-MET319 Word count: 3546 Contents: Introduction: 3 Objective: 4 Methods: 4 Table 1: Search strategy 5 Critical appraisal of the literature: 5 Discussion: 17 Conclusion: 17 References: 18 Introduction: Surgical Site Infection (SSI) is a common complication in surgical practice. The incidence depends on multiple factors including the type and location of surgical procedure ranging from 2%-4% in simple skin lesions (Rogues et al., 2007) to 36% in cases of reversal of stoma (Liang et al., 2013). Incidence of SSI can be kept low by simple measures such as rescheduling elective procedures in presence of infection; e.g.: Urinary Tract Infection, Respiratory Tract Infection which can seed Bacteria to surgical wounds (Ollivere et al., 2009). Prophylactic Antibiotics given prior to elective surgery remains debatable and of questionable value considering the risk of side effects, emergence of Multi-drug resistant Pathogens and Anaphylaxis, and therefore should be used according to guidelines like in patients with higher risk for developing SSI (Wright et al., 2008, Dixon et al., 2006). Also, procedures at certain body sites and those involving surgical reconstruction are better covered with prophylactic Antimicrobial agent (Rosengren and Dixon, 2010). Use of antiseptic scrub has been...
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...Perioperative Shavings Victor A. Moore Western Governors University Prepping a patient for a surgical procedure usually involves removing the Hair at the incision site. The surgical care improvement project commonly known as SCIP is a national partnership of organizations focused on improving surgical care by significantly reducing surgical complications. One complication is surgical site infections SCIP has developed recommendations for hair removal. There are several SCIP measures, antibiotic within one hour before incision, received prophylactic antibiotic consistent recommendations, prophylactic antibiotic discontinued within 24 hours, control of postoperative serum glucose and appropriate hair removal. (Patterson, 2011, p. 120) What is appropriate hair removal? Razors can remove hair and has been the traditional method of hair removal, powered surgical clippers can trim hair at surgical site and does not leave cuts and microscopic abrasions where microscopic Flora can colonize in the surgical site causing postoperative infection. The National Quality Forum has endorsed to SCIP infection control measures. According to the Surgical Quality Alliance, which is a collaboration among specialty societies that provide surgical and perioperative care to improve the quality of care for the surgical patients, states that” following the endorsement by the National Quality Forum SCIP measures were incorporated into Medicare's reporting of Hospital Quality data for annual...
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...for short distances. He has orders to get up in a chair twice a day. Joan, a student nurse, is caring for Mr. Gordon this morning. She has reviewed his medical record and is now ready to start caring for him. Joan assesses Mr. Gordon using the Braden Scale and determines that his score is 12. What does this score indicate about Mr. Gordon’s pressure ulcer risk? Joan is assessing Mr. Gordon’s skin and notices that he has a 3 cm blister and a shallow crater on his buttock. Mr. Gordon winces when Joan palpates the area. How should Joan stage this area? A. Stage I pressure ulcer B. Stage II pressure ulcer C. Stage III pressure ulcer D. Stage IV pressure ulcer Rationale: Mr. Gordon has drainage coming from his surgical incision, and his dressing needs to be changed. What assessments of the incision should Joan perform while changing? Answer: Rationale: Claudia asks Joan what she can do when she takes him home to help prevent more pressure ulcers. How should she answer? Answer: Rationale: Elvis Baker, a 65-year-old black male, is being admitted to the preoperative suite for a colon resection for removal of a tumor. Mr. Baker is a retired coal miner. He has a history of hypertension and type 2 diabetes. He smokes one pack of cigarettes daily. His wife and brother are both with him. He has not had surgery before,...
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...19th, 2013 Preoperative Phase The preoperative phase is the time period between the decision to have surgery and the beginning of the surgical procedure. For some patients, the preoperative period may last for months, during which testing and other procedures may be done. For an emergency, such as an appendectomy, the preoperative period may last only a few hours. During the preoperative phase, preadmission testing is done to assess health history, family medical history, and any known allergies to medications. During which time explanation of the surgical procedure and patient education is taking place. Patient education advises the patient on pre-surgical preparation such as bowel preparation, nutritional and fluid intake the day before the procedure and when to stop eating, and how to proceed with medication therapy the day before surgery. Diagnostic testing includes ECG monitoring, blood testing and vital signs. The trauma of surgery can greatly be relieved by psychological preparation of the patient before surgery, so during preadmission testing psychological evaluation is also taking place to assess the patient for any fears or anxiety related to the surgical procedure. The nurse should discuss techniques to aid physical recovery and ways to lessen the pain and anxiety that is related to surgery. This phase is the most crucial and it is what sets the pace for the entire experience and helps in maintaining patient safety. Psychological preparation is very important...
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...EBT1: Evidence Based Practice and Applied Nursing Research COMPLETE COURSE WGU RN-BSN IF You Want To Purchase A+ Work Then Click The Link Below , Instant Download http://www.hwnerd.com/EBT1-Evidence-Based-Practice-and-Applied-Nursing-Research-709077666.htm?categoryId=-1 If You Face Any Problem E- Mail Us At Contact.Hwnerd@Gmail.Com TASK 1 The research obtained in this particular study does support the conclusion. When all five area’s were studied, it verified that the incidence of ventilated associated pneumonia was decreased when oral care and dental care was performed onto these mechanically ventilated patients. The background information that was provided was direct, to the point and relevant to the impact of today’s heath care. Millions of dollars are being spent every year for incidences within hospitals that can be prevented and this study was set out to prove just that, that ventilator associated pneumonia can be prevented. The logic was simple. That logic was to clear the mouth and airway of any harboring microorganisms that can pool in the mouth and result into an infection. The test groups were relevantly the same size and the characteristics of age, sex, APACHE scores and reasons for admissions were comparable. The conclusion was predictable in verifying that strict oral cleaning did result in a lower incidence of ventilator associated pneumonia in patients. A.4. During the course of this research, ethics would be addressed. Before...
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...EBT1: Evidence Based Practice and Applied Nursing Research COMPLETE COURSE WGU RN-BSN IF You Want To Purchase A+ Work Then Click The Link Below , Instant Download http://acehomework.com/EBT1-Evidence-Based-Practice-and-Applied-Nursing-Research-WGU-8906543.htm If You Face Any Problem E- Mail Us At JohnMate1122@gmail.com TASK 1 The research obtained in this particular study does support the conclusion. When all five area’s were studied, it verified that the incidence of ventilated associated pneumonia was decreased when oral care and dental care was performed onto these mechanically ventilated patients. The background information that was provided was direct, to the point and relevant to the impact of today’s heath care. Millions of dollars are being spent every year for incidences within hospitals that can be prevented and this study was set out to prove just that, that ventilator associated pneumonia can be prevented. The logic was simple. That logic was to clear the mouth and airway of any harboring microorganisms that can pool in the mouth and result into an infection. The test groups were relevantly the same size and the characteristics of age, sex, APACHE scores and reasons for admissions were comparable. The conclusion was predictable in verifying that strict oral cleaning did result in a lower incidence of ventilator associated pneumonia in patients. A.4. During the course of this research, ethics would be addressed. Before the study had begun, the...
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...line placement for the last decade, but surgical- site infections (SSI) continue to increase raising the question if betadine is a sufficient agent for surgical insertion of a CVC or is there an alternative proven through evidence- based practice to be a more effective anti-microbial. A2a. Basis for Practice Procedures and protocols are researched by the safety committee who release their findings to the clinical practice committee for review and evaluation. In a culture that use to accept betadine as the primary anti-microbial agent to cleanse the skin prior to CVC insertion has been questioned and through evidence based practice is in favor of using chlorhexidine gluconate (CHG) as the primary agent by identifying and concluding that it is superior to betadine by reducing the risk of SSIs by approximately 50% (Chaiyakunapruk, Veenstra, Saint, and Lipsky (2009). If the clinical practice committee approves the use of CHG for CVC insertion it is communicated to the department of nursing followed by the nurse managers, educators and staff nurses. A2b. Rationale CHG and betadine are anti-microbial agents that reduce the incidence of primary SSIs. Cleansing the surgical incision site of the CVC is practiced by disinfecting the skin...
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...conditions and other factors contribute to the development of Surgical Wound infections. * Determine the aims or purposes of analysis The purpose is to understand the effect of environment in surgical wound infections. Prevention of infection requires the application of the principles of microbiology and accept practice. Measure of this concept is based on the stages of wound healing and the Centers of Disease Control and Prevention guidelines defining surgical site infection as occurring 30 days postoperative. * Identify all uses of the concept The Merriam-Webster Dictionary was used to explore the general definition of surgical wound infection Surgical of or relating to the process of performing a medical operation: of or relating to surgery. Wound an injury that is caused when a knife, bullet, etc., cuts or breaks the skin. Infection is the act or process of infecting someone or something: the state of being infected. The Oxford English Dictionary (OED) was also used to explore the definition. Surgical relating or used in surgery. Wound is an injury to living tissue caused by a cut, blow, or other impact, typically one in which the skin is cut or broken. Infection is the process of infecting or the state of being infected History of Surgical Wound Infection Hippocrates (Greek physician and surgeon, 460-377 BC), known as the father of medicine, used vinegar to irrigate open wounds and wrapped dressings around wounds to prevent further injury. The scale...
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...Sometimes in the best of circumstances, incidents occur with patients that cause undue harm. This paper will differentiate between negligence, gross negligence, and malpractice. It will also discuss the article “Amputation Mishap; Negligence” from the Neighborhood newspaper. It will discuss the importance of documentation and the ethical principles that would guide my practice as a nurse. Negligence can be defined as the failure to use reasonable care that a reasonably prudent person would exercise in like circumstances. (West, 1998). Negligence occurs when a medical health professional fails to perform his or her duties with the patient in question. If a nurse fails to give medications as ordered, and as a result the patient's condition worsens or he dies, the nurse may be found negligent. If a nurse has inadequate nursing skills or fails to pay attention to tasks, it may result in a suit of negligence against a nurse who fails to provide approved standards of care. A good nurse knows their duties and has good communication between the patient and the physician. The nurse knows board regulations and practices within legal guidelines. Gross negligence can be defined as a conscious and voluntary disregard of the need to use reasonable care which is likely to cause foreseeable grave injury or harm to persons, property, or both.(West, 1998). An example of gross negligence would be if a nurse had a patient in restraints and failed to release the restraints for range of motion...
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...Western Governors University XTT Task 1 January 2, 2015 CURRENT NURSING PRACTICE In the United States there are approximately 5% of sterile surgical operations that will become infected each year. The number one nosocomial infections regarding surgical patients are infections at the surgical site (Kalb, Lefevre, Dididze, & Levi, 2013). For reductions of infections on any surgical site, this skin will need to be cleaned (or prepped) and covered with a sterile towel or drape. The site of the incision is prepped so that bacteria or microbes that cause the infection are found on the skin surface. Due to these microbes, prepping a patient’s skin will be the most important step prior to any surgery. Different hospitals throughout the United States use many different products for the cleaning or prepping stage. At the hospital of my place of employment, there are three different agents that can be used. This list includes Chlorhexidine gluconate, chlorhexidine alcohol, and povidone iodine. Any type of infection involving the incision site can cause complications that could be long term for any patient to deal with and may have financial consequences to any hospital. This particular hospital is considering a change to standardize the prepping solution and needs to determine the cost factor if it were to change to a new product or to add premixed applicators of particular type of surgical prep solution. At this hospital, the current standard is using a surgical prep cleanse...
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...MANAGEMENT OF FRACTURES CASTS A cast is used to immobilize and hold bone fragments during reduction. It is made up of layers of plaster or fiberglass (water-activated polyurethane resin) bandages molded to the body part that it encases. Indications * To apply uniform compression of soft tissues * To permit early mobilization * To correct and prevent deformities * To support and stabilize weak joints Types of Casts 1 Short and long -arm cast for the upper limbs. : Extends from below the elbow to the proximal palmar crease. 2 Gauntlet Cast (thumb spica): from below the elbow to the proximal palmar crease. 3 Short and Long-leg Cast for the lower limbs. 4 Body Cast: Encircles the trunk stabilizing the spine. 5 Spica Cast: Incorporates the trunk and extremity. 6 Shoulder spica: encloses trunk, shoulder, and elbow. 7 Hip spica: encloses trunk and a lower extremity and can be single or double. Single extends from nipple line to include pelvis and one thigh while double includes both thighs and lower legs. 8 Cast-brace: External support about a fracture that is constructed with hinges to permit early motion of joints, early mobilization, and independence. 9 Cylinder Cast: Can be used for upper or lower extremity e.g. fracture or dislocation of knee or elbow dislocation. Complications of Casts * Pressure of cast may cause necrosis, pressure sores, and nerve palsies. * Compartment syndrome * Cast syndrome associated especially of...
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...Executive Summary Accreditation Audit - Communication Nightingale Community Hospital A. Compliance Status Nightingale Community Hospital (NCH) has a vital role as a not-for-profit community hospital providing health care and services in various areas such as critical care, general medical and surgical services, oncology etc. This executive summary provides overview in terms of NCH`s compliance of priority focus area on communication: * The current status of the NCH`s communication compliance with the communication requirements of the Joint Commission (JC) on Accreditation of Healthcare Organization. * Corrective action plan for a compliance with the JC’s standards for the communication focus area. * Justification of an importance for the communication standards for NCH. Current Status NCH Communication standards compliance to 2013 Joint Commission Hospital Standards for Communication NCH current standards and protocols in place | Joint Commission(JC) Standard Number | Joint Commission Standards, retrieved from Joint Commissions on Accreditation of Healthcare Organizations (2013) | NCH Preprocedure Hand-Off form | UP.01.01.01 | Conduct a preprocedure verification process. | Overall finding: Based on the provided material, NCH preprocedure hand-off form, there appears to be a preprocedure verification process in place within the hospital. This form, however, does not have a clear division of information areas that are collected and the data provided...
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