Anaesthetic Phase
According to the HPC Code of Conduct (2015), all registrants and students must respect service user’s right of confidentiality. Therefore, the author will fictionally refer the patient as Sibert. Before Sibert came to theatre for surgery, a pre-assessment is conducted in the pre-assessment clinic. During this assessment, medical history, general health and family history are checked and assessed. Aikenhead et al., (2007) stated that full medical must be compiled before surgery as this will in some way affect the anaesthetic process. Sibert had no history of medication or drugs taken. Having this information was important because drugs may cause resistant to induction agents or sedative drugs as mentioned by Davis and Cashman,
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The National Institute of Health and care Excellence, (2008) (NICE) issued national guidelines of what checks should be done in anaesthetic room. The Sign in on the WHO surgical checklist was conducted. The WHO surgical checklist requires practitioners to confirm details such as patient’s identity, surgical site, allergies, consent and airway issues. This was done before induction of anaesthesia. McHale and Tingle (2007), stated that it is a legal and ethical principle for practitioners giving care to patients to have a valid consent before starting treatment. This will show that the patient’s rights are being respected and it is a fundamental of good practise as recommended by HCPC, (2015). Haynes, et al., (2009) mentioned that WHO Surgical Checklist will provide efficient planning of and it will minimise errors thereby providing safe and effective patient care. The ECG and Blood pressure monitors were the put on Sibert by the author whilst the anaesthetist was preparing the drugs. Sibert was having a General Anaesthetic. Sibert’s vital signs before induction of anaesthesia were in the normal range. The author assisted the anaesthetists to establish venous access by slightly sweezing Sibert’s hand to expose the veins. The anaesthetist then inserted the Intravenous Cannula size 18 gauge venflon. The venflon was then secured with a transparent …show more content…
When Sibert was not responding the anaesthetist then allowed a slow inhalation of Isoflurane to be delivered to patient through the face mask. When the patient was fully anaesthetised the author assisted the anaesthetist to secure the airway by passing size 4 Laryngoscope and size 8 endotracheal tube (ETT). The ETT was cuffed and tightly secured. Sibert was then transferred to the operating table and monitoring continued. Anaesthesia was maintained with O2, Isoflurane, and N2O on spontaneous ventilation with closed circuit. Anaesthetist explained to the author that Isoflurane was suitable for Sibert because of his age and healthy status. Furthermore, Smith et al., (1992) also mentioned that Isoflurane is a good anaesthetic agent for adults and causes less cardiovascular effects. Again, Frink et al.,(1992) emphasised that Isoflurane when used on patients with ASA grade 1,the incidence of post-operative nausea and vomiting is very less even though it causes respiratory
Scope of Practice: Overall, Dr. Jaen’s main responsibility is to administer anesthesia to patients before surgery. Surgery includes a wide variety of procedures. Anesthesiologists even administer anesthesia to young children and neonatal patients prior to diagnostic tests such as MRIs. For intensive care patients, anesthesiologists are often responsible for ventilator and airway control. In addition, anesthesiologists have the authority to prescribe drugs to patients.
Justin is the registered nurse that has been given the handover for Kelly Malone’s postoperative care in the surgical unit. Kelly Malone is a 49 female patient who has had a septoplasty and a right ethmoidectomy. Justin is working with Kelly to identify Kelly’s needs in order for Kelly to be discharged from the hospital. Kelly’s postoperative observations were a temperature of 36.2 degrees celsius; heart rate of 68 beats per minute; respiratory rate of 18 breaths per minute, blood pressure of 111 systolic over 73 diastolic millimetres of mercury; oxygen saturation at 93 percent of room air and a self-rated pain score of two out of ten. Kelly has a history of ‘not being able to breathe well through her nose’ and a history of disturbed sleep.
• When retrieving information from a nurse to update the patient 's file, never share that information to another nurse even if a question is asked. It is against HIPAA, and if a fellow employee overhears, it could cause possibly termination. • When asking a patient to update his demographic information on paper, be sure do it when other patients are not around. Scan the sheet immediately into the computer and dispose of if correctly in a shred-bin located in either zone of the emergency department. • When a family member of a patient comes in to the emergency looking for that patient, be sure the family member can verify the date of birth and first and last name of the patient they wish
Things that are good: a warm summer day, apple pie, family time, and informed consent. The most important goal of informed consent is that the patient has an opportunity to be an informed participant in her health care decisions. At the same time patients want to limit access to information about themselves, they are equally concerned about the mirror image of this information management problem – how to gain access to the facts needed for making informed judgments about treatments, physicians, and health care plans (Yount, 2001). Today, throughout the United States, physicians are legally required to provide this information and obtain written consent before carrying out any major medical procedure (Yount, 2001).
B. Informed Consent and Truth-Telling Hippocrates advocated “concealing most things from the patient while you are attending to him…revealing nothing of the patient’s future or present condition.” This attitude would undoubtedly be troublesome today. Competent adult patients have a moral and legal right not to be subjected to medical interventions without their informed and voluntary consent, but to seeking appropriate treatment for their autonomy also. Lying or withholding information from patients can seriously undermine their ability to make informed decisions about life-altering treatments. In order to give their informed consent and exercise their right of self-determination, patients must have access to all relevant information.
Informed consent is the process by which the treating health care provider discloses appropriate information to a competent patient so that the patient may make a voluntary choice to accept or refuse treatment. (Appelbaum, 2007)1 It originates from the legal and ethical right the patient has to direct what happens to her body and from the ethical duty of the physician to involve the patient in her health care. In order for the consent to be valid, the patient must be competent to take the particular decision; have received sufficient information to make a decision; and not be acting under stress.2,3 This may be an issue if consent is obtained upon the day of surgery. Most patients will have firmly decided to proceed for surgery. However,
Outcome 1 History taking History taking is fundamental in a consultation and should incorporate not only physical health but their Psychological and Psychosocial information (Cox, 2004). I have anonymised the patient so as to protect their identity in line with the Nursing, Midwifery code of professional conduct Council (2015). I was asked to go and see Mr Brown who had been referred to the Reablement team on discharge from hospital following a fall at home which resulted in a fractured neck of femur requiring a partial hip replacement.
After observing these providers, I became increasingly intrigued by the profession. After a lot of research into this profession and shadowing multiple anesthetists, I knew I had found my calling. During my time at the Children’s Hospital, I learned that the Anesthesiologist Assistant is a skilled medical professional who works as part of the anesthesia care team in the operating room and receives direction from an Anesthesiologist. They have an extensive amount of training in the induction and maintenance of different anesthetics and also advanced monitoring techniques that allow them to keep the patient safe throughout the procedure. They are skilled providers who have training in inserting invasive catheters used for monitoring patient’s vitals, trained in advanced airway and life support techniques, and prepare an anesthetic plan with the licensed Anesthesiologist.
Introduction: Consent review: “Every human being of adult years and sound mind has a right to determine what shall be done with his body; and a surgeon who performs an operation without his patient’s consent for which he is liable in damages. This is true except in cases of emergency, where the patient is unconscious and where it is necessary to operate before consent can be obtained”( Showalter 2015 pg. 364). To give a patient consent, the person should be legally competent and he should possess a reasonable knowledge and understanding about proposed medical and surgical treatment. The physicians and hospitals use two types of consent forms. Firstly, the general consent forms is a part of the registration process to grant the hospital permission
Mr. A is admitted to the critical care unit post bowel resection, splenectomy, acute respiratory distress syndrome (ARDS) and patient-ventilator dyssynchrony (PVD). He is an eighteen-year-old African American man who is placed on an IV infusion of Norcuron and Ativan. The major outcomes expected for Mr. A would be for him to be able to wean of the ventilator, be hemodynamically stable, heal adequately, tolerate his diet, have adequate bowel elimination, and be able to adjust to his life with optimal functioning. The problems that are to be manage include, being on the ventilator, being sedated, having an elevated temperature, having a low hemoglobin, post surgical bowel resection, splenectomy, hypoxia and diet intolerance.
Changes to lower the number of medical mistakes According to Media Health Leaders medical mistakes are the third leading cause of death in the United States. Hospitals today are making life threatening mistakes and are looking for a way to fix their ways of error. Three methods that would help lower the number of medical mistakes are the increasing patients’ engagement, improving physician guidelines, while decreasing faculty shifts hours. Being aware of your condition and diagnosis would help decrease the chance of experiencing a medical error, because you would have more than just the doctor involved in your overall treatment.
Question 1: Airway: Patient’s airway is patent and protected, a lack of noisy breathing or stridor rules out partial obstruction, the ability to talk in full sentences rules out silent complete airway obstruction, and also indicates the patient is ventilating and oxygenating sufficiently (Robertson & Al-Haddad, 2013). Cardiogenic shock does not result in airway collapse, obstruction, or hypoventilation (Van Thielen & Price, 2010). High priority: monitor the patient’s level of consciousness and cognizance using the Glasgow Coma Scale (GCS) (Urden et al., 2014). The GCS measures consciousness by evaluating the patient’s ability to open their eyes, respond verbally, and perform motor tasks.
An important point here is that after the confrontation Dr. Frederick admitted his mistake and for future decisions respect patients and verify that the informed consent is completed and the patient understands the risks they are exposed to, along with that the patient is in his right to change his mind, and if necessary notify it and complete a new consent for the benefit of all, but especially for a patient who is ultimately the one that suffers the physical and emotional damage and for the institution to avoid legal claims. As nurses is our responsibility to monitor the safety of the patient and the informed consent is an aspect which monitors the Joint Commission and a legal claim is the first aspect to be evaluated. Not only procedures
The anaesthetist removed the ETT and proceeded to place a tight fitted mask on patients face. (REF)She then alerted the team that there was a problem with the patient airway (REF). The mask did not mist up – indicating of no air movement return, there was no carbon dioxide trace on the capnography and the patient oxygen saturation dropped steadily from 100% to 90%. He instigated vigorous jaw thrust to improve oxygenation, and using continuous positive airway pressure(CPAP) to deliver 100% oxygen flow through the breathing bag attached to the anaesthetic machine but all this effort was not having any effect on the ventilation. He then asked my mentor the Operating Department Practitioner (ODP) to administer 50mg/5ml of intravenous Propofol.
It was measured with a ruler in the upright sitting position.(8,12,13) A TMD less than 6 cm was considered to be predictive of difficult intubation.(4,14) To maintain blinding, only one anesthetist assessed the predictive tests while other blinded anesthetists performed the patients’