Routine IV Site Replacement Analysis

What priority problem(s) did you identify for Rashid Ahmed? What information led to identification of the priority problems?

Unfortunately, one of the IVs infiltrated when we started a NS bolus. I was very upset about this because the patient was in pain due to the infiltration. My nurse explained that this does not make me a “bad” nurse. It happens to everyone, even the most experienced nurse. Fortunately, the patient was also very understanding, and was not upset. On the other hand, I felt more comfortable being on my own during my assessments and asking the right questions. I was also able to document more accurately and

Hospital births and midwife assisted home births are two substantially different methods to achieve the same goal, a healthy and safe childbirth. Obstetricians are trained to view childbirth as a medical procedure, but Midwives are trained to view birth less clinically. Midwife assisted home births are more oriented towards low risk routine pregnancies while hospitalized births are more wide-ranging. Since the introduction of midwives, in 1955, media has played a huge role of influencing mothers on deciding on the type of childbirth they want to participate in.

As I approached the scene I saw two Suffolk County police department sector cars on scene and a first responder. This was a summer evening, you could still feel the humidity lingering in the air. Over the radio, the cops relayed that CPR was in progress. I approached the house, entered using the side entrance. Before I even step foot in the door I could hear sobbing and the distress in a woman 's voice. I carried in the necessary equipment, the cops were actively doing CPR as the advanced life support provider (ALS) was looking for IV access. As EMS personnel we took over for the cops, we placed a LUCAS device on him, it 's a device that does compressions for you. Then, we continued ventilating the patient and placed him on a backboard in preparation to transport and move the patient.

Providing care for hospitalized patients can be both stressful and demanding. Nurses often find themselves overwhelmed with the number of tasks they are expected to complete. Due to the large amount of patient care tasks, many nurses forget to implement orders or educate patients on important prophylactic treatments. All hospitalized patients are at an increased risk of developing a venous thromboembolism, no matter the reason for their hospitalization (The American Heart Association, 2017). Venous thromboembolisms pose great risks and are a substantial source of morbidity and mortality to hospitalized patients. Although most venous thromboembolisms are considered preventable, the use of prophylactic treatment is underused in hospitals (National

The problem is that the discharge process on my orthopedic surgical unit is long and drawn out with really no organization to it. The doctors do not place discharge orders by a certain time, making it difficult to get our new surgical patients in their rooms. The doctors also do not always have all their discharge instructions in the discharge summary, and then this causes delays in the timing of the discharge. Proficient and timely discharge has an impact on patient satisfaction levels. The goal would be to have the doctors place a discharge by a certain time, so that the patients can be discharged earlier making them happier and allows for other new surgical patients to get a room faster. I understand some patients may not fall into these criteria, but most can be discharged earlier. Utilizing a discharge nurse could be beneficial to getting patients out on time. Since discharging patients is all they would be doing, they would have more time to effectively discharge the patient in a timely manner.

As we all may know, change is at times difficult to implement but at times necessary. In addition, we need to obtain value increasingly when we serve our patients. A little update on how we have been doing; our post-op success rate is down by 20% than in previous years largely due to increased length of stay from surgical wound infections. Recently, post-op recovery patients who normally recover in three days or less are recovering in six days or more due to the onset of infections in the surgical site. This drastically increases the length of stay and out-of-pocket expenses for our patients. This is unacceptable! Our goal is to decrease patient’s out-of-pocket expense, and length of stay while continuing to provide outstanding patient care in addition to a positive experience. There is a change that is necessary and very needful, in order to remain in the top ten hospitals in our region for successful surgeries and highest recovery rates. Having said that, the necessary change is administering a new antibiotic one hour prior to surgical procedures, which is also becoming a requirement and will be publicly reported on our hospital website. There are valid claims and concerns, but

When inserting foley catheters the CDC (2009) strongly recommends performing hand hygiene. Hand hygiene must occur immediately before and after insertion and with any manipulation of the catheter device or site. Facilities should ensure that only properly trained staff who have been trained on the correct technique of aseptic catheter insertion and maintenance is given this responsibility. Competency check offs are a way to ensure proper insertion technique of

Patient was given perineal care prior to the straight catheterization, which is performed every four hours. Beforehand, the cna had a bladder scan on the patient and there was 321 milliliters of urine left in the bladder. During the process of inserting the straight catheter, the patient was asked to take a deep breath while they inserted the catheter through the urethra. At the same time, the nursing students had to teach the patient about bladder management and possible the high risk for urinary tract infections due to multiple insertions of the straight catheter.

The preferred site of insertion of a central venous catheter depends on various factors including the skill and expertise of the operator and the availability and experience in ultrasound guided insertion of catheter. Patient related factors including risk of bleeding and pneumothorax and the urgency of placement of the central venous catheter also play a role in determining the site of insertion of the central venous

In the examples of catheterization witnessed in the hospital, those three patients were placed at risk for the development of infection. The nursing intervention of catheterization if done improperly can impair the patient. Jan Powers states urinary tract infections account for 30% of hospital infections, and of the 30%, 70-80% are related to urinary catheters (Impact of an aseptic procedure). The four nursing literature pieces used consult three main factors in preventing complications related to urinary catheterization. The first factor is the duration of how long the catheter will remain in the patient. Septimus and Moody state, “The major contributing risk for developing CAUTI [Catheter Associated Urinary Tract Infection] is the duration of the urinary device is present” (Prevention of Devise-Related Healthcare Associated Infections). Duration is important because catheters create a direct portal inside a patient. This portal will establish a perfect incubation site for bacteria or infections in the tubing and the patient. The second factor for catheters is the sterile insertion. Lindsey Underwood writes in The effect of implementing Comprehensive Unit-Based Safety Program on Urinary catheter Use, techniques matters. Underwood emphasizes hand hygiene before the procedure, cleaning perineal area, identifying urinary meatus at this time especially if female, prepping kit, using sterile gloves, utilizing drapes, properly cleaning with betadine, and proper insertion. Underwood gives a few tips in her research including: using new kit if the first try is unsuccessful, do not test balloon before inflating because it can cause urethral damage upon insertion, using the smallest catheter as possible, and continuously assessing patient’s catheter. The third factor is care of a catheter. Judith Clayton states in her research, Indwelling

A perioperative nurse is a nurse who is responsible of taking care of surgical patients prior to, during and after surgery. These tasks include attending to their physical, logistical and emotional problems. Perioperative nurses report on everything that transpires during their surgical care, including meticulous recording of vital signs, diagnostic tests and laboratory results, surgical dressings and drugs. In addition to all this, they are responsible for the overall assessment and any warnings about the change in status, which to the physician are crucial. The perioperative nurse is an integral part of a surgical team, and as such, the role it plays is crucial to the health and welfare of their patients. (Phillips, 2014)

I believe the Parkland Formula is a good formula for a hospital setting. There are many other formulas out there to use but most of them are semular to the Parkland formula with as much math involved or more, some examples are the Evans Formula, Brooks Formula or Monafo Hypertonic Formula. These formulas are more designed for hospital settings using crystalloids with colloids over a period of time, this can be very helpful for the pt to replenish the patients fluids and to give the patient the best recovery after a major burn. In a prehospital setting this can be very hard to accomplish so that is why is don’t recommend any other formulas that I found. The system I prefer is form the Victoria Fire Department protocol over burns. The protocol has a standard system depending on the patients age to give an amount of fluids over an hour. This protocol uses normal saline instead of lactated ringers due to the department doesn’t carry lactated ringers. The protocol states to give two large bore IV's and infuse a total 124cc per hour of normal saline to pt that is less then the age of five. A patient from the age of six through thirteen give the pt 250cc per hour and a patient above the age 13 give the pt 500cc of fluid per hour. Why do I prefer this standard over other formulas is cause how easy it is to use and remember it takes the stress out of doing math during a stressful call. Using the patients age to determine the amount of fluids over his or her weight like in the parkland formula is easier due to if the patient is unconscious and his or her weight can not be

Thus, the CDC set standards that health care institutions must follow to prevent Catheter Acquired Urinary Tract Infection. For example, the CDC set guidelines for when is catheter necessary and what are the risk factors for CAUTI. Furthermore, the Center for Disease Control and Prevention recommends that health care organization implement quality improvement (QI) programs to enhance the appropriate use of indwelling catheters and to reduce the risk of Catheter-Associated Urinary Tract

Administer oxygen and intravenous (IV) fluids as ordered. McKinney (2018) recommends administering oxygen by face mask at 8-10 L/min and administration of a bolus dose of IV fluids as ordered to increase blood flow to the fetus.