2. The fact that she has been kept almost totally stationery for 3 days following surgery, when she should have been exercising her limb

3. The small urine output that may signal post-operation infection.

4. Her living quarters -- in a trailer that provide plenty of opportunity for falling and re-fracturing of limb.

5. Her age which again places her at greater risk for falling.

6. Mrs. Well's desire to return to her housework. "Only very light work should be performed post-surgery of the hip with no bending, twisting, or crossing the legs at the hip joint, or at the ankles"(Queen Elizabeth Hospital Birmingham). Similarly, Mrs. Wells lives in a rural area- she should avoid gardening. Only light housework should be engaged in.

7. Mrs. Wells needs someone to help her do routine tasks such as bathing and dressing. She only has a son who lives with her, and she is poor. This may indicate…...

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References

Queen Elizabeth Hospital Birmingham. Information for patients about precautions following Hemiarthroplasty surgery Hemiarthroplasty.pdf www.ofc-oregon.com Complications of orthopedic surgery http://www.ofcoregon.com/assets_ofc/COMPLICATIONS_OF_ORTHOPEDIC_SURGERY.pdfhttp://www.ihb.nhs.ik/pdf/Pifollowing

Antiemetic Efficacy of Ipa Inhalation
Post-Operative Nausea and Vomiting

Antiemetic Efficacy of IPA Inhalation in High-isk PONV Patients

Antiemetic Efficacy of IPA Inhalation in High-isk PONV Patients

Post-operative nausea and vomiting (PONV) is considered a significant enough threat to patient health that surgical patients are often treated prophylactically to prevent its occurrence (reviewed by Murphy, Hooper, Sullivan, Clifford, and Apfel, 2006). PONV has been defined as an episode of nausea, vomiting, or retching (non-productive vomiting) that occurs within 24 hours following surgery, which can cause patient distress, post-operative complications, prolonged recovery times, and increase the cost of post-surgical care. The prevalence of PONV for the average surgical patient is estimated to be between 20 and 30%, but high-risk patients may have up to an 80% or higher chance of experiencing this condition. The high variability in PONV risk precludes standard prophylactic treatment, due to the cost and the increased risk to patient health that…...

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References

Apfel, Christian C. (2005). PONV: A problem of inhalational anaesthesia? Best Practice & Research Clinical Anaesthesiology, 19(3), 485-500.

Cullen, Karen A., Hall, Margaret J., and Golosinskiy, Aleksandr. (2009). Ambulatory surgery in the United States, 2006. National Health Statistics Reports, 11, 1-28. Retrieved 9 Oct. 2012 from  http://www.cdc.gov/nchs/data/nhsr/nhsr011.pdf .

Hines, S., Steels, E., Chang, A., and Gibbons, K. (2012). Aromatherapy for treatment of postoperative nausea and vomiting (review). Cochrane Database of Systematic Reviews, April 18(4), 1-52. Retrieved 11 Oct. 2012 from  http://onlinelibrary.wiley.com/doi/10.1002/14651858.CD007598.pub2/abstract .

Lummis, Sarah C.R. (2012). 5HT3 receptors. Journal of Biological Chemistry, in press, October 4. Retrieved 8 Oct. 2012 from  http://www.jbc.org/cgi/doi/10.1074/jbc.R112.406496 .

It was noted that factors affecting the removal of third molars vary from country to country depending on the stakeholders (Esposito, 2005).
In this section, we discussed the origins of third molars, as well as the different types of impaction that can occur. The effects of the type of impaction were found to be a factor in the ease if removal and the complications that may occur. Understanding types of impactions and the affect that they can have on the potential for complications is an important step in preventing complications before and after surgery. The following section will discuss the surgical procedures for removal of mandibular impactions.

Surgical Extraction of Impacted Mandibular Third Molars

Surgical extraction of third molars is performed for a number of reasons. They are sometimes performed to prevent surgery in older patients, although this reasoning is questionable (Valiati, Ibrahim, & Poli, et al., 2009). It can be performed…...

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References

Al-Asfour, a. (2009). Postoperative Infection After Surgical Removal of Impacted Mandibular

Third Molars: An Analysis of 110 Consecutive Procedures. Med Princ Pract 18:48-52.

Bernard, G. & Mintz, V. (2003), Evidence-based means of avoiding Lingual Nerve Injury

following Mandibular Third Molar Extractions. Brazilian Journal of Oral Science. 2 (5):

Tonsil Problems
Surgery is a traumatic and often dangerous event. While tonsillectomies are somewhat common in the history of surgical procedures, it is necessary to investigate the problems of Amy as listed in the case study following a post operative procedure in which her tonsils were removed. In order to determine the patient's pathophysiology it is necessary to identify the problematic or typical physiological processes that are occurring with the patient.

The first step in discussing this problem should identify any problems or situations that are out of the normal set of circumstances for a tonsillectomy. Most of these types of surgeries are simple and require little to no healing time and prescriptions to finish the process. Here in Amy's case however, there seems to be a definite problem. The main problems deals with the patient's mental state and her fear of not healing. This fear has no doubt complicated her body's…...

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References

Audit, N.P.T., & van der Meulen, J. (2004). Tonsillectomy technique as a risk factor for postoperative haemorrhage. The Lancet, 364(9435), 697-702.

Aukburg, S.J., Ketikidis, P.H., Kitz, D.S., Mavrides, T.G., & Matschinsky, B.B. (1989, November). Automation of physiologic data presentation and alarms in the post anesthesia care unit. In Proceedings of the Annual Symposium on Computer Application in Medical Care (p. 580). American Medical Informatics Association.

Berry, J.G., Blaine, K., Rogers, J., McBride, S., Schor, E., Birmingham, J., ... & Feudtner, C. (2014). A framework of pediatric hospital discharge care informed by legislation, research, and practice. JAMA pediatrics, 168(10), 955-962.

Brar, M.S. (2009). Airway management in a bleeding adult following tonsillectomy: a case report. AANA J, 77(6), 428-430.

(Sussman and Bates-Jensen, 2007)
Assessment data is reported to enable the clear communication among clinicians about the wound and in making the provision for "continuity in the plan of care" as well as allowing for "evaluation of treatment modalities." (Sussman and Bates-Jensen, 2007) Wounds that are classified as red, yellow and black are those that require examination of deep tissue involvement. (Sussman and Bates-Jensen, 2007) The wound must be monitored during the healing process since monitoring provides the means of "checking the wound on a regular and frequent basis for "signs and symptoms that should trigger a full reassessment, such as increased wound exudate or bruising of the adjacent or periwound skin. Included in monitoring is the "gross evaluation for signs and symptoms of wound complications, such as erthema (change in color) or periwound skin and pus, which is indicative of infection." (Sussman and Bates-Jensen, 2007) Included as well should…...

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References

Aseptic Technique (2008) Aseptic Technique. Section G. NHS Foundation Trust. Online available at:  http://www.cht.nhs.uk/fileadmin/departments/infection_control/policies/Section_G_-_Aseptic_Technique_Issue_2.pdf 

Burney, R.E. et al. (1997) Core Outcomes Measures for Inguinal Hernia Repair. Journal of the American College of Surgeons. Vol. 185, Issue 6. Online available at:  http://www.journalacs.org/article/S1072-7515%2897%2900108-7/abstract 

Issues in Wound Care: Appropriate Use of Dressings. Report from a Wound Academy Expert Forum. Sponsored by the Molnlycke Health Care Wound Academy. September 2007. Online available at:  http://www.molnlycke.com/Global/Wound_Care_Products/UK/Wound%20Academy/IssuesAppropriateusefinalSept07.pdf 

Khan, Y. And Fitzgerald, P. And Walton, M. (1997) Assessment of the postoperative visit after routine inguinal hernia repair: A prospective randomized trial. Journal of Pediatric Surgery. Vol. 32, Issue 6. June 1997. Online available at:  http://www.jpedsurg.org/article/S0022-3468%2897%2990644-8/abstract

Benson, H.; Dusek, J.A.; and Sherwood, J.B. "Study of the Therapeutic Effects of Intercessory Prayer (STEP) in Cardiac Bypass Patients: a Multicenter
Randomized Trial of Uncertainty and Certainty of Receiving Intercessory

Prayer." American Heart Journal. Vol. 151 (2005): 934-42. Reported by Carey,

in "Long-Awaited Medical Study Questions the Power of Prayer" The New

York Times, (March 31, 2006). Retrieved March 12, 2011 from:

http://www.nytimes.com/2006/03/31/health/31pray.html

Intercessory prayer in medicine is the use of prayer to divine powers to assist and benefit the welfare of patients in clinical circumstances. Various studies have produced conflicting results with some purporting to demonstrate a benefit toward positive clinical outcomes and other concluding that the act of praying for medical patients is useless. This study sought to examine the issue empirically through a formal quantitative analysis designed to compare the medical outcomes of surgery patients who received intercessory prayer and those who did not.

Statistical Procedures Used in the Study

The patients selected…...

In this case, that power dynamic was only exacerbated by the fact that the entire MSICU nursing team had never received training in management of the type of clinical issues presented and by the fact that they were excluded from any consultation in connection with a post-operative management plan.
Therefore, it is recommended that the institution immediately implement a policy of "see something, say something" according to which all members of healthcare teams are encouraged to speak up irrespective of power differentials. Furthermore, that protocol must include a statement of policy insulating any member of a healthcare team who does voice a legitimate concern in good faith from any retaliation or other negative response that could conceivably deter such diligence. Finally, the record of this case also indicates the immediate need for protocols requiring all members of the healthcare team to identify themselves to other members of the team, especially…...

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References

Bosk, Charles L. (2003). Forgive and Remember: Managing Medical Failure.

Gawande, Atul. (2008). Better: A Surgeon's Notes on Performance.

Groopman, Jerome. (2008). How Doctors Think.

Timmermans, Stefan. (2003). The Gold Standard: The Challenge of Evidence-Based

NICE Standards
NICE Compliance Standards eview

NICE has developed a set of guidelines and standards to help minimize the risk of VTE and ensure healthcare protocols are in place to educate patients about the risks of VTE. The purpose of this literature review is to examine a tool to access a Hospital Trust compliance with the National Institute of Clinical Excellence (NICE) published standards on Venous thromboembolism (VTE) prevention. The tool will have the capability to monitor, report, and disseminate relevant information.

National Institute for Clinical Excellence

The National Institute for Health and Clinical Excellence, or NICE, is an institution whose goals including providing clinical quality guidelines and standards to help manage a nationwide database. The purpose of this database includes help improve total healthcare at multiple levels, including at the cardiovascular, vascular, mental, neurological at other levels of health (NICE, 2011). The goals of NICE include prevention of disease, treating disease, and monitoring…...

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References:

Department of Health (DH). (2010 March). "Venous Thromboembolism (VTE) Risk

Assessment." Department of Health. Retrieved July 23, 2011: Publications PolicyAndGuidance

NHS Evidence. (2011). NHS Evidence: Evidence in Health and Social Care. NHS Evidence,

Retrieved July 23, 2011:  http://www.evidence.nhs.uk/

Aortic dissection is a disease of the wall of the aorta in which the aortic blood bursts into the muscular layer of the great artery, thus forming a blood filled channel along the planes of the muscularis layer. This false lumen can re-rupture back into the true lumen, through a second distal intimal tear, creating a biluminal or double barrelled aorta. Due to weakened walls, there is threat of rupture into the surrounding tissue with fatal consequences. (Boon, , Colledge, Walker, & Hunter, 2010)
The pathophysiology behind the condition is often a spontaneous or iatrogenic tear in the intima. However, in about five to ten percent of patients, these tears are absent. An intimal tear can occur anywhere along the aorta, although a vast majority of tears are found within ten centimeters of the aortic valve. The dissection may extend towards the heart, affecting the coronary arteries, or it may rupture…...

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REFERENCES:

Duranki. (n.d.). Type an aortic dissection - the silent killer. Retrieved from   -- You-Wont-See-It-Cominghttp://duranki.hubpages.com/hub/Beware-High-Blood-Pressure-It-will-Kill-You 

Erbel, R., Alfonso, F., Boileau, C., & Dirsch, O. (2001). Diagnosis and management of aortic dissection*.European Heart Journal, 22(18), 1642-1681. Retrieved from  http://www.escardio.org/guidelines-surveys/esc-guidelines/GuidelinesDocuments/guidelines-aortic-dissection-FT.pdf 

Multum, C. (2012, Feburary 12). Morphine injection. Retrieved from  http://www.drugs.com/pro/morphine-injection.html 

Nicholas A. Boon, Nicki R. Colledge, Brian R. Walker, John A.A. Hunter.(2010). Davidson's Principles and Practice of Medicine . India, Elsevier.

Failure Mode and Effects Analysis (FMEA)
Description of FMEA

As applied to the healthcare industry, "Failure Modes and Effects Analysis" (FMEA) is a proactive process for assessing risks of patient injury by anticipating possible system failures and prioritizing them (Davis, Riley, Gurses, Miller, & Hansen, 2008, p. 1). Rather than reviewing a past incident of failure, FMEA teams focus on processes and ask, "How could these systems fail?" (Davis, Riley, Gurses, Miller, & Hansen, 2008, p. 1). Originally developed in 1949 by the U.S. Military (V. Bulletin Solutions, Inc., 2011) and then adopted by the business world, FMEA consists of 2 types of analysis:

Process FMEA, which assumes that the product works and examines the process for possible defects and their possible effects;

b. Design FMEA, which assumes that the process works and examines the product for possible defects and their possible effects (Reiling, Knutzen, & Stoecklein, 2003).

FMEA's Usefulness to Improve Healthcare Organizations in…...

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Works Cited

Davis, S., Riley, W., Gurses, A.P., Miller, K., & Hansen, H. (2008). Failure Modes and Effects Analysis Based on In Situ Simulations: A Methodology to Improve Understanding of Risks and Failures. Retrieved from Agency for Healthcare Research and Quality:  http://www.ahrq.gov/downloads/pub/advances2/vol3/Advances-Davis_60.pdf 

HealthLeaders Media. (2010, May 7). Joint Commission Updates: Sentinel Events Statistics. Retrieved from Health Leaders Media Web site: http://www.healthleadersmedia.com/content/QUA-250699/Joint-Commission-Updates-Sentinel-Event-Statistics##

Joint Commission on Accreditation of Healthcare Organizations. (2001, July 1). Revisions to Joint Commission Standards in Support of Patient Safety and Medical/Health Care Error Reduction: Effective July 1, 2001. Retrieved from JCAHO Web site:  http://www.dcha.org/JCAHORevision.htm 

Reiling, J.G., Knutzen, B.L., & Stoecklein, M. (2003, August). Healthcare: FEMA - The Cure for Medical Errors. Retrieved from American Society for Quality Web site:  http://asq.org/pub/qualityprogress/past/0803/qp0803reiling.pdf

References

Boulton, Martha (2005) Exploring alexithymia, depression, and binge eating in self-reported eating disorders in women. Perspectives in Psychiatric Care

Dahm, Lori (2005) Obesity update: are we getting any thinner?(Special Report)

Private Label Buyer

Merrick, Joav (2005) Psychosomatic reasons for chronic pains.(Editorial)

Southern Medical Journal

____(2006) Obese people may be more sensitive to pain.(NEWS Breaks)(Brief article) Nutrition oday

PORER, LAWRENCE C. WAMPLER, RICHARD S (2000) Adjustment to Rapid Weight Loss. Families, Systems & Health

Rubin, Jay J. (2005) Psychosomatic pain: new insights and management strategies.(CME opic: Psychosomatic Pain) Southern Medical Journal

ucker, Miriam E. (2005) Depression tied to poor adherence to cardiac Rx: results of two studies show that use of aspirin and [beta]-blockers was lower in depressed patients.(Psychosomatic Medicine) Clinical Psychiatry News

MEHODOLOGY

his study will seek to determine whether or not obese post operative patients have a higher incidence of psychosomatic disorders and illnesses than non-obese post op patients have.

Need for study

he need for this study is evidenced in…...

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The need for this study is evident. The cost factor of psychosomatic illnesses may be reduced if it can be determined whether or not the obese patient population has a higher incidence of psychosomatic illness in post op. If it does then future steps can be taken to better prepare the obese patient population for surgery to reduce the incidence of post op psychometric illness.

REFERENCE

Tucker, Miriam E. (2005) Depression tied to poor adherence to cardiac Rx: results of two studies show that use of aspirin and [beta]-blockers was lower in depressed patients.(Psychosomatic Medicine) Clinical Psychiatry News

Mrs. Mansfield is being handed over to care from the operating theatre nurse. We would require an update chart information. She has had an ovary removal (bilateral salpingo-oophrectomy) and is currently on an IV infusion of .8% Normal Saline. In order to continue her care, we would need previous vitals, lab work, and any details on her condition. We know she has a bellovac drain insitu and a PCA along with O2 via nasal prongs. We would need the orders on the PCA and the physician's assessment of pain medications. There would likely be instructions on wound draining, as well as potential additional fluids and/or blood transfusion information (part of vitals in chart). Post-operative care instructions would be mandatory -- including diet, hourly rounding instructions and additional materials to assist with her post-operative care condition (Fogel & Woods, 2008 p. 428).
Q2 -- esearch shows that unrelieved pain has a detrimental…...

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REFERENCES

Beattie, S. (2008, June 1). Beside Emergency: Wound dehiscence. Retrieved from Bedside Emergency: Wound dehiscence: http://www.modernmedicine.com/modern-medicine/news/bedside-emergency-wound-dehiscence

Chumbley, G., et al. (2004). Pre-Operative information and patient-controlled analgeisa. Anaesthesia, 59(4), 354-8.

Common Postoperative Complications. (2013, April). Patient.co.uk. Retrieved from patient.co.uk:  http://www.patient.co.uk/doctor/common-postoperative-complications 

Doctor QA.com. (2009, April). Compression Socks. Retrieved from doctorqa.com:  http://www.doctorqa.com/vein/procedures/compression-socks

Music and Pain
The use of music in relation to relaxation and pain control is universal in application. Many cultures use music, tones, chanting, drums, or other forms of biofeedback to treat patients in acute pain, women in labor, recovery, and now, most recently, in pre- and post-operative care. In fact, the therapeutic value of music has been recognized as vital and powerful since Ancient Times; archaeological evidence shows flutes carved from bone in pictures of physicians healing patients, Greek physicians used music and vibration to heal, aid in digestion and induce sleep; the Early Egyptians used musical incantations to help with the healing process; and certainly, numerous native tribes use singing and chanting as part of their healing rituals (Nilsson, 2008).

Further, most postoperative patients have pain, despite the use of analgesia. Nurses are constantly trying to be more effective in delivering pain medication. One study showed that patients who were…...

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WORKS CITED

Ghetti, C. (2011). Active music engagement with emotional-approach coping to improve well being in liver and kidney translplant recipients. Journal of Music Therapy. 48 (4): 463-85.

Good, M., et.al. (2010). Supplementing Relaxation and Music for Pain After Surgery. Nursing Research. 59 (4): 259-69.

Goodwin C.J. (2010). Research in Psychology: Methods and Design. New York: John

 http://www.experiment-resources.com/scientific-control-group.html

More times than not, a patient will argue that he did not understand what the physician stated to him; even amidst documented proof the medical professional and the patient did engage in an informed conversation. "The fact that a meeting took place does not necessarily mean that there was a meeting of the minds" (Informed consent…, 2010, ¶ 5). This issue leads some health care providers to assert that informed consent forms possess little value, particularly when a legal battle ensues and the professional cannot prove the patient did, in fact, understand the informed consent process.
Currently, lawyers routinely challenge informed consent forms in courtrooms throughout the United States (U.S.). "The model consent forms incorporate substantial details of anesthesia techniques, risks and other elements of 'informed consent', so that a strong presumption is established on its face" (Informed consent…, 2010, ¶ 7). During the informed consent process, to help inoculate…...

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REFERENCES

Anaesth, B.J. (2009). Perioperative visual loss: What do we know, what can we do? Department

of Anesthesia and Critical Care. University of Chicago. Retrieved January 25, 2010 from  http://bja.oxfordjournals.org/cgi/content/short/103/suppl_1/i31 

Booth, B. (2008). Informed consent at the heart of New York lawsuit. Retrieved January 26,

2010 from  http://www.ama-assn.org/amednews/2008/03/10/prca0310.htm

bmj.com/cgi/content/full/325/7369/887
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John a Heit, (Sep 2005), "Cancer and Venous Thromboembolism: Scope of the Problem', Cancer Control, Vol! 2, Supplement 1.

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MEDSURG Nursing -- October 2006 -- Vol. 15/No. 5, Available online at, http://www.medsurgnursing.net/ceonline/2008/article10282288.pdf

Race, Tara Kay SN, RN, CCRN; Collier, Paul E. MD, (July-Sep 2007), 'The Hidden Risk of Deep Vein Thrombosis -- the Need for Risk Factor Assessment: Case Reviews.', Critical Care Nursing Quarterly, 30(3):245-254

Susan egelman MD, 'Venous Thromboembolism', Retrieved 29th Feb 2008, from, ' http://www.clevelandclinicmeded.com/medicalpubs/diseasemanagement/cardiology/vthromboembolism/vthromboembolism.htm

Roxanna oelsen, RN, MS, AOCN, (2001), 'Clinical Focus: Deep…...

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Bibliography

MF Scully (2005), 'Clinical Guide Cancer and Thrombosis', retrieved Feb 28th 2008, at http://www.tigc.org/pdf/cancervte05.pdf

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