Core Competencies For Healthcare Professionals.pdfCore Competencies For Healthcare Professionals

Core Competencies For Healthcare Professionals
My Leadership SMART Goal
The Institute of Medicine has defined five core competencies for healthcare professionals. These
competencies are to "provide patient–centered care, work in inter–professional teams, employ
evidence–based practice, apply quality improvement, and utilize informatics."(Finkelman, 2012, p.
214). Nurse leaders recognize that the need to put the patient first is at the heart of patient–centered
care and is significant in all aspects of nursing care. Patient–centered care incorporates collaboration
with the patient and family and takes into consideration cultural diversity or issues that will affect
the patient's ability to manage and maintain their health. Keeping the lines of communication open
with our patients involves assuring that they are kept abreast of their health management and
provided with up to date education to help them utilize measures to maintain their health. As nurses
we are accountable to our patients and need to stay current with our own education and commit to
lifelong learning (Fights, 2012) to be sure we are passing on up to date and relevant information.
Acquiring certification is an important way of validating our practice and proving our commitment
to providing quality patient–centered care. Fights challenges us to ask ourselves if we are committed
to lifelong learning or furthering our education. Signing up at Chamberlain to obtain my BSN was
an important step for me but I will not let this be the end of learning.
Achieving
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An Evaluation Of A Laparoscopic Hysterectomy Essay
During my rotation in the operating room at Community medical center, I observed the
preoperative, intraoperative, and postoperative care for a patient who underwent a laparoscopic
hysterectomy. I believe that an appropriate preoperative plan of care for this patient would have
included a full physical exam and an interview for patient history, a pelvic exam to look over and
understand the nature of the patient's complications, blood testing including a CBC and WBC to
note any signs of infection or contraindications for the procedure, and a urine test to rule out any
urinary tract infections or pregnancy. It would be important to interview the patient and ask
questions to determine how the patient is feeling about their procedure and to better assist with any
anxiety or pain they may be dealing with preoperatively. It is important to consult with the patient
well before the procedure to ensure that she knows to refrain from smoking for at least 8 weeks
before the procedure because this reduces the risks of complications such as infections, issues with
blood pressure, heart rate, blood flow, and respirations when under anesthesia, and promoting
overall health and risks associated with smoking after the procedure. (ASAHQ) It is also important
to educate the patient to consume no food or drinks after midnight the night before the scheduled
procedure. (Health Communities) During my rotation I observed that the patient did indeed have
labs drawn and a urine test run. Her lab

The Effects Of Therapeutic Play With School Age Children
For children, surgery can be an overwhelming and stressful experience. Compared to adults,
children undergoing surgery are more likely to experience stress, anxiety, and feelings of ambiguity
due to their cognitive development and limited capacity to understand reasoning behind his or her
surgery. Today, the implementation of child focused preoperative preparation is lacking. With the
increasing amount of same–day surgical procedures, children only have hours to build rapport with
their healthcare team and receive preparation. Play is an important component in interventions used
with children who experience stress in the hospital. Most studies focused on therapeutic play have
been conducted on preschool age children, which is why the authors of the current study chose to
focus on the effects of therapeutic play with school–age children. The authors aimed to examine if
school–age children who received therapeutic play would (a.) report lesser anxiety directly
before/after surgery; (b.) demonstrate lesser negative emotions during anesthesia; and (c.) report less
pain following their operation, when compared to school–age children who received standard care.
Two hundred and three school–age children undergoing day surgery participated in the current study
and were randomly assigned to either the experimental group (n=97) or to the control group
(n=106). Those in the control group received routine preparation at the time of admission to the unit
for evaluation, which was

Preoperative Phase The First Interaction I Had With My...
In the preoperative phase the first interaction I had with my assigned patient was at the holding area
where the assigned nurse asked Mr. A.G. for family members present at the hospital, the need for
last minute calls, and if there was any questions about the surgery and post surgery procedures.
At this time MR. A.G. particurlarly felt a little nervous, and anxious about the operating room but he
understood that this was a needed surgery; when asked about family member, he replied that only
his brother will be staying at the hospital with him; explaining that his wife was at work and, his
kids were at school. Mr. A.G appear a somewhat serious and a little pale.
There was limited use of the electronic health record, the assigned nurse mainly use the chart to
verify consent forms and physician's orders prior to surgery.
The assigned nurse explained to the patient about pain management/ pain scale after surgery and
how he will be waking up in the Intensive Care Unit where he was going to have chest tubes to
remove the extra fluid from the chest cavity; he confirmed understanding and was ready to move on
with the procedure. The role of the preoperative nurse is to ensure patients safety , provide
information and emotional support to patients and family member awaiting surgery; they are also
responsible for ensuring that all the preoperative information data is obtained and that it is in the
patient's chart.
In the Intraoperative phase Mr. A.G. was

Bloom Research and Response Paper
Bloom Research and Response Paper
Benjamin Bloom developed Bloom's Taxonomy in 1956. It identifies three domains: cognitive,
affective, and psychomotor, used to evaluate knowledge assimilated by the learner. Each domain has
hierarchical categories that progressively measure the level of understanding achieved. This paper
reviews each domain and list the categories found within, discuss how Bloom's taxonomy apply to
the case study presented by Larkin and Burton's article 'Evaluating a Case Study Using Blooms
Taxonomy of Education', and highlight the benefit of Bloom's taxonomy as it relates to developing
individualized nursing instructions.
Larkin and Burton's abstract preface the Joint Commission's directive for effective communication
... Show more content on Helpwriting.net ...
The record does not document any nurse–initiated interventions or call to the doctor requesting a
chest x–ray or recommending a respiratory therapy consult for breathing treatment and incentive
spirometer. On post–op day two Ms. C's respiratory status declined requiring a non–rebreather
mask, rapid response team consult, and a transfer to the intensive care unit for a diagnosis of
respiratory distress (p. 392).
There were multiply factors that contributed to the above scenario; Larkin and Burton writes that
"after this near–miss, failure to rescue incident" (p. 394) a task force consisting of management,
clinical nurse specialist (CNS) and unit educator convened to discuss the event. The task force
concluded that the nursing staff members were ineffectual in critically evaluating the patient's signs
and symptoms. The CNS chose a framework that utilized "Bloom's Taxonomy of Educational
Objectives", that provided measurable outcomes to the educational activity and enabled the nursing
team to optimize their critical skill levels. A workshop to assist staff to navigate through the case
study in a realistic manner was implemented (Larkin & Burton, 2008, p.395).
The cognitive domain contains six intellectual skills that measure: knowledge, comprehension,
application, analysis, synthesis, and evaluation of information

Postoperative Nausea
Management of a Patient with Postoperative Nausea and Vomiting
Susanne Frycek
Advocate Lutheran General Hospital
Introduction Post–Operative Nausea and Vomiting (PONV) is defined as any nausea, retching or
vomiting occurring during the first 24 hours after surgery (Oxford Journals). It is an uncomfortable
and unpleasant experience for the patient and can adversely affect the post recovery outcome by
causing dehydration, electrolyte imbalance, aspiration, wound dehiscence, increasing length of stay
(LOS), unanticipated admission, and increased healthcare costs, not to mention a top concern and
great dissatisfier for the patient (JPN, Hodgens). Since approximately 30% of all post–operative
patients ... Show more content on Helpwriting.net ...
It is a large patient dissatisfier with many of my patients telling me that they would rather
experience post operative pain (which they expected) than nausea (which they did not expect). The
pathophysiology of PONV is very complex, because it can be triggered by several perioperative
stimuli; including opioids, volatile anaesthetics, anxiety, adverse drug reactions and motion( ). The
complex set of activities that culminate in vomiting come from two anatomically unique and distinct
units within the brain stem; the vomiting center and Chemoreceptor Trigger Zone (CTZ) (Smith–
Collins, 2011, p.36). They receive information/signals from a number of outlying sources and their
excitement triggers vomiting. The "vomiting center" receives afferent (nerve fibers carrying sensory
information toward a location) signals from several major sources; Viseral afferents from the
Gastrointestinal Tract (GI distention, irritation), Viseralafferents outside the GI tract (Bile ducts,
heart, variety of other organs), afferents from outside the area of the vomiting center of the brain
responsible for vestibular disturbances (motion), psychic stimuli (odors, fear) and trauma, along
with the CTZ. Since the Chemoreceptor Trigger Zone (CRZ) is situated outside of the blood brain
barrier its responsibility is to detect chemical abnormalities in the body, such as

Risk And Implement Falls Prevention Measures
More Staff is Not the Solution to Decrease Patient Falls Falls in an acute care setting lead the list of
injury related deaths and deaths in the elderly. "A fall is defined as any event which patients are
found on the floor (observed or unobserved) or an unplanned lowering of the patient to the floor by
staff or visitors" (Kalisch, Tschannen, and Lee, 2012, p. 6). Medicare and Medicaid changes in 2008
list falls as one of the 10 hospital acquired conditions for which hospitals will no longer be
reimbursed because falls are considered preventable conditions. Joint Commission accredited
hospitals are required to assess for falls risk and implement falls prevention measures. Central to
nursing ethics is the principle of nonmaleficence ... Show more content on Helpwriting.net ...
Patients being admitted to hospitals today have multiple co–morbidities and are on a number of
medications making them a high risk for falls. Having an awareness of a patients diagnoses,
pertinent history and current medications is key in establishing an appropriate plan of care. Staffing
shortages can lead to omission of tasks such as a complete admission history and falls risk
assessment. As with any assignment, regardless of the amount of patients one is caring for,
prioritization needs to be utilized when completing tasks and making care decisions. "Further work
must be done to assist nurses in completing necessary tasks...which may or may not mean additional
staff members" (Kalisch, Tschannen & Lee, 2012, p. 11). Developing strategies such as
computerized reminders and checklists are necessary to ensure complete and appropriate nursing
care is delivered. (Kalisch, Tschannen & Lee, 2012, p. 11) The lack of proper education on
identification of falls risk and falls prevention measures impact patient falls. Staff turnover and the
use of temporary staff contribute to miscommunication or lack of communication on processes such
as fall prevention measures. Experience levels vary on any given unit. Educational needs
assessments should be routine and include temporary and new staff. Authors Manojlovich, Sidani,
Covell, and Antonakos (2011) define nurse dose as "the level of nurses required to provide patient

Aft2 Task 2
Accreditation Audit
4 June 2015
Contents A. Sentinel Event 3 A2. Personnel Involved 4 A3. Personnel Issues 6 Interactions
improvement 6 A4. Quality Improvement 7 B1. Risk Management Program 8 Resources 9 Works
Cited 10
A. Sentinel Event
This sentinel event involves child abduction from the surgical unit of Nightingale Community
Hospital on Thursday, September 14, 2014 at approximately 1230hrs. The patient, a three–year old
female, arrived accompanied by her mother, for an outpatient surgical procedure at 0800hrs and
proceeded to registration where all currently required documentation was completed and signed by
the mother; this included the authorization forms for the surgery. After registration, the patient and
her ... Show more content on Helpwriting.net ...
Specifically, the pre–op nurse who acquired the parental contact information, or upon being
informed that the mother would be leaving the facility did not document it in the patient chart or
pass it along to the O.R. nurse. 3) Surgeon: Was directly involved in the events leading up to the
sentinel event. The surgeon was responsible for all activities taking place in the surgical suite and
directly related to the surgery of the pediatric patient. The surgery was completed safely and
successfully; however, the surgeon had relevant information in the patient chart at his office yet did
not share this information with the hospital. He also did not supply an appropriate or accurate
H&P that would have included custodial status for the pediatric patient to the hospital. The
surgeon is greatly concerned in the events that lead to the sentinel event and wants to ensure that his
patients will be cared for and safe at Nightingale Community Hospital. 4) O.R. Nurse: Was directly
involved in the events leading up to the sentinel event. The O.R. nurse is responsible for assisting
the surgeon in the surgical suite and providing continuity of care throughout the surgical procedure
from pre–op to post–op. The surgery was completed safely and successfully and the patient was
handed over to PACU for recovery appropriately; however, the O.R. nurse did not verify that all
relevant information was obtained from

Budget Analysis
Budget Management Analysis for the Post Anesthesia Care Unit The budget management process is
not an easy task. It is time consuming and difficult. There are some ways to overcome the challenge
of managing budgets within forecasts. One way is to budget and report beyond the ledger. Data
should be looked at beyond the company's financial system. This will allow the company to create
more accurate forecasts. Next the budget software should be user–friendly. If it is easy to use, the
happier the employees are to use and understand it. Thirdly, the budget should have the options to
incorporate a flexible financial model. Managers should be able to input information on how their
particular department relates to other departments or functions. ... Show more content on
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The prior year's budget was $28,600. Supplies My manager stated that she had a fixed monthly
budget of $1,800. This is a shared budget for pre–op and PACU. The actual amount spent in the
current month was $2,102. The explanation given for the $302 unfavorable variance was the need
for additional thermometers. There were multiple broken and non–working thermometers in both
areas so this was an uncontrollable expense. The prior year's budget $1,500. Equipment
Management For the current month, the budget for equipment management was for $600. The actual
cast for equipment management was $330. This had a favorable variance of $270. In the PACU,
there is little equipment to manage. Each bay has a monitor that displays cardiac rhythm, heart rate,
blood pressure, pulse oximetry, and respirations. The majority of equipment comes from other
departments. The monitoring or maintenance done on the monitors or IV pumps are done remotely.
The previous year's budget was $500. Printing and Copying There are one full–size copier and one
copier for approximately 12 computers on wheels and two desktops. There are more desktops in the
surgery department in which can print to the copier or printer in the PACU. The budget is $350 for
the current month. The actual cost of $270 for the month produced a favorable variance of $80. She
explained that there is no possible way to control whose printing or copying where because the
department is wide open, and all

Career Path to Become a Certified Registered Nurse...
Certified Registered Nurse Anesthetists (CRNAs) are one of the most advanced types of nurses.
They are responsible for providing quality anesthesia and anesthesia–related care in order to
facilitate diagnostic, therapeutic and surgical procedures (America Association of Nurse
Anesthetists, 2010). While their services are mainly used in the surgical setting, CRNAs can also
provide assistance for pain management associated with obstetrical labor and delivery or for chronic
and acute pain. Although they typically work under the supervision of Anesthesiologists, based on
states regulations and by laws, they may also work independently (Kansas University Medical
Center, 2014).
Nurse Anesthetists may work in a variety of settings– from hospital ... Show more content on
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CRNAs are a way to provide cost–effective services– as they are less costly to employ than
anesthesiologists, in a time where healthcare facilities are scrambling to cut healthcare costs. As
such, CRNAs will continue to be in high demand particularly in medically underserved areas and as
they continue to become more widely recognized and accepted as a source for healthcare (Inner
Body, 2013). Certified Registered Nurse Anesthetists are one of the most stressful nursing
specialties, yet they are also one of the most lucrative. The median annual wage for a CRNA as of
May 2012 was $96,460, with the lowest paid and less experienced making approximately $66,330
and the top ten percent and most experienced making slightly over $161,030 (U.S Department of
Labor, Bureau of Labor Statistics, 2014). As a Nurse Anesthetist, there are many opportunities for
advancement available especially with additional education and increased experience working in the
field. The more knowledge one has as well as the higher the degree, certainly proves as cutting edge
on the healthcare field. For example, those with a Doctorate in Nursing (DNP) versus those with
only a Master's degree, are more likely not only get paid more, but also be awarded more leading
opportunities, such as being the

Post-Cooperative Nursing Research Papers
What is Post–operative Nurse?
When a patient leaves the care of the anesthetist after an operation, they wake up under the
supervision of a post–operative nurse. These health care professionals work in recovery rooms to
ensure that post–operative patients, who often wake up in physiologically fragile states, will be
expertly and continuously supervised.
Basic Responsibilities
Post–operative nurses have two basic responsibilities: transfer and monitor patients after surgeries.
After surgeries, post–operative nurses assess the patient's condition and determine if they are able to
be moved to the post–anesthesia care unit (PACU). If the vital signs are instable or if the surgical
team encounters problems, the patient may need to remain in the operating room. Once the doctor
determines that the patient can safely be moved, they will be transferred to the PACU for continued
care under the watchful eyes of a post–operative nurse. There, patients will be carefully monitored
when they wake up, so they will know what is going on. Post–operative nurses ensure that patients
stay comfortable while they monitor their vitals and deliver pain medications.
Registered Nurse PACU Job Description
Most post–operative nurses are actually RN's who work in PACU's, which may refer to either post–
anesthesia care units ... Show more content on Helpwriting.net ...
Most employers usually require a minimum of two years' experience in an ICU or PACU setting
such as an ambulatory surgery center. An active state RN license and valid BCLS and ACLS
certifications are recommended. Post–operative nurses need knowledge of operative care standards
and post–anesthesia techniques. They also need a strong attention to detail because they must ensure
that all medical documentation is legible, accurate and complete. Knowledge of applicable
regulations, compliance standards and accreditation requirements should make a difference during
job

Why Are You Interested In The University Honors Case Study
Why are you interested in participating in the University Honors Program (500 words) I have
completed many IB and AP courses throughout my high school career. I have taken AP Biology, AP
World History, IB HL 1 (equivalent to AP BC Calculus), AP US History, and AP Human Geography
and will complete IB HL 2 (similar to Calculus 3), AP Psychology, AP Chemistry, and AP Statistics.
I have taken all honors classes my freshman and sophomore year. I always challenge myself to
achieve higher goals. I understand that I don't know everything about the world, but challenging
classes expand my worldview. I attended the CSU Anatomy camp in the summer of 2016 and
experienced a taste of college level lectures. I touched real cadavers and learned so ... Show more
content on Helpwriting.net ...
Researching a medical topic and then presenting it is very exciting to me. The Honors Day was also
informative about the seminar style classes and the thought provoking discussions that the classes
are going to provide. A CSU student once said to the group tour I was on that, "You can make a big
school feel small but you can't make a small school feel big." I am trying to accomplish that with
CSU. I am in the Biomedical Sciences program, which is a vigorous major, but I also want my other
courses to be challenging as well. The Biomedical Science program is a small program and the
Honors Program is also a small program. Seminars sound like a way to delve into the curriculum
and make the class interesting and challenging to me. I also have met with Kelly Swetich who is the
undergrad advisor for Biomedical Sciences and she strongly recommended paring the Honors and
Biomedical Sciences major together since they compliment each other. Finally, my ultimate goal is
to get into Medical School and become a surgeon. The Honors program is the best way I can stand
out on my application. I am ready and prepared for the challenge of college and I want to be
accepted into the Honors Program. What special qualities do you bring which will contribute to the
ethnic, cultural, and/or intellectual diversity of the Honors Program I have always been interested
and achieved at math. I push myself to experience all types of math like calculus and statistics

Why I Am A Nurse
I will always remember one piece of advice a teacher taught me during my senior year of high
school. She said: "If you love what you do, you will never work a day in your life!" I have been
incredibly fortunate to say I have not worked since I became a nurse. Become a nurse is much more
than simply a calling. Nursing is a way of life; the compassion and care we give to our patients each
and every single day is not something many people have the ability to do. To date, I have been one
of the millions of compassionate and hardworking nurses around the world for over two years.
I have reached a point in my nursing career where I am ready to advance further in the field of
nursing. The excitement and potential to learn a new a new field in anesthesia and embrace the
challenges in that field truly drives me. I have been preparing for a future as a Nurse Anesthetist
since I got my first job. I have been blessed to have started my nursing career in two large Magnet
teaching hospitals; all of which I've been working in the Intensive Care Unit. My experience in a
Cardio/Thoracic ICU as well as Surgical ICU that includes a Cardiovascular/Thoracic ICU has
helped mold me into the type of nurse that is prepared for the challenges in Anesthesia, as well as a
CRNA program. My exposures to these two types of units have included multiple types of surgical
procedures, high acuity patients, conscious sedation, rapid sequence intubations, and emergent
situations. Working alongside

Identifying a Researchable Problem
Identifying a Researchable Problem Marilynn Kirk Walden University NURS 6052N, Section 22,
Essentials of Evidence–Based Practice December, 2015
Identifying a Researchable Problem: PICOT Question Researchers identify a research problem
based on a topic of interest. The problem is then researched to solve it. In nursing practice research
problems is the basis for evidence–based practice (EBP). "Evidence obtained from the study should
have potential to contribute ... Show more content on Helpwriting.net ...
Five Questions Related to Post–Operative Nausea and Vomiting When deciding what to research
"you need to consider whether the problem is significant enough to produce evidence to improve
nursing practice" (Polit & Beck, 2012, p89). The research questions address the problem to be
studied. Questions should be compatible with the chosen paradigm and its associated methods
(Polit& Beck, 2012). Research questions need to be properly worded and lend themselves to
empirical inquiry (Polit& Beck, 2012). Analysis of the questions generated for PONV was
based on the usefulness to nursing practice, identifying key concepts, and population. "Feasibility
involves the issues of time, cooperation of participants and other people, availability of facilities and
equipment, researcher experience, and ethical considerations" (Polit& Beck, 2012, p 92).
Preliminary PICOT Question and Description of each Relevant Variable The problem question is:
"In adult patients undergoing general anesthesia does aprepitant decrease PONV post–operatively
compared to patients receiving other antiemetic therapy of a placebo?" (Milnes, 2014).
The five questions that I have generated to address the problem: (1) P (patient population of interest)
– What population is served in this

The Treatment Of The Surgical Setting
The surgical setting is very different from the generalized floors that I have become accustomed to.
The exposure I had today included observing the operating room setting, the PACU, and the
exchange of patient care to a generalized or outpatient floor. In preparation for my clinical day I had
finished the module readings relating to peri–operative care which I found useful because I had a
base knowledge of information to build upon. I selected one patient to gather information from
which included his surgery, patient information, and care he received in the different stages of the
surgical process.
Patient Data
Patient JC is a 63–year–old male, he is Caucasian and is not Hispanic. He presented to the
emergency room on Monday April 4th after noticing pain, swelling, and a "blue tint" to his left fifth
digit. He has a history of hyperlipidemia, GERD, cardiac disorder, osteoarthritis, hematuria, prostate
cancer (resolved), and hammer syndrome. He has dentures and partial vision loss in both eyes. JC is
a construction worker. The patient's current problem with his left fifth digit is believed to come from
his history of hypothenar hammer syndrome. Hypothenar hammer syndrome is caused by repeated
use of the palm of the hand, such as when you use a hammer to push or grind objects. This can result
in damage of certain blood vessels in hand, especially the ulnar artery. This artery goes through the
hypothenar area of the palm and supplies blood to the fingers, damage to the ulnar

Medical Guideline Policy And Carilion Clinic Policies On A...
Cesarean Section Birth Brandon Caldwell Jefferson College of Health Sciences 11/1/14 Introduction
Cesarean section (C/S) births can occur in the hospital for several reasons. Some women choose to
have elective C/S birth and others require C/S births out of infant or maternal safety, complications,
or by necessity. This paper discusses both elective and emergency C/S deliveries and reviews both
National Guideline policy and Carilion Clinic policies on C/S births. The problem statement is: in
pregnant women (population), does C/S delivery following National or Carilion policies (IV:
exposure vs. none–exposure) differ in terms of patient care and outcomes concerning maternal and
neonatal health (DV)? The guidelines: National ... Show more content on Helpwriting.net ...
In depth discussion of planned and emergency C/S deliveries were also discussed. Planned C/S
births were defined as "breech presentation, multiple pregnancy, preterm birth, small for gestational
age, placenta praevia, morbidly adherent placenta, cephalopelvic disproportion in labor, mother–to–
child transmission of maternal infection, Hepatitis B and C viruses, Herpes, and maternal request for
C/S birth was outlined" (National Guideline Clearinghouse, 2011). An in–depth outline of anesthesia
and surgical techniques followed. It seems that this source addressed nearly every type of C/S birth
technique, including "method of placental removal, exteriorization of the uterus, closure of the
uterus, peritoneum, abdominal wall, and subcutaneous tissue, use of superficial wound drains,
closure of skin, and even timing of antibiotic administration and thromboprophylaxis for C/S births.
Care of the woman after C/S surgery, routine monitoring, pain management, eating and drinking
after surgery, and removing the urinary catheter after C/S surgeries was also discussed(National
Guideline Clearinghouse, 2011)". There is even a benefits/harms section that looks at potential risks
and successes of C/S deliveries. The National Guidelines Clearinghouse

Personal Narrative: I Volunteer At The Post-Anesthesia...
Since last year, I have volunteered at Cedars–Sinai Medical Center at the Post–Anesthesia Care Unit
and until recently the Emergency Room. My time there has brought to my attention the more
unpleasant side of medicine. Whether escorting patients or attending to their needs, I noticed that
many of them were quiet and avoided eye contact. Several of the doctors spoke to and treated these
patients in a brute manner which I found quite upsetting. These sick or injured patients were worried
and scared, and were served with the promise that no one would be turned away. Yet many were
silent as they were afraid of "bothering" the doctors. In spite of this, I did my best giving patients
some peace of mind by just spending a few moments of my time to chat and to listen their needs as
liasion and support. Seeing them smile and at ease has shown me that I have done my job but more
Bahareh Schweiger, DO, a pediatric endocrinologist. As I saw her examine her young patient, the
boy immediately clenched his fists. I knew he was scared, but I soon watched the child's fearful face
turned to awe as Dr. Schweiger offered her stethoscope to listen to his own heart. The little boy was
so fascinated that he hardly noticed as Dr. Schweiger completed the check–up, expertly assessing
the boy in mere moments. I felt an immediate sense of awe at Dr. Schweiger's skill and compassion
toward the fearful little boy. As a endocrinologist, Dr. Schweiger works with a lot young diabetic
patients and their families. Not only does she treat the patient but uses the opportunity in getting to
know her patients and to team up to in order for them educate/enagege her to maintain healthy
habits including adequate exercise and good eating habits. I continue to recognize the necessity of
"treating the patient not just the disease". experienced the importance of empathizing with a patient
and establishing trust by making patients even as young as four feel respected and

The Effect Of Fast Track Care On Length Of Stay Patients...
Running Head: FAST TRACK CARE
Review of Literature
The Effect of Fast Track Care on Length of Stay in Patients Undergoing Cardiac Surgery
Alisa Ruffner, BSN
Fall 2014
University of Tennessee Health Science Center: College of Nursing
NSG 819: Evaluation of Practice
Introduction Cardiac surgery is among the most frequently performed surgical procedures in the
United States. According to the American Heart Association, over 575,000 open heart surgeries were
performed in 2005. Until relatively recently, sedation and prolonged ventilatory support through the
first twelve to eighteen hours post operatively have been standard. This allowed adequate time for
the patient's hemodynamic, respiratory and coagulation physiological ... Show more content on
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How does fast track care compare to conventional care after cardiac surgery?
Methods
An electronic review of literature was conducted through PubMed, Clinicalkey, and MEDLINE
OVID databases. Key words and phrases searched included 'fast track', 'cardiac surgery', 'length of
stay', 'intensive care unit', and 'protocols'. The evidence in the articles were evaluated and examined
in the attached table. The evidence was also categorized for quality using the Grade model rating
from A to D.
Findings
The most significant publication found involving fast track care was a Cochrane review entitled
"Fast–track cardiac care for adult cardiac surgical patients". This review examined 25 trials and
included over 4,000 patients. The trails included in this review were randomized control trials "that
compared the use of low–dose opioid based general anesthesia versus high–dose opioid based
general anesthesia, and early extubation using time–directed protocols versus usual care for
extubation" (Zhu, Lee, & Chee, 2012). This review examined several outcomes including mortality,
post–operative complications, time to extubation, ICU length of stay, hospital length of stay, and

inpatient costs. The authors concluded, based on these studies, that fast track care was safe for
patients undergoing low to moderate risk cardiac surgery. The
combination of low dose opioid anesthesia combined with a rapid extubation protocol post
operatively is shown to decrease the time on

Registered Nurse Anesthetist Essay
CERTIFIED REGISTERED NURSE ANESTHETIST
To start with, Certified Registered Nurse Anesthetist provide anesthesia for surgical procedures,
such as therapeutic, diagnostic, and obstetrical measures. They also provide any related care needed;
before and after surgical procedures. Similarly, CRNAs provide emergency services and pain
management services. They work on all type of surgical procedures; from simpler ones to composite
ones. Anesthetists are responsible for drug dosage calculations, handling patient's pain levels and
vital signs. Anesthetists need to be able to communicate effectively so that patients feel comfortable.
They are required to support and stabilize patients, during trauma.
Per the university of Kansas medical Center, Certified anesthetists deliver many types of services to
the patients and they are divided into four categories: "pre–anesthetic preparation and evaluation;
anesthesia induction, maintenance and emergence; post–anesthesia care; and peri–anesthetic and
clinical support functions." CRNAs mostly work in operating rooms, but they also offer anesthesia
services in other areas, for instance, MRI units, cardiac catheterization labs, and lithotripsy units.
Certified registered nurse anesthetists are a major part of today's health care setting. They are hired
by community ... Show more content on Helpwriting.net ...
The anesthesia program takes about two years to complete. The program education consists of
clinical training either at the university hospital or at the community hospital before graduation. A
person who wants to get admission in anesthesia program must have bachelor's degree in nursing.
The requirements for an admission into the CRNA school are bachelor's degree in nursing, a license
as a registered nurse, and pass Graduate Record examination

Operative Case Study : Patient Data
Peri–Operative Case Study
Patient Data
Patient CB is a 36 year old African American Female. She has a past medical history of
hypertension, acid reflux, heartburn, and a hernia repair one year ago. She is a nonsmoker and
reports never taking recreational drugs. Diagnostic tests related to her diagnosis include an
abdominal ultrasound showing gallstones, an x–ray to verify stone presence, and tenderness with
touch on the abdomin. CB was having a cholecystectomy because she was having pain in her
abdomen related to gallstones. Her hernia was a result of a weakening of the abdominal wall.
Surgery
CB underwent a laparoscopic cholecystectomy with open incisional hernia repair in the Surgery
Center of Pinehurst. This means that she had ... Show more content on Helpwriting.net ...
This is due to the fact that the muscles must be paralyzed so the patient does not move around
during the procedure. Fentanyl, Diazepam, and Propofol were administered to put CB to sleep,
paralyze her muscles, and provide relaxation and memory loss of the procedure (Deglin). Potential
post–operative complications from this procedure include malignant hypertension, hypoventilation,
and nausea.
Post Anesthesia Care Unit (PACU) The first assessment of CB in the PACU revealed that she was
still deeply sedated. The anesthesiologist almost had to administer Narcan to reverse her anesthesia
because she was having such a difficult time waking up. She had clear breath sounds bilaterally and
her skin was warm to the touch. Her initial blood pressure reading was 134/72. Her bladder was
non–distended and her pain rating was 9/10 in her abdomen. An IV push of 2 grams of Dilaudid was
given for her pain. Additionally CB was given Zofran for nausea. Specifically in the PACU the
nurses are monitoring the patient's airway, their pain, level of consciousness, any bleeding at the
incision site, and nausea. CB was kept in the PACU, or stage I as it is referred to in the Surgery
Center, for an hour until she was alert and able to breath on her own without a nonrebreather mask.
Every patient is put on a nonrebreather and EKG when they arrive in stage I. Vitals are taken every
five minutes times four, then once before they leave. There is a specific documentation

Why Is Advanced Training Necessary For Nurse Anesthetists...
Nurse Anesthetist
Why is advanced training necessary to Nurse Anesthetists provide specialized care? Nurse
anesthetists work in a wide variety of healthcare settings, including hospitals, physicians ' offices,
schools, and clinics. Most APRNs work full time. To become a nurse anesthetist must earn at least a
master's degree in one of the APRN roles. They must also be licensed in their state and pass a
national certification exam. Employment for nurse anesthetist is said to grow about 31 percent from
2014 to 2024.
Certified Registered Nurse Anesthetists (CRNAs) are advanced practice nurses who safely provide
more than 32 million anesthetics for surgical, obstetrical and trauma care each year in the United
States. They administer every type ... Show more content on Helpwriting.net ...
CRNAs carry a heavy load of responsibility and are compensated accordingly. The reported average
annual salary in 2012 was approximately $157,000 with more experienced CRNAs earning up to
$214,000 each year.
The prospects for finding a good job in this field are excellent for the foreseeable future: According
to the U.S. Department of Health and Human Services, there is a significant and growing need for
CRNAs across the country.
In order to be accepted into an accredited nurse anesthesia program, you must be a currently
licensed RN with a Bachelor of Science in Nursing (BSN) or other appropriate baccalaureate degree
and at least one year of experience in an acute care setting. Certified Registered Nurse Anesthetist
(CRNA) programs, which lead to a master's or doctoral degree, take two to three years and include
clinical training in university–based or large community hospitals. Following graduation, you must
pass the national certification exam before you can begin practice. However, certification is not a
one–time accomplishment: In order to maintain their certification standing, CRNAs must obtain a
minimum of 40 hours of continuing education every two years.
Generally, the path to becoming a CRNA begins with a 4–year undergraduate degree in nursing or
another field. Although it is not required to possess a degree in nursing, a current license as a
registered nurse

Patient Care Technicians ( Pct )
Patient care technicians (PCT's), formally known as nursing assistants, are the backbone to any
nursing department. They create rapport with the patients and family members, as well as the
nursing and medical staff. Some of the tasks PCT's are responsible for include: obtaining and
recording vital signs, collecting and labeling specimens, blood glucose specimen, and obtaining
electrocardiograms (ECG). All these tasks are important and critical in an emergency. PCT's
designated to work in medical surgical floors may not remember the steps for obtaining a good ECG
reading. Like the saying goes: if you don't use it, you lose it. The most common reason ECG's are
misinterpreted is due to incorrect lead placement. PCT's in critical settings such ... Show more
content on Helpwriting.net ...
Other reasons for ECG's:
Stroke–like symptoms
Dizziness
Epigastric abdominal pain
Shortness of pain
Altered mental status
Loss of consciousness
Upper back pain
Electrode Lead Placement Electrodes must be placed in the correct landmarks to prevent
misinterpretation of the ECG. If the electrodes are placed incorrectly, the ECG may read as ST
changes, electrical axis, location of bundle branch blocks and location of infarcts (Riddle, 2008,
para. 5). During the ECG, a total of 10 electrodes are applied to the patient. Six electrodes (V1–V6)
are placed on the anterior chest in the proper anatomical landmarks, and these leads must be placed
precisely for an accurate ECG interpretation. Electrodes V1 and V2 are placed on the fourth
intercostal space with V1 on the right and V2 on the left (Riddle, 2008). Electrodes V3–V6 are
placed on the left chest wall on the fifth intercostal space in the following order: V3 to the right of
V4, V4 at the midclavicular line, V5 to the right of V6, V6 to the midaxillary line (Riddle, 2008).
The remaining four electrodes are placed on both upper and lower extremities without touching the
chest.
Objectives for PCT Workshop on ECG placement
The PCT will be able to demonstrate correct lead placement
The PCT will be able to troubleshoot the ECG machine and obtain missing equipment
The PCT will demonstrate techniques

Intraoperative Room
During this weeks clinical rotation I was given the opportunity to observe how nurses provide care
in the post anesthesia care unit also known as the PACU. The PACU is a place where patients go
after receiving surgery and anesthesia. The PACU provides patients with intense observation and
care until the patient is stable enough to be discharged home or to another unit in the hospital. Last
semester my fellow classmates and I was able to follow patients from the Preoperative area into the
intraoperative room. After observing preop and intraop it was nice to be able to observe how care is
managed postoperatively. After visualized how invasive many of these surgeries are its nice to know
there is a place where patients are cared for until they ... Show more content on Helpwriting.net ...
They were pleasant, and very informative. They did an exceptional job explaining the process of
how they perform care. My fellow nursing students and I shadowed Liz a registered nurse with vast
experience working in the critical care setting. She had a binder filled with educational information
for the students. The binder contained information on respiratory care including ABG
interpretations, PostOP nausea and vomiting, and abnormal ECG strips. In–between patient care
when we had down time Liz went over the ECG strips with us. She also planned out a scavenger
hunt to locate commonly used IV solutions as well has other commonly used equipment. My
classmates and I mixed up some of the solutions so Liz explained to us the difference and why it
was important to know when and when not to use specific solutions. Liz also created scenarios that
nurses frequently come across during patient care in the PACU. We were able to critically think of
interventions we would use if we were the nurses caring for this patient. Liz then let us know if we
was right or wrong and she then provided us with the rationale as to why we would perform that
specific intervention. I believe I learned from these scenarios because she didn't just give us the
answer instead she made us think and then she explained it in a way that I was able to fully

Research Paper On Professional Nursing
Professional Nursing: Emerging and Growing Through Research
Nursing as a profession involves multidisciplinary and holistic approaches to integrate the essence
of scientific practices into compassionate and humanistic approaches in rendering care to patients. It
is an art that reflects an expression of science, emotions, power and creativity to deliver the so–
called "tailored" delivery of patient care. From the time of Florence Nightingale up to the present,
countless developments and improvements in the field of nursing evolved. This is the outcome of
thorough research activities that influenced the modernization of this noble profession. Nursing
research is critical to the practice of professional nursing, it is a continuous process that entails
identification ... Show more content on Helpwriting.net ...
The information is disseminated to nurses to be applied and incorporated into practice to be a better
advocate for patients and to provide optimal nursing care (Tingen, Burnett, Murchison, & Zhu,
2013).
Defining Fundamental Pattern of Nursing Knowledge
As a nursing professional, several aspects of knowledge are involved in the application of care. The
fundamental pattern of nursing knowledge starts with science or empirical evidences governed by
factual and explicit information and acceptable knowledge, such as the procedures and guidelines of
nursing practice. It is derived from scientific methodology that supports the intellectual explanation
of health and illness phenomena and the processes involve in the cycle of human life. (Carper,
1978). The second pattern represents the esthetic part of nursing knowledge which is also known as
the art of nursing. The concept that is represented in this pattern is the expressive nature of delivery
of care rather than descriptive and objective in nature.

Perioperative Observation Paper
Perioperative Observation Paper
Jenna Vaccaro
Lewis University College of Nursing and Health Professions
Abstract
As a clinical requirement for my Adult 1: Medical–Surgical course, I had the opportunity to observe
a patient in the Operating Room and in the Post Anesthesia Unit of Advocate Good Samaritan
Hospital. The procedure that I observed was a left total knee replacement. The patient needed this
surgery because she was experiencing osteoarthritis, and this surgery could alleviate her pain and
discomfort. I was with the patient from the end of her stay in the pre–operative holding area to the
Operating Room, and then to the Post Anesthesia Care Unit. This paper will include background
inquiry, preoperative and operative ... Show more content on Helpwriting.net ...
X–rays can be used for the diagnosis of osteoarthritis; the images would reveal damage and other
changes related to osteoarthritis. With osteoarthritis of the knees, the patient would experience
progressively increasing pain, stiffness, and they would have a decrease in daily functions. Patients
experiencing these symptoms can be eligible for a total knee replacement. The surgical procedure. A
total knee replacement is a surgical procedure where the diseased knee joint is completely replaced
by artificial materials that resemble the original knee joint. The orthopedic surgeon removed the end
of the femur and the end of the tibia by using metal pieces and sawing the bone, to ensure that he
removes the right amount of bone. The end of the femur bone is replaced with metal and the end of
the tibia bone is replaced with plastic and metal. A plastic piece was added under the patella because
the surface under the patella was damaged as well. These artificial materials, called prosthesis, have
smooth surfaces so when they rub against each other, it does not cause damage and is pain–free. The
purpose of this surgery is to remove the diseased portions of the joint and replace it with artificial
materials to prevent further deterioration and eliminate pain, stiffness, and decreases in function that
were caused by the osteoarthritis.
Preoperative and Operative Phase The surgical suite was clean, well lit, and very organized. All of
the tools and

Ambulatory Surgical Center Career Analysis
The ASC (Ambulatory Surgical Center) provides a variety of career opportunities. Basically, a ASC
is a health care facility where surgical procedures not requiring an overnight hospital stay are
performed. I have been able to shadow several jobs within the ASC. Out of all the careers, a PACU
nurse sparked an interest. PACU Nurses are specialized to work in the post anesthesia care unit.
They provide intensive care and treatment for patients who have gone under anesthesia. PACU RNs
can also be referred to as a recovery room nurse. A PACU nurse must first obtain a bachelors degree
in nursing (BSN) and then pass the NCLEX exam. A BSN can be achieved at any accredited nursing
program. The best educational choices are courses in anesthesia–related

Observing A Right Hip Fracture Repair
Operating Room Observation Experience This past week, I was able to observe a right hip fracture
repair. The patient had broken his hip and was undergoing surgery to place screws and plates into his
hip. I was able to see the whole process through the preoperative, intraoperative and postoperative
stages. The preoperative stage is when the patient comes to the OR and is being prepped for the
surgery. The patient is verified by the nurse, who needs to check patient identification, patient
records and make sure is calm for the surgery. Before this particular surgery, the anesthesiologist
came down before the surgery to administer a block to the patient. The block is to dull the nerve
ending so when the patients comes out of surgery he will be in less pain. The consent form is signed
by two people, the patient and the doctor performing the surgery. The consent form is the
responsibility of the doctor, the nurse just verifies that both the doctor and the patient signed the
form. It is very common for a patient to be anxious right before a major surgery. My patient didn't
seem anxious but just wanted it to be over and done with. One of the most important part of a
nurse's job is to keep the patient calm and relaxed. That can be accomplished just by talking to them
and reassuring them. Keeping the patient company will also ease their nerves. The nurse makes sure
the patient is calm and relaxed right before surgery. It is also important for the holding area nurse to
make sure

A Study to Assess the Knowledge Level of the Patient...
[pic] [pic] POST OPERATIVE CARE SUBMITTED BY:– (GROUP 'VI') "A STUDY TO ASSESS
THE KNOWLEDGE LEVEL OF THE PATIENT STUDENT NURSE REGARDING POST
OPERATIVE CARE & TO IMPROVE KNOWLEDGE & PRACTICE IN HAMIDIYA HOSPITAL
YEAR – 2010" Study Submitted In Partial Fulfillment Of The Requirement For The Degree Of
Bachelor Of Science In Nursing SUPERVISED BY:– SIGNATURE OF PRINCIPAL MISS
ROSHANI GANGULI Asst. Lecturer SIGNATURE OF INTERNAL SIGNATURE OF
EXTERNAL EXAMINER EXAMINER MANSAROVAR NURSING COLLEGE, BHOPAL M.P.
| | | |Research Approach | | | |Research Design | | | |Setting | | | |Population | | | |Sample & Sampling
Techniques | | | |Data collection, Tools & Techniques | | | |Data Collection | | | |Summary | | |IV
|ANALYSIS AND INTERPRETATION | | | |Demo graphic Data of respondents | | | |Research out

Reflective Journal Number Two Essay
Reflective Journal Number Two
I am going to look back at a situation on my unit in the operating room (OR) where I implemented a
change using some of the distinguishing characteristics authentic leaders posses according to Maria
Shirey in 2006. I have worked in the OR for 13 years and have witnessed many changes take place,
both good and bad. Our situation was unique because staffing coverage must be 24 hours due to our
level 1 trauma status. The RN's brought forward the current system used for scheduling during
holidays was unfair with no apparent pattern. It was very random with many of the same RN's
working the majority of the holidays. Nurses comments ranged from, "Why am I always on the
major holidays, I never get to spend the holidays with my family," and "the same people are getting
the holidays off, why is that?" Management overlooked the fairness for covering the schedule.
Holiday coverage is reduced to two teams and a charge nurse which consists of five staff members,
allowing more staff to be off. Everything was status quo to management until it was mentioned at a
staff meeting with much dissatisfaction.
I was asked by my manager to lead a committee of RN's. She chose the staff to participate on this
committee. The goal was to propose a new system for holiday scheduling that was fair and
systematic. My leader was empowering her staff to make positive changes; she was encouraging
creativity by motivating her followers (Grossman & Valiga, 2013).

Post Anesthesia Care Unit On Nursing Class Of 2017 For...
I went to the post–anesthesia care unit on February 2, 2016 for the Wilkes Community College
Nursing Class of 2017 for observation. Another student and I were assigned to this unit from 8am–
2:30pm. Even though our time was cut short we still got to observe the flow and atmosphere in this
unit. It took awhile before we had our first patient, so we go to explore the area, determine what
equipment is in this area, and communicate with the nurses. We had them explain the documentation
process, and the main differences from a floor nurse than a PACU nurse. The post–anesthesia care
unit is next to the operation room and pre–operative patient waiting area. This area has an open floor
plan that allows easy communication with other health care members (CNA, Nurse, Doctor,
Anesthesiology, Radiography) and visually see patient while getting their medication or a drink.
They were 8 different stations in the PACU unit. Each station has equipment for any emergency that
could happen in this area. The equipment included a monitor, suction equipment, a sharps container,
oxygen, IV pole, call light, ambu bag, emebag, air valve and a trash can. This equipment was
present at each station. They were a nutritional area, medication area, and a nurse's station to toward
the back of the unit and on the other side of the unit they were a crash cart, warming blanket
machine and a large clock on the wall. This was all placed in the unit to improve transportation and
efficient patient care. When the

The Recovery Room
From the birth of the recovery room in the 1940s to the postanesthesia care unit (PACU) of the 21th
century, the look and function of this unit have been in a constant state of evolution. Throughout the
six past decades, surgical procedures have become more extensive and complicated and thus require
more specially prepared nursing staff and equipment for the care of the patient (Odom–Forren,
2013). The PACU of today is an intensive care specialty that provides care to wide range surgical
patients. Many of these patients have more than one chronic condition, such as chronic obstructive
pulmonary disease, diabetes mellitus, chronic pain, and chronic heart problems. In order to provide
safe patient care, the PACU nurse needs to develop the ability to blend expert clinical knowledge
that is based on experience, education, and collegial sharing with caring practices that comes from
within and from being a nurse (Odom–Forren, 2013).
For many years, critical care experience was a must have requirement prior to working in the PACU.
The PACU was staffed with experienced intensive care unit (ICU) nurses with different backgrounds
and a solid nursing knowledge base. Nowadays, many of these nurses are retiring or taking different
paths in their careers forcing the PACU managers to revise hiring requirements and open the PACU
doors to non–ICU and new graduate nurses. In order to assist the new graduate nurses transition to
their professional roles in the critical care setting, the Christ

Post-Anesthesia Care Unit PACU
Post–Anesthesia Care Unit (PACU) Phase The role of the Post–anesthesia Care Unit nurse is to
monitor patient's that have just been through a surgical procedure and were placed under anesthesia.
In this phase, the nurse is assessing the patient as he begins to regain conscious, the airway status,
and vitals (Bjorklund, et al., 2013, p. 117). The hand of report from the circulating nurse to the
PACU nurse is very brief consisting of the patient's name and DOB, the procedure done, any
complications, medications the were used, the amount of fluids received; this report mimics the
SBAR technique because it gives the PACU nurse the basic, precise knowledge he or she needs to
know in order to properly care and tend to the patient. Recovery time

Nurse Driven, Sleep Hygiene Protocol, A Source Of Anxiety...
The inability to sleep is a source of anxiety and stress for patients in the intensive care unit (ICU);
this inability can lead to cardiorespiratory disturbances, immune system dysfunction, impaired
wound healing, hormonal and metabolic imbalances, cognitive changes, and delirium. Through the
use of quiet times and nursing actions that encourage sleep, or, sleep hygiene bundles, nurses can
assist in improving sleep quality in the ICU. These bundles include noise and light reduction,
scheduling routine procedures outside of reserved sleep times, the use of earplugs and eye masks,
and the grouping of nursing care activities to minimize sleep interruptions. The aim of this proposal,
therefore, will be to implement a nurse–driven, sleep hygiene protocol, in order to improve patient
care by promoting quality sleep in ICU patients. Barriers to implementation include staff resistance
to the concept, concerns regarding patient care during sleep times and difficulties in coordinating
care with other units. Studies used to gather information for this proposal were published between
the years of 2011 and 2016 and were found in several databases: Academic Search Complete,
Medline, and OVID Journals.
Keywords: ICU, intensive care unit, critical care, quiet time, noise, and nursing. Quiet Time in the
ICU
One of the top three sources of anxiety and stress for patients during an intensive care unit (ICU)
stay is the inability to sleep (Kamdar, Needham, & Collop, 2012). There is

A Literature Review On Opioid-Free General Anesthesia Versus
A Literature Review on Opioid–Free General Anesthesia versus Opioid–Based General Anesthesia
for Bariatric Surgery Ina Basha University of New England One third of the American adult
population is considered to be overweight, a figure that is still on the rise. Numerous studies have
presented the negative impacts that obesity has on health and how every organ system in the human
body is affected. When minimally invasive strategies such as life style changes fail, bariatric surgery
procedures have become the other option. The purpose of this literature review is to look at the
outcomes of post–operative pain, post–operative nausea and vomiting, and the length of stay in the
post–anesthesia care unit in obese adults undergoing bariatric ... Show more content on
Helpwriting.net ...
As a result, obesity does not merely affect the individual alone, but an entire society. With a
prevalence of one third of adults considered to be overweight (not dealing with childhood obesity,
which is becoming an epidemic in its own right), more patients are turning to surgery as a solution.
In 1992 there were 16,200 bariatric surgical procedures in the United States and by 2008 that
number had increased to 220,000 (Schumann, 2010). This paper aims at answering the following
question: "In obese adults undergoing bariatric surgery, how does opioid–free anesthesia compare to
opioid–based general anesthesia and its effect on post–operative outcomes in terms of post–
operative pain, post–operative nausea and vomiting (PONV), and length of stay in the post–
anesthesia care unit (PACU)?" Bariatric surgery is the last resort for morbidly obese patients who
have tried other options, such as diet and exercise, but have fallen short from obtaining their desired
health goals. The surgery is safe and effective, but as with any surgery, there are risks involved.
Furthermore, the National Institutes of Health (NIH) has put forth very specific criteria that must be
met before bariatric surgery can be performed on a patient. The Obesity Action Coalition

The Post Anesthesia Care Unit At Miami Children's Hospital
A Harmonious Exemplification
On the post anesthesia care unit at Miami Children's Hospital, students and nurses alike witnessed a
harmonious exemplification of the six competencies of Quality and Safety Education for Nurses,
more commonly known as QSEN. The post anesthesia care unit, PACU, was off to a slow start just
before teamwork between the preoperative unit, also called PREOP, the operating room, and PACU
were put to the test. A 4 year–old, already extubated, female patient had come to the unit from the
operating room, more commonly referred to as the OR. The OR nurse proceeded to inform the
receiving PACU nurse that the patient just had an arterial line placed in the femoral artery in order to
later undergo apheresis for cancer treatment. Upon performing an assessment, the nurse noticed that
the patient's pressure dressing was saturated with blood due to a hemorrhage. A team consisting of
PACU nurses, the anesthesiologist, the OR nurse and students rushed to the bedside to assist in
restraining the squirming patient in order to keep her flat and still. Ultimately, the dressing was
replaced a total of four times before the hemorrhage ceased, the patient received one unit of packed
red blood cells, and had a new intravenous line, or IV, started because the previous site had
developed a reaction to the Demorol administered in the OR. To prevent further distress for the
patient, the anesthesiologist, surgeon, and primary care physician collectively decided to

Chapter 28 Cpt Coding
Chapter 28 CPT
CPT coding is to make sure the patient is getting billed for the correct services that was rendered.
The Tabular list is a compilation of codes divided in different categories: Category I, II, III.
Category I is the basis of CPT codes. Category II is used for tracing information. Category III is
short term codes for collection of services rendered and procedures. There are 15 appendices that are
used as guides. Modifiers help report situations. Locating codes are done by finding the main term.
Assess information provided such as notes and terms. Locate the code. Guidelines are presented in
the front of the sections. Special instructions help point out rules on how to use codes. Instructional
notes are located in parentheses ... Show more content on Helpwriting.net ...
Codes are divided because of the location of sinuses. Endoscopy can be performed three different
ways; transnasal, transnoral, and transorbital. Occasionally, procedures are grouped by size, type or
differences.
Chapter 39 Cardiovascular Pacemakers can be short term or long term. Batteries for pacemakers
hold up for about 5 to 15 years. Nonselective catheter is approached through the aorta or vessel.
Selective catheter is approached through a vessel going to the aorta then proceeds to other arteries
that sector from the aorta to vessels that need fixing. Coding for selective catheter is from the greater
distal area. Second branch order is the subclavian artery.
Chapter 31Evaluation and Management Criteria: setting evaluation, contact was it direct or indirect,
is patient a child or infant, service provided, is the patient established/new. Service level consist of
three components, which is the history, exam, and decision made at the time of visit. Patient that has
seen the doctor for three year is established. One that has not seen the doctor is new. There are four
levels of making a decision. HPI factors relate to the issue the patients is dealing with. ROS factors
relates to the sign of illness. PFSH factors deals with the history of the patient and history of the

Utilization In Healthcare
Resource utilization is an important aspect in managing today's healthcare world and resources in
healthcare are limited, especially when it pertains to surgeries. It is vital for healthcare organizations
to efficiently distribute resources while also not letting resources be wasted, these efforts do cost
time and money. High performing, highly productive organizations can offer competitive edges
against other organizations, however, organizations must strategically plan how this occurs.
According to Sokal, Craft, Change, Sandberg & Berger (2006) the increase in the number of patients
needing surgery, reduced number of operating rooms and staff shortage are reasons why surgeries
and operating rooms are under capacity limitations. This paper will evaluate the operational strategy
that was performed at Massachusetts General Hospital on maximizing the utilization of the
operating and recovery rooms. Synopsis ... Show more content on Helpwriting.net ...
The first parallel process was accomplished by currently performing the turnover area with the
anesthesia induction process. This improved the workflow process without any additional staffing
requirements. "The multi–room configuration allows for realignment of staff and post anesthesia
care unit resource to support concurrent induction and operating room set up" (Sokal, Craft, Change,
Sandberg & Berger, 2006 pp. 390). The second parallel process that was researched was testing
three induction rooms, three operating rooms and three post anesthesia care units (PACU) compared
to having only one recovery room (PACU). This study performed 49,887 cases using the standard
operating room process and 1,220 cases using the parallel process with using one PACU, this was
performed over a 2–year

The Path Of Nursing And The Path To Nursing
A pathway towards nursing Nursing is one of the many appreciated careers within the medical field.
Nurses provide safe and efficient care for patients. They have the chance to make a difference in
people's lives. Nurses require many responsibilities because patients and family members rely upon
nurses so they achieve goals that are crucial for the well–being of a patient. They inform patients
and families about diseases and how to prevent them. Nursing requires empathy and effort in order
to succeed and help patients that need them the most. Nursing would be a great career to pursue
because it deals patient care and safety , it is a promising career, and the job stability is high because
it is in demand. Nursing is the practice that involves patient care and safety because nurses treat and
monitor a patient. Nurses have a huge responsibility that requires intensive training and knowledge
within this position. The ability to make your own decisions is a huge responsibility, for example
working in a pre–operative surgical unit and PACU (post anesthesia care unit) requires healthcare
workers to work as a team. Nurse constantly have to work with anesthesiologist and surgeons in
order to make decisions that will have an impact on a patient. Anesthesiologist are great to back up
nurses in a difficult decision. Nurses sometimes have to follow their gut instinct that they know will
comfort a patient . It is labor intensive because it is hands on work that involves helping

Notes On Time Management Through Delegation
Time Management Through Delegation
A personal goal for this project is time management through delegation. The Plan–Do–Check–Act
cycle (PDCA) is a tool that will be used to develop a plan for quality improvement and achieve the
goals that would be beneficial for the nurse and patient care outcomes. The personal goals are to
discharge all patients with finished documentation according to the certified post anesthesia nurse
(CPAN) rules by using the process of delegation to obtain ancillary help. DELEGATION Delegation
is the cornerstone to being a nurse leader, it facilitates the work effort of the staff to accomplish the
mission and goals of the healthcare organization. The optimum administration of a unit is contingent
on how well the staff functions as a team. One study stated the most intricate skills a nurse leader
can have is delegation; proper judgment and knowledge is required to effectively transfer the
authority, responsibility, and accountability to a subordinate. Understanding the concept of
delegation is essential in conveying an assignment, this is the final accountability for the care of a
patient. When delegation is not effective, valuable resources are substandard (Weydt, 2010).
TIME MANAGEMENT As a critical care nurse working in a post anesthesia care unit the most
valued resources is time management. Resources are the means for a healthcare system to deliver
services; time is a valuable resource

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