Osteoarthritis - Pre-Operative Nursing Assessment, Risks for Surgical Site Infections - Case Study Example

Surname: Task Tutor Date АСUTЕ НЕАLTH САSЕ STUDY- ОSTЕОАRTHRITIS Part A. Pre-operative nursing assessment Preoperative preparation includes the assessment of features that are relevant to all patients irrespective of the surgery that they undergo. Nurses are the main characters involved in the preparation of patients for surgery. Reassessing of knowledge and understanding that reinforces the information given to the patients through the pre operation is crucial. According studies, patients have problems with processing all the detailed information given preceding operation. The problem is that, with any surgery, it is very hard to tell anyone how it will be after the operation. Just as the physical preparation for any surgery is important psychological support preparation education and assessment are also crucial (Coello R, 2005). All preoperative patience including Margaret requires the preoperative teaching for them to understand what they are going through and prepare them for the results. Almost all surgical patients experience a mild anxiety such as the fact that Margaret diagnosysis involves depression this makes her even more vulnerable, but a routine action will always help out. Individualized nursing assessment and diagnosis are also imperative (Garcia-Miguel F.J., 2003). It is critical to identify potential especially if the patients have underlying conditions that put him or her on higher risk. Margaret required undergoing individualized diagnosis to evaluate her eligibility to go through the operation. Initially, in refereal to an orthopaedic surgeon, Margaret was adviced that weight could not allow her get into the waiting list for the surgery. She had a BMI of 40 with a height of 168 centimeters and weight of 113.4 kg. She was required to reduce his weight to 97.5 kg getting her a BMI of 35. With such weight, it was possible that she would suffer from the obesity induced physical challenges that would interfere with her lifestyle and the operation itself. Her BMI was a hindrance towards success of her operation. The medical practitioner had to advise her out (Coello R, 2005). Obese patients such as Margaret need to pass through psychological evaluation and taken care an internist who is a specialist in obesity. Postoperative results will highly be affected by any inappropriate treatment of mental sickness such as active eating disorders, abuse of the substance and much another personal disorder which obese people like Margaret likely suffer from. Such personal disorder for Margaret is depression that was eating her life away (Ferrando A, 2005). Well informed patients who are highly motivated with understanding concerning the risks of the operation and have the ability to participate in long term treatments with following ups should be considered first. Other than ensuring that a patient poses cognitive abilities to comprehend the entire operation and its inherent risks the patients’ conditions medically cannot be very unstable in that it will render risks of the surgery and this is totally unacceptable. The medical team should always ensure that everything that can bring complications during and after the operation is eliminated and made clear to avoid surprises (Garcia-Miguel F.J., 2003). Margaret needed to be instructed that even though she meets the requirements for the surgery, other third party players may insist on other additional requirements before allowing her to be operated on. Usually what is required is one or more documented weight loss efforts that are supervised(Ferrando A, 2005). These third party requirements vary evenly, depending on the third party it is always worth to understanding. She may have been highly frustrated when she was asked to go through months of supervised weight loss efforts while other patients with the same problems were being operated on. It is always important that both the medical team and the patients are well informed of the procedure that is needed to be fulfilled before any plan is laid for the surgery. In a recent study, it is demonstrated that the insurance mandated the preoperative dietary advisory; this was mandated by various third party co players. The entire process almost denied patients from getting surgery and this had no much impact on the on their weight loss general outcome or the support operation compliance (Coello R, 2005). TKA is known to be successful and long lasting treatments, especially for the young patients. With patients under the age of forty unlike that of Margaret, must they discussed the indication of TKA with the doctors(Garcia-Miguel F.J., 2003).. This is because the expectations and the functional demands endanger the successful mid-term result of the operation. In any case of litigation, must the situation be totally clarified before the operation is done. It is also critical to note that, athletic activities will increase the stresses on the prosthetic knee mostly at the bone-cement-implant interfaces especially at the joint bearing surfaces (Ferrando A, 2005). It was important that Margaret loses enough weight before the surgery since, after the surgery; his athletic activities will be limited to ensure that she successfully goes through the postoperative without adding more weight. From demonstrations that have been given, it is clear that the cement is the most appropriate barrier against the polyethylene debris which mostly leads to the aseptic loosening when TKA is carried out (Coello R, 2005). Low force athletic tricks such as swimming, walking, and cycling is recommended after the total knee arthroplasty for patients as Margaret. Since she is obese, it is even trickier since her body mass index is like to limit more of her movements and this might lead to rapid addition of weight that might cause another healthy complication. She can approach high impact and strenuous athletic activities including cross country and the downhill skiing depending on the post operative skill of the patient but with her weight this might be a challenge(Ferrando A, 2005). It is highly discouraged for patients to participate in the high impact athletic workouts, they are not allowed until the quadriceps and the hamstring muscles are enough to be rehabilitated. Only young patients with good health conditions are allowed to participate in such activities that are of high impact such as alpine skiing this is because young patients are mostly good at alpine skiing using carving skis that might generate high eccentric and the shearing loads, therefore, compromising the result of long term healing after the total knee replacements(Garcia-Miguel F.J., 2003).. During the interoperation time, nurses are prompted to use their highly specialized skills; they have to communicate well with the patient, the anesthetic team and the surgical staff to ensure success of the operation. Just as the preoperative procedure affects the postoperative success the intraoperative period also affects the postoperative success (Garcia-Miguel F.J., 2003). Preoperative planning is significantly important in that the procedure concerns cuts of bones and release of ligamentous. It also involves routine sacrifice of the PCL and the implant of postero-stabilized design. The mid-term functional success and the preoperative complications determine entirely how total knee arthroplasty goes for individuals like Margaret(Coello R, 2005). The fact that Margaret is aged 56 putting her in the category of the elderly, therefore, she is less active and her prostheses are subjected too much lower mechanical demands. Therefore, they are unlikely of developing the, therefore, aseptic loosening and all-polyethylene tibial component that may be implanted in a non obese, sedentary patient with a good rate of success comparable to such a metal-backed tibial constituent. However, the case of Margaret is different as she instead is obese and this may be a disadvantage to her recovery (Garcia-Miguel F.J., 2003). Part B Risks for surgical site infections Effects such as contaminants of bacteria, preoperative status of the client, the preoperative preparation of the operation room and the patients, and the operation procedure to be undertaken determines whether surgical site infections will occur. The factors should be considered to avoid causing the infections (Coello R, 2005). The number of pathogens that enter the operative fields is one of the most important determinants of the occurrence of surgical site infection. Contaminating bacteria can be can be contacted from within, on the patient or the environment of the operation room(Bruce J, 2001). There is various security set to ensure that contamination of bacteria is reduced. These include disinfection of the operation room, advising the patient to take preoperative antiseptic showers, and use of antiseptics on the operation site (Garcia-Miguel F.J., 2003). The ideology of using prophylactic antibiotics is meant to help in neutralizing the bacterial infections in the surgical site just before tissue lodgment and event of invasion. Virulence of foreign materials that cause in pathogens to contaminate the field of operation in important in determining the chances of disease that will follow the operation method (Bruce J, 2001). The presence of foreign materials makes it more advantageous for bacteria to cohabit in the site. To evade such problems occurring Margaret is advised to take serious all instruction given to her by all the medical practitioners helping her on the use of antiseptics and cleanliness (Ferrando A, 2005). The status of the patient just before the operation is also an important part. Serious indicators of the preoperative health are highly associated with the occurrence of the surgical site infections. They include immunosuppressive medications, morbid obesity as in the case of Margaret, starvation, the level of blood sugar, and other infections that are totally remote from the operative site (Mangram AJ, 1999). It was paramount that Margaret’s obese condition be amended before operation that is why she was advised to reduce her BMI to 35. Her obese conditions posed her more risks of surgical site infections. Other conditions such as malnutrition and diabetes can also be amended before the patient is operated on(Garcia-Miguel F.J., 2003). A good number of the procedure is known to affect the event of the support operation surgical site infection. Such factors include the operation technique, duration of the operation, and asepsis, these factors are relevant to all sorts of operations. Orthopedics joint replacement is one of the procedures that are significant as they can easily cause the occurrence of surgical site infections. The procedure use bulb syringe lavage of either high pressure or low pressure(Ferrando A, 2005). These two can lead to seeding of pressure deeply in the bones and can cause musculoskeletal damage. It is advised that the low pressure lavage be used if bacterial contamination is minimal. The solutions that are used in the operation should also be tested with normal saline solutions to determine their contamination before surgery. Scholars have reached an agreement that either use of suction drainage or no use in the operation does not affect the occurrence of would complication or development of surgical site infections(Garcia-Miguel F.J., 2003). Another issue that is of high power in control of surgical site operation for patients as Margaret is the long lasting debate that concerns the drainage of the wound. A meta-analysis showed that a closed suction drainage escalates the transfusion needs and this represents no significant advantages (Bruce J, 2001). Many scholars have supported the fact that a wound drain brings down the rate of drainage, ecchymosis formation and the erythema. They came into an agreement that either the use of or non use of the suction drainage does not affect the event of wound complication or infections after total knee arthroplasty. If the drain is used in patience as Margaret then the optimal time in place should never go beyond 24 hours. Other operative steps that include maintaining effective homeostasis, use of the topical antiseptic and the antimicrobials to the surgical incisions before closure of the wound, closing of the dead space properly and using different surgical techniques will always have effects on the development of the surgical site infections (Garcia-Miguel F.J., 2003). Major bacterial contamination is usually caused while the wound is open, the most significant factor that is associated with efficacy of the antimicrobial prophylaxis is the presence of the high contents of antibiotics with a strong concentration in the tissues and the blood bathing of the would during the entire surgery process (Bruce J, 2001). The duration of operation is another an important factor that is used to determine chances of surgical site infections. According to studies that have been made operation, time is mainly an independent risk factor for the periprosthetic joint infection. For patients like Margaret’s operation depends on how it is handled from the pre operational period to the post operation time (Ferrando A, 2005). The risk of surgical site infection developing does not stop immediately after the operation has been performed and the wound totally closed. Proper wound care should be taken seriously, dressing procedures should be made in the most professional way to bring the risks of getting infections (Bruce J, 2001). The dressing is recommended to be permeable, transparent, flexible, absorbent and waterproof. Use of antibacterial dressing helps in reducing the risks of surgical site infection. Making sure that the wound is kept dry and clean is paramount (Garcia-Miguel F.J., 2003). A number of issues that are dangerously compromise the outcome of the patients that can lead not only to severe morbidity but death are possible (Garcia-Miguel F.J., 2003). Despite the fact that all measures of protection against surgical site infections it is important to understand that this does not remove completely the chances of getting the disease. These infections happen when various and virulence of bacteria pathogens overcome the physiological capability of the patient to respond(Coello R, 2005). To avoid contracting infections from such contamination of both the extrinsic and intrinsic factors that cause the disease. The procedure and patient related factors should be set at the forefront in dealing with such impending problems. Reducing the risks as much as possible ensures that the optimal conditions for disease and conduction of the operative therapy together with the postoperative management. References Bruce J, R. E. (2001). The measurement and monitoring of surgical adverse events. Health Technol Assess Journal, 1-194. Coello R, C. A. (2005). Adverse impacts of surgical site infection in English Hospitals. J Hosp Infect journal, 93-103. Ferrando A, I. C. (2005). Guidelines for preoperative assessment: impact on clinical practice and cost. International Journal for quality in health care. 17(4) , 323-329. Garcia-Miguel F.J., S.-A. P.-B. (2003). Preoperative assessment. Lancet 362(9397) , 1749-1757. Mangram AJ, H. T. (1999). Guidelines for prevention of surgical site infection. Am J infect control, 97-132. Read More