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This assignment will give students the opportunity to examine the research and find evidenced based nursing practice that is related to current trends and issues in medical-surgical nursing. Students will apply that research in developing a nursing care plan that will help promote health for a medical-surgical client.

This assignment contains 3 parts completed in two components. First, you will write a scholarly paper on a procedure or trend/issue that impacts the health of a medical-surgical client. Second, you will then apply your scholarly paper findings/research to describe how the evidence best supports the change of nursing procedure/trend/issue and the impact of the change on the health outcomes of the client. Third, this evidence will then be applied in a nursing care plan for a theoretical medical-surgical client.

  1. Select a topic from the list below or you may select a topic that interests you, but speak with your instructor first if you are choosing your own topic.
    1. Care and use of different types of chest tubes (e.g., wet/dry/Heimlich valves).
  1. Increasing incidents of a super infection (ESBL, BRE, and MRSA) in the acute care setting and how these can be avoided. Choose one super infection to focus on.

  2. Types and trends of post-operative infections in the acute care setting in Alberta.

  3. Clean vs sterile techniques for tracheostomy care, bladder irrigation, or intermittent catheterization.
  1. Preventing complications such as DVTs, respiratory complications, and skin breakdown in the immobilized acute care client (skeletal traction, external fixators, strict bed rest etc.). Choose one complication to focus on.

  2. Issues of early discharge of the post-operative client from the acute care setting.

  3. Research your topic of choice. Provide a brief description of the procedure or trend/issue. In your research include:

    1. Compare previous and current practice
  1. Include evidence based practice that promotes the health of the medical-surgical client in the hospital following their discharge home

  2. Identify teaching information that is important for the medical-surgical client that promotes health of the client specific to the chosen procedure/trend/issue.
  1. Part A needs to include the following:
  1. Typewritten and follows APA 6thEdition formatting guidelines
  2. Utilize headings (see marking guide for headings)
  3. Contains a title, introduction/conclusion, and body of the paper
  4. Support your findings with the literature (peer reviewed articles, journal, or textbooks)
  5. No more than 3 pages in length (excluding the title and reference pages)
  6. Reference page must include at least 3 current resources (within 7 years)
  1. Create a care plan (template below) based on the evidence-based research from part A.

    1. Write 3 nursing diagnoses that relate to the topic that you have researched

      1. One addressing a priority (an actual problem from the research in part A)
      2. One addressing a potential complication
  • One addressing an educational need
  1. Write 1 goal for each nursing diagnosis, and1 expected outcome for each goal using the SMART criteria.

  2. Write 3 nursing interventions for each goal. Support each intervention with evidence from the literature

  3. Include interventions applicable to the care of the client, and health promotion teaching that is applicable to the acute-care setting or the home setting after discharge
  1. Interventions should be specific and measurable
  • Interventions must directly relate to achieving the goal and represent best practice in nursing from your research paper
  1. Write 1 evaluative statement for each goal to indicate how each goal could be met. This is a hypothetical statement and indicates how you, as the nurse, would know if the stated goal and outcome were achieved
  1. Part B will utilize the Care Plan template

The Impact of Respiratory Complications on Medical-Surgical Clients

Respiratory complications have been reported as common incidences in Canada; research has shown that majority of respiratory complications occur due to post-operative surgical procedures and during general anaesthesia in hospital settings. These often contribute to acute respiratory failure in patients who have undergone surgical operations. Incidences of respiratory complications have been commonly reported post-surgery, lung surgery being most common. Atelectasis (complete lung collapse), acute respiratory failure and pneumonia are common complications post-surgery. Respiratory complications may lead to deleterious outcomes in patients, which as a result require improved nursing care and beneficial nursing care plan to reduce respiratory fatalities.

Respiratory complications have been common post-surgery, atelectasis or complete lung collapse being a common complication reported among Canadian patients with estimates of 3.7 -7.9% (Brueckmann et al., 2013). Pulmonary oedema, pneumonia and re-intubation are also commonly associated among patients post-surgery. These complications lead to re-hospitalizations and often fatal outcomes for the patients. This is where the nursing care and practice come into play to minimize the incidences of respiratory complications and thereby promote an improved wellbeing of the patients and quality patient care.

Past research evidences show that acute respiratory failure resulting post-surgical procedures were treated and managed through non-invasive ventilation. Non-invasive ventilation involved the delivery of mechanical ventilation preventing intubation requirements. Non-invasive ventilation involves conventional tubing connected through a face mask with disposable foam. The oxygen pressure support was increased in a regulated manner to provide patient comfort. Standardized treatment through oxygen supplementation used to be a method of treatment for acute respiratory failure (Scala & Pisani, 2018). Endotracheal intubation was sometimes involved as an intervention for patients who did not respond to standard oxygen supplementation or non-invasive ventilation. Endotracheal intubation provided mechanical ventilation to protect the alveolar airways and managed to remove the patient’s inability to undergo non-invasive ventilation. Conventional ventilation involving intravenous administration of benzodiazepines was used alongside intubation treatment.

These previous nursing practices have shown that the patients who have received post-operative treatments to minimise the respiratory failure, have shown a chance of re-hospitalizations due to lack of proper care post discharge. Many patients did not support non-invasive ventilation due to their inability to tolerate the face mask associated with non-invasive ventilation. Additional respiratory troubles have been encountered among patients post-surgery. Ventilator induced injuries of the patients’ lungs are also observed (Ladha et al., 2015). Over-inflation of lungs with decreased compliance have been observed among patients receiving ventilator treatments.

Previous Nursing Practices for Respiratory Complications

Based on patients’ clinical outcomes, nursing practice has evolved through training and education to focus on the roots of the respiratory complications and promote quality patient care through designing and implementing various care plans in response to patients’ conditions. A simple and inexpensive strategic care plan in the name of ‘I COUGH’ program has been developed and intervened in providing patient care in hospital settings This incorporated lung expansion exercises, educating patients and their families about personal hygiene (Ruscic et al., 2017). Relieving pain is also involved as a part of the strategic plan. Post-operative pain management is also a necessity in mobilization goals.

Nursing officials play an extensive role in these practices. Collaborative efforts, communication skill development, performing within multidisciplinary team, providing individual patient care in response to their conditions are prime qualities of nurses which determine the efficient implementation and beneficial outcomes of these practices.

With the increasing incidences of respiratory complications and its adversities among patients post-surgical procedures, nurses have developed themselves with time through education and training to enhance their knowledge and incorporate practice guidelines to achieve quality patient care. The nurses have developed care plans based on past evidences and have implemented these care plans and models to achieve an increased improvement in patient care (Schmidt & Brown, 2014). The nurses involve in a multidisciplinary health care team to devise a strategic care plan focussing on comprehensive patient and family education. An ‘I COUGH’ nursing program has been designed and implemented as an evidence-based nursing intervention to minimise incidences of respiratory complications (Cassidy et al., 2013). The ‘I COUGH’ program puts its emphasis on incentive spirometry, both coughing and deep breathing, oral care and understanding through education provided to patients and their families, getting out of bed thrice on a daily routine and head-of-bed elevation (do Nascimento Junior et al., 2014). Nurses and clinical physicians are provided with education to put this ‘I COUGH’ intervention into practice.

Major incorporation of the ‘I COUGH’ program involved providing education to patients and their families, nursing officials and clinical physicians. Patients and their families are provided detailed education regarding necessity of post-operative care to prevent respiratory complications. A proper demonstration on the use of incentive spirometry is provided to patients, nurses and clinical physicians in the preoperative setting. A brief knowledge about I COUGH program elements is provided to the patients and their families. A comprehensive nursing education formed a key initiative in the intervention procedure. Attending clinical physicians and involved house staffs are similarly educated to promote improvement in patient care (Veronovici et al., 2014). The nurses involved in clinical follow up of patients are provided with necessary education and training, they collaborated with unit nursing officials to clinically review the intervention outcomes and teach these unit nurses about the principles of the ‘I COUGH’ intervention program.

The Evolution of Evidence-Based Practice for Nursing

Conclusion

Severity of respiratory complications in the post-operative stages occur due to gaps in in nursing care. Efficient management of patient complications lead to reduced rates of complications. Efficacy in treatment and management prior to operation leads to better patient outcomes. The clinical improvement in respiratory complications cannot be fully attributed to the nursing care; with newer levels of respiratory complications arising with patient cases, the nursing care evolves through evidence-based research and enhanced learning skills. Effective nursing care plan developed through evidence-based research lead to a positive patient outcome through effective reduction of complication rates. Care models and care plans are therefore better nursing interventions to reduce respiratory complicacies through time to time modification.

References

Brueckmann, B., Villa-Uribe, J. L., Bateman, B. T., Grosse-Sundrup, M., Hess, D. R., Schlett, C. L., & Eikermann, M. (2013). Development and validation of a score for prediction of postoperative respiratory complications. Anesthesiology: The Journal of the American Society of Anesthesiologists, 118(6), 1276-1285. doi:10.1097/ALN.0b013e318293065c

Cassidy, M. R., Rosenkranz, P., McCabe, K., Rosen, J. E., & McAneny, D. (2013). I COUGH: reducing postoperative pulmonary complications with a multidisciplinary patient care program. JAMA surgery, 148(8), 740-745. doi:10.1001/jamasurg.2013.358

DiBardino, D. M., & Wunderink, R. G. (2015). Aspiration pneumonia: a review of modern trends. Journal of critical care, 30(1), 40-48. doi.org/10.1016/j.jcrc.2014.07.011

do Nascimento Junior, P., Modolo, N. S., Andrade, S., Guimaraes, M. M., Braz, L. G., & El Dib, R. (2014). Incentive spirometry for prevention of postoperative pulmonary complications in upper abdominal surgery. The Cochrane Library. DOI: 10.1002/14651858.CD006058.pub3

Gattas, D. J., Dan, A., Myburgh, J., Billot, L., Lo, S., Finfer, S., & CHEST Management Committee. (2013). Fluid resuscitation with 6% hydroxyethyl starch (130/0.4 and 130/0.42) in acutely ill patients: systematic review of effects on mortality and treatment with renal replacement therapy. Intensive care medicine, 39(4), 558-568. doi: 10.1007/s00134-013-2854-7.

Ladha, K., Melo, M. F. V., McLean, D. J., Wanderer, J. P., Grabitz, S. D., Kurth, T., & Eikermann, M. (2015). Intraoperative protective mechanical ventilation and risk of postoperative respiratory complications: hospital based registry study. Bmj, 351, h3646. doi.org/10.1136/bmj.h3646

Ruscic, K. J., Grabitz, S. D., Rudolph, M. I., & Eikermann, M. (2017). Prevention of respiratory complications of the surgical patient: actionable plan for continued process improvement. Current opinion in anaesthesiology, 30(3), 399.

Scala, R., & Pisani, L. (2018). Noninvasive ventilation in acute respiratory failure: which recipe for success?. European Respiratory Review, 27(149), 180029. DOI: 10.1183/16000617.0029-2018

Schmidt, N. A., & Brown, J. M. (2014). Evidence-based practice for nurses. Jones & Bartlett Publishers.doi:10.1111/j.1365-2648.2011.05707.x

Semler, M. W., Janz, D. R., Lentz, R. J., Matthews, D. T., Norman, B. C., Assad, T. R., & Kocurek, E. G. (2016). Randomized trial of apneic oxygenation during endotracheal intubation of the critically ill. American journal of respiratory and critical care medicine, 193(3), 273-280. doi.org/10.1164/rccm.201507-1294OC

Stéphan, F., Barrucand, B., Petit, P., Rézaiguia-Delclaux, S., Médard, A., Delannoy, B., & Bérard, L. (2015). High-flow nasal oxygen vs noninvasive positive airway pressure in hypoxemic patients after cardiothoracic surgery: a randomized clinical trial. Jama, 313(23), 2331-2339.  doi:10.1001/jama.2015.5213

Veronovici, N. R., Lasiuk, G. C., Rempel, G. R., & Norris, C. M. (2014). Discharge education to promote self-management following cardiovascular surgery: An integrative review. Canadian Journal of Cardiovascular Nursing, 13(1), 22-31. doi.org/10.1177/1474515113504863

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