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Nursing Essay On Perioperative Nursing Care

Question

Task:
This nursing essay case review requires you to select a patient of interest to you that you have cared in your workplace that has undergone orthopaedic surgery.

In your essay, explore the patient’s clinical episode by introducing the patient and the rationale for selecting them. You will then outline your nursing role; the clinical care you provided and delivered during the phase of care related to your nursing role. Throughout your essay: case review, you are to provide a critical analysis about the patient care provided, based on current peer reviewed literature and contemporary perioperative nursing evidence.

Answer

Introduction
As per the research on nursing essay, it is specified that World Health Organization has taken consideration towards different regional as well as global initiatives in order to ensure safe surgical processes throughout the globe. WHO's Second Global Patient Safety Challenge "Safe Surgery Saves Lives" focuses on ensuring safety procedures and practice in case of surgical care. It is so because, with the increasing case of operative conditions in today's world, the surgical setting has been provided with greater importance in health care organizations (World Health Organization, 2021). Orthopedics is known to be one of the significant and essential departments in terms of clinical care which focuses on multiple factors such as physiology, anatomy as well as pathology of the musculoskeletal system of the human body. It is also known to have a major contribution in assessing the effectiveness of the application of different treatment and management procedures using drugs, physics as well as surgery to sustain normal functioning and physiology of the system (Lv & Yang, 2021). In the field of orthopedics, perioperative nurses have been playing a major role in the process of successfully performing the treatment and care involved with the human musculoskeletal system. Perioperative nursing is a field of nursing that has a significant role in addressing and nursing patients who need to be operated on or are going to undergo any kind of invasive treatment procedure. They have a chief role in working in collaboration with orthopedic surgeons, nurse anesthetists, nurse practitioners, anesthesiologists as well as surgical technologists (Gumus et al., 2020). Among the registered Scrub Scout nurses, the instrumental perioperative nurses have known to be essential in initiating better movement and recovery of the skeletal and muscular system before and after the surgical process. Thus, focusing on the above-mentioned information, the assessment will focus on evaluating the significant care and treatment delivered by the effective role of perioperative instrumental nurses to a patient suffering from femoral neck fracture due to osteoarthritis.

Discussion:
The assessment focuses on a patient, XYX a 59 years old woman, who has sustained a femoral neck fracture and had a history of osteoarthritis. XYX has been seeking treatment for osteoarthritis for the last few months, though suddenly reported to sustain a hip fracture due to a major fall. She lives alone since her husband died in the year 2011 and is self-depended in terms of care and economic support. The patient with femoral neck fracture and history of osteoarthritis has been selected for the condition of the assessment where perioperative nursing will be provided to the patient to sustain better care and treatment outcome. She has been suffering from severe pain, a disability to carry out any activity, and disrupted mobility. Thus, the patient has been appointed to perioperative nursing before proceeding with total hip replacement surgery. The patient has a medical history of heart attack, diabetes, hypertension as well as depression for which she has been seeking care and taking prescribed medications.

Rationale:
Hip fracture has been developing a major humanistic as well as societal cost throughout the globe. Similar to the prevalence of myocardial infarction in the case of adults above the age of 80, the prevalence of femoral neck fracture has also been increasing in the elderly population and has become a major threat to public health (Veronese & Maggi, 2018). Focusing on the condition of hip fracture and the condition of osteoarthritis, the case of the patient has been selected as, in such cases hip replacement and perioperative care is highly recommended to ensure a better patient outcome. Hip replacement is known to be performed in the highest frequencies when compared to any other type of operation, hip replacement surgery has a significant role in initiating life alerting changes in the case of a patient with hip and knee fracture (Dissanayake & Wijesuriya, 2015). In order to assess the significance of perioperative nurses, their role in orthopedics as well as patience care , the selection of the case was quite appropriate to the current issue. During femoral neck fracture and total hip replacement, the perioperative nurses possess a major role in developing an effective relationship with the suffering patient in order to prepare and assist the patient be for sustaining the surgical process (Chammout et al., 2017). The perioperative nurses have a vital role in educating, ensuring safety as well as advocating the patient effort in the surgical process to sustain better physical and cognitive health (Minty-Walker et al., 2020).

The chief reason behind recommending the patient for total hip replacement surgery involves the condition of femoral neck fracture with common involvement of osteoarthritis. Hip fracture and osteoarthritis are the two frequently occurring musculoskeletal diseases that are known to increase the societal as well as a global burden (Ackerman et al., 2017). The condition of osteoarthritis develops when the cartilage present in the surface of the joint sometimes known by the term articular cartilage or hyaline cartilage starts wearing away. In such conditions, only the raw bone present below the cartilage gets exposed to the bone present in a similar end. The functions of the cartilage are to act as a bearing joint or pad between two bones which is slicker in nature (Chow & Chin, 2020). In the case of osteoarthritis, as the cartilages are worn away, the joints tend to sustain a rough outer surface which leads to joint stiffness and severe pain. It led to difficulty in the mobility of the joints causing disability and pain. When the condition occurs in the joints and bones present in the hip, it causes severe pain, joint deformity as well as joint stiffness which often leads to femoral neck fracture in cases where the injury is sustained (Hawker, 2019). Thus, the condition explains the urgent need for surgical procedures where often total hip replacement is recommended in order to reduce pain and stiffness. It helps in regaining the ability to move, walk as well as carry out other activities in life. Total hip replacement is thus necessary in case of several other orthopedic issue such as rheumatoid arthritis and many more.

One perioperative nursing role:
Focusing on the case study of the patient with a femoral neck fracture, it is necessary to assist the patient with a perioperative nurse before proceeding with the total hip replacement surgery. Perioperative nurses are designated to provide treatment and care to patients before and after the patient undergoes surgical or invasive procedures. These nurses have a wide range of advanced roles in the surgical department which accounts for anesthetic, instrumental, or scrub nursing, circulating as well as recovery care (Robinson et al., 2021). Instrumental nursing is one of the primary responsibilities of perioperative nurses where they tend to provide the surgical team and the patient with required supplies and tools in order to lead a successful surgery and patient recovery. They focus on keeping the tools, instruments, and supplies used before, during, and after surgery sterile and functional in order to ensure that the care and surgery are appropriate enough to sustain better recovery (Boney et al., 2015). They tend to have a vigilant role in assessing and identifying the change in the condition of the patient, complications during the intra-surgical phase as well as the response of the patient to care and treatment. Scrub nurses are often known as instrument nurses as they focus on assessing and evaluating the function and cleanliness of the tools and instruments in the perioperative and postoperative phases. They tend to have a significate role in responding and assisting the patient and the health care professionals effectively and instantly on request in order to manage the operative phase with better outcomes (Jones, 2018). The safety and betterment of the patient roles on the hand of Scrub perioperative nurses as they tend to assist the patient before, during, and after surgery and ensure no complication or risk of infection is functioning near the patient (Markström et al., 2020). Thus, XYX is assisted by a scrub nurse to ensure that she is free from any risk relating to trauma or stress associated with fracture and surgery. It has been found that often stress due to fracture or injury, fear of surgery, all together increase the risk of complications in health such as heart attack, chest infection as well as stroke. In the case of a fractured neck of the femur, the risk of thromboembolism is high. Thus, it explains the need for a scrub nurse to assist the patient XYX with proper sterilization and assistance to avoid such risk factors. Scrub nurses in perioperative nursing facilities are also known to be registered nurses who have multiple roles of assisting surgical procedures, day surgery, ambulatory care, private care, and many more. Thus, focusing on the patient XYX, the scrub nurses have a significant role in assisting the patient as well as preparing the surgical room with the necessary instruments and tools that will be required to carry out the total hip replacement surgery. The nurse will make sure that the patient before surgery is properly kept under cleanliness and supervision to avoid any risk of complication as well as assist her to the operation theatre with effective communication, advocacy as well as guidance (Klingler et al., 2021). The perioperative nurse will guide the professionals with effective communication and knowledge relating to the patients' health condition, vitals, and necessary tools used for the nursing producer or total hip replacement (Walker et al., 2013).

Key issues: Thromboembolism related to hip fracture
Venous thromboembolism (VTE) is one of the potential risk factors associated with the perioperative phase which impacts patient’s mobility, health care cost as well as the rate of mortality. It is known to be an effective yet preventable complication related to the phase of peri and post-operative care (Klok et al., 2018). Venous thromboembolism (VTE) is known as a health complication where deep vein thrombosis, as well as pulmonary embolism, occurs at the same time. It occurs when blood clots form within the deep veins of the thigh, lower leg, and pelvis causing deep vein thrombosis, and later the cloth breaks and with the help of the bloodstream reaches the lungs causing a pulmonary embolism (Martín et al., 2020). The patient XYX has been provided with perioperative nursing care as she sustains the greater risk of sustaining venous thromboembolism. It is found that the risk of suffering from venous thromboembolism (VTE) increases in the case of patients who have witnessed a major surgical procedure or sustains a fracture or injury. Also, patients with a history of heart attack, cancer, and heart failure also sustain similar risk factors. As the patient sustains a history of cardiac issues, diabetes, and heart attack, along with the current state of femur neck fracture and osteoarthrosis she has the greater chances of witnessing Venous thromboembolism (VTE) (Goel et al., 2018). The major signs and symptoms of venous thromboembolism (VTE) increases pain, redness as well as swelling. In the case of Venous thromboembolism (VTE), the patient before or after surgery might sustain severe pain and shortness of breath which often makes the condition of the peri and post-operative phase complicated and risk-prone (Zeng et al., 2020). Thus, it explains the need for a significant perioperative care for patient XYX with the risk of venous thromboembolism (VTE) as oaten with hip fracture are consecutively at higher risk of sustains complications such as Venous thromboembolism (VTE) which increases the rate of morbidity and mortality in such cases (Mula et al., 2020).

Perioperative nursing role:
There are multiple and critical roles and responsibilities that are provided to the perioperative nurses in the field of surgical care and setting. These duties tend to support the patients as well as professionals with executing better care and treatment to ensure effective patient recovery. One of the main roles executed by the perioperative nurses is to measure, plan, implement, execute as well as evaluate the care and treatment attained by the patient before, during, and after the operative phase (Hertel-Joergensen, Abrahamsen & Jensen 2018). According to standard 1 for perioperative nurses of the Nursing and Midwifery Board of Australia, it is the role and duty of the perioperative nurses to critically think and assess nursing role and practice and deliver it to the patients accordingly (NMBA, 2021). These nurses also pose a complex role to assist and guide the health care professionals and surgical team with the medical history, vital signs, diagnosis, and other related information in order to maintain the efficacy of the care and treatment provided. They also focus on managing and maintaining the functioning and efficacy of the equipment used before, during, and after surgery (Grant et al., 2019). According to the standard 3 and 4 for perioperative nurses of Nursing and Midwifery Board of Australia, it is the role and duty of the perioperative nurses to maintain the fair capability for conducting effective nursing care and participant in group activities as well as carry out health assessments comprehensively for the betterment of the care and treatment outcome (NMBA, 2021). They have known to possess the role of a bridge between the care provider, the patient, and the family of the patient as they form a connection between these stakeholders and ensure working as a team to sustain effective health recovery. According to standard 7 for perioperative nurses of Nursing and Midwifery Board of Australia, it is the role and duty of the perioperative nurses is to focus on evaluating patient needs, and treatment outcomes and involve a team where the patient is the stakeholder are guided about the proper nursing practice, treatment procedure and recovery options to the patient before and after operation and discharge (NMBA, 2021). They are also known to serve as a physiological, emotional and psychological care provider for the patient as build their strength and emotional welling to sustain the fear and trauma of surgery. Also, the Australian College of Perioperative Nurses (ACORN) functions within the premise of the health care organization of Australia focuses on guiding and assisting the perioperative nursers with proper care and treatment practices to ensure better reviver of the patients (ACORN, 2021). These standards have been guiding the nurses with the ethics, values, and nursing practices that they need to maintain within their roles to make sure that the health care organization witnesses better patient recovery and satisfaction.

Conclusion:
After completion of the assessment based on the necessary role of perioperative nurses in orthopedic cases, it has been found that nursing in the case of surgical care is one of the complex roles for the care and treatment facilities. The assessment helps in understanding the rinsing issue of fracture and the need for total hip replacement in today's world. It has been found that operative procedures are one of the complex treatment measures provided to patients and thus require assistance and supervision of skilled nursing facilities. Thus, perioperative nurses have been provided with the responsibility to assist patients and health care teams in the surgical ward. It has been found from the case assessments that the complex and versatile role and responsibility displayed by these nurses help in conducting a successful operative procedure as well as minimize the risk of further complications. It has also been evaluated that patient with hip fracture explains the need of perioperative nursing assistance as they are at higher irks of witnessing thromboembolism which often leads to morbidity and mortality.

References:
World Health Organization. (2021). Safe surgery. Who.int. Retrieved 11 August 2021, from https://www.who.int/teams/integrated-health-services/patient-safety/research/safe-surgery.

Lv, H., & Yang, N. (2021). Clinical effect of application of nursing concept of rehabilitation surgery for improvement of quality of postoperative recovery in orthopedics. Journal of Orthopaedic Surgery and Research, 16(1), 1-7.

Dissanayake, M., & Wijesuriya, N. (2015). Audit of perioperative management of patients with fracture neck of femur. Sri Lankan Journal of Anaesthesiology, 23, 17-21.

Gumus, K., Akbuga, G., Bahceli, A., & Oral, S. E. (2020). Are Surgical Nurses Aware of Up-to-Date Perioperative Care Practices?. International Journal of Caring Sciences, 13(3), 2014.

Minty-Walker, C., Donohoe, P. L., Hadlow, S. E., & Wilson, N. J. (2020). Perioperative nursing. In Nursing in Australia (pp. 67-77). Routledge.

Robinson, A., Slight, R. D., Husband, A. K., & Slight, S. P. (2021). Designing the Optimal Digital Health Intervention for Patients' Use Before and After Elective Orthopedic Surgery: Qualitative Study. Journal of medical Internet research.

Markström, I., Bjerså, K., Bachrach?Lindström, M., Falk?Brynhildsen, K., & Hollman Frisman, G. (2020). Operating room nurses' experiences of skin preparation in connection with orthopaedic surgery: A focus group study. International Journal of Nursing Practice, 26(5), e12858.

Grant, S., Blom, A. W., Craddock, I., Whitehouse, M., & Gooberman-Hill, R. (2019). Home health monitoring around the time of surgery: qualitative study of patients’ experiences before and after joint replacement. BMJ open, 9(12), e032205.

Boney, O., Bell, M., Bell, N., Conquest, A., Cumbers, M., Drake, S., ... & Metcalf, L. (2015). Identifying research priorities in anaesthesia and perioperative care: final report of the joint National Institute of Academic Anaesthesia/James Lind Alliance Research Priority Setting Partnership. BMJ open, 5(12), e010006.

Jones, A. (2018). A Perioperative Journey: Hello and Goodbye.

Hertel-Joergensen, M., Abrahamsen, C., & Jensen, C. (2018). Translation, adaptation and psychometric validation of the Good Perioperative Nursing Care Scale (GPNCS) with surgical patients in perioperative care. International journal of orthopaedic and trauma nursing, 29, 41-48.

Walker, C., Esquieres, E., Fowler, S. B., & Tennaro, S. (2013). The perioperative Magnet journey at one specialty hospital. AORN journal, 98(5), 525-531.

Veronese, N., & Maggi, S. (2018). Epidemiology and social costs of hip fracture. Injury, 49(8), 1458-1460.

Chammout, G., Muren, O., Laurencikas, E., Bodén, H., Kelly-Pettersson, P., Sjöö, H., ... & Sköldenberg, O. (2017). More complications with uncemented than cemented femoral stems in total hip replacement for displaced femoral neck fractures in the elderly: a single-blinded, randomized controlled trial with 69 patients. Acta orthopaedica, 88(2), 145-151.

Ackerman, I. N., Bohensky, M. A., de Steiger, R., Brand, C. A., Eskelinen, A., Fenstad, A. M., ... & Garellick, G. (2017). Lifetime risk of primary total hip replacement surgery for osteoarthritis from 2003 to 2013: a multinational analysis using national registry data. Arthritis care & research, 69(11), 1659-1667.

Chow, Y. Y., & Chin, K. Y. (2020). The role of inflammation in the pathogenesis of osteoarthritis. Mediators of inflammation, 2020.

Hawker, G. A. (2019). Osteoarthritis is a serious disease. Clin Exp Rheumatol, 37(Suppl 120), 3-6.

Klingler, J. H., Scholz, C., Hohenhaus, M., Volz, F., Naseri, Y., Krüger, M. T., ... & Hubbe, U. (2021). Radiation Exposure to Scrub Nurse, Assistant Surgeon, and Anesthetist in Minimally Invasive Spinal Fusion Surgery Comparing 2D Conventional Fluoroscopy With 3D Fluoroscopy-based Navigation: A Randomized Controlled Trial. Clinical Spine Surgery, 34(4), E211-E215.

Klok, F. A., Barco, S., Turpie, A. G., Haas, S., Kreutz, R., Mantovani, L. G., ... & Ageno, W. (2018). Predictive value of venous thromboembolism (VTE)?BLEED to predict major bleeding and other adverse events in a practice?based cohort of patients with VTE: results of the XALIA study. British journal of haematology, 183(3), 457-465.

Martín, A. M., Díaz, E. G., Escobar, I. G., Montero, R. M., Martínez-Marín, V., Olmos, V. P., ... & Fernández, M. S. (2020). SEOM clinical guideline of venous thromboembolism (VTE) and cancer (2019). Clinical and Translational Oncology, 22(2), 171-186.\

Mula, V., Parikh, S., Suresh, S., Bottle, A., Loeffler, M., & Alam, M. (2020). Venous thromboembolism rates after hip and knee arthroplasty and hip fractures. BMC musculoskeletal disorders, 21(1), 1-7.

Goel, R., Patel, E. U., Cushing, M. M., Frank, S. M., Ness, P. M., Takemoto, C. M., ... & Tobian, A. A. (2018). Association of perioperative red blood cell transfusions with venous thromboembolism in a North American registry. JAMA surgery, 153(9), 826-833.

Zeng, C., Bennell, K., Yang, Z., Nguyen, U. S. D., Lu, N., Wei, J., ... & Zhang, Y. (2020). Risk of venous thromboembolism in knee, hip and hand osteoarthritis: a general population-based cohort study. Annals of the rheumatic diseases, 79(12), 1616-1624.

NMBA. (2021). Lo.unisa.edu.au. Retrieved 11 August 2021, from https://lo.unisa.edu.au/pluginfile.php/580202/mod_resource/content/3/Uni%20SA%20Perioperative %20NCAS%20Reference%20Guide1.pdf.

ACORN. (2021). Retrieved 11 August 2021, from https://www.acorn.org.au/standards/.

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