Care Of The Patient In Recovery Inadvertent Hypothermia Case Nursing Essay

Care Of The Patient In Recovery Inadvertent Hypothermia Case Nursing Essay Before the author can discuss hypothermia in regards to the patient above they must first review how the body regulates heat control within the body. Many sources, give varying definitions of what normal body temperature or normothermia is. For example Marieb (2004) defines this as a core temperature range from 35.6 °c and 37.8 °C. Meanwhile Kiekkas and Karga (2005) defined the normal temperature range of adult patients as between 36.5 °C and 37.5 °C. National Institute for Health and Clinical Excellence (NICE) 2008 guideline for the management of inadvertent perioperative hypothermia agree with this definition. Core temperature, defined by Kiekkas and Karga (2005), is the blood temperature of the central circulatory system, which can be measured for example at the pulmonary artery, rectum or via the tympanic membrane, which occurs in recovery at Hospital x. The hypothalamus is the central organ that acts as the bodys heat promoting and heat loss centre, then brains thermoregulatory centre. Body temperature is kept stable and regulated with the help of blood. The neuronal centre in the posterior hypothalamus is triggered when there is a decrease in temperature in the blood or the external temperature is low. Mechanisms for heat conservation and heat production are triggered such as, shivering, which is the bodys natural response to cold, constriction of blood vessels in the skin and increased metabolic activity to produce energy (Hatfield and Tronson, 1996; Marieb, 2004). As with the varying definitions of normothermia, there are also differing definitions in hypothermia. NICE (2008) guideline defines hypothermia as a core temperature of less than 36 °C. Similarly several authors agree with this definition, Aikenhead et al (2007), American Society of Peri Anesthesia Nurses (ASPAN) (2009); Clarke and Clark , 1997). Meanwhile Kiekkas and Karga state, hypothermia as a core temperature of more than 1 (standard deviation) less than the mean value under resting conditions in a thermoneutral environment (Kiekkas 2005, p444) There are 4 ways in which the body loses heat; conduction, convection, evaporation and radiation. Talk about these briefly! There are patients who are more at risk of developing hypothermia these include; older and younger patients. The size of the patient: thin, due to the lack of tissue mass and obese, due to the large surface area. The type of procedure: open thoracic, abdominal, gynaecological or genitourinary. Patients having a combined general and spinal anaesthesia (Welch, 2002) Patient A falls into some of these categories, because of the type of surgery, age and anaesthesia she will be having. As part of the pre operative check in Patient A was asked the last time she had eaten, this was 12 hours before the procedure. Advice of fasting for 6 hours plus is given to patients to prevent nausea and vomiting during and after the induction of anaesthesia, as this along with the spinal causes the constriction of the abdomen and stomach. This in turn deprives the body of the metabolic system of energy it needs from food digestion (Cobbold Money 2010; McNeil, 1997). Following administration of Propofol and Remifentanil via a TIVA syringe pump, the patient was intubated with a size 7 endotracheal tube. Anaesthetic medications such as those given to Patient A; Propofol, depress the central nervous system which mean the hypodermic thermoregulatory centre function is decreased. This occurs as there is an increase in conduction and radiation to the peripheral points of the skin, where heat loss is at most, as the skin has a large surface area. This loss of heat is difficult to manage after anaesthesia has been administered as heat distribution, which is the increase in peripheral temperature and a decrease of core temperature has taken place (Kiekkas Karga, 2005; Sasad Smith, 2000). With her airway secured, Patient X was positioned for the administering of a spinal. Her back was exposed and sprayed with chlorhexidine gluconate solution, for pre operative skin disinfection (BNF, 2008), a cold solution thus further contributing to the decrease in Patient As body temperature, via evaporation (Bellamy, 2007). The effect of administering Diamorphine and Marcain Heavy ® is that it causes the sympathetic nervous system to be compromised as vasodilatation occurs (Fallacaro et al, 1986). Patient A was taken into theatre, where the ambient temperature as recorded by the author was 21 °C, reason for the temperature being so low is to minimise the growth of bacteria. However such a low temperature would affect Patient A as her body temperature will vary according to the environments conditions (Bellamy, 2007). McNeil (1998), advocates that the temperature in theatre should be raised from 21 °C to 24 °C to maintain Patient As core temperature, which unfortunately was not taken until the procedure in the operating had started. Whilst the author agrees with the later point so that the patients temperature is taken into consideration, they have to agree with Bellamys (2007) point on minimising bacteria production. Patient A was exposed for catheterisation and for the Bair Hugger ® to be positioned. This is a forced air system used in Hospital X, which several sources agree, is the best form of preventing inadvertent hypothermia (Hegarty et al, 2009; NICE Guidelines, 2008; Welch, 2002). This was however switched on at 36.5 °C after Patient A had been prepped and draped. Fluids were firstly administered to Patient A in the anaesthetic room at room temperature; they were then transferred into a warming coil at a temperature of 37 °C. Whilst the NICE (2008) guidelines recommend warm fluids are administered in the operating room at the temperature stated, the author feels that warm fluids should have been started in the anaesthetic room. The monitoring of Patient As temperature occurred after draping and prepping, it was measured using an oesophageal temperature probe as this measures the core temperature accurately and documented every 15 minutes (Al-Shaikh and Stacey, 2002; NICE, 2008). NICE (2008) recommends that temperature of a patient should be 36 °C before a procedure should proceed, the temperature of Patient A on arrival to the anaesthetic room was not taken and the first temperature in theatre was 35.6 °C increasing to 36.0 °c at the end of the procedure. After the procedure, which had no surgical complications and Patient A was extubated, she was transferred to recovery where the tympanic temperature; which is associated with the brain temperature therefore reflects the core temperature (Al-Shaikh and Stacey, 2002), was taken in recover 10 minutes after the patient arrived and was recorded to be 35.4 °C. Handover to the recovery personnel included patients name, date of birth, procedure, what drugs had been administered and the anaesthetist made an emphasis on the patients temperature which they wanted to make sure was up to at least 36.0 °c before the patient was transferred to the ward, part of the NICE (2008) guidelines. Standard recovery monitoring including Oxygen saturation, electrocardiogram and blood pressure results were constantly observed, with results being documented every 15 minutes. The effects of hypothermia are not known until the patient comes into recovery for some time as the effects are masked by the anaesthetic drugs given to Patient A. (Kiekkas et al, 2005). To prevent this a Bair Hugger was placed on Patient A to continue the warming cycle. There are many complications associated post operatively with hypothermia, the most common is post anaesthetic shivering, which is an involuntary muscular activity. This is bought on by the body returning to normal Delayed emergence, where the metabolism of drugs is decreased, as it makes it more difficult for the anaesthesia to be reversed due to the hepatic and renal functions being impaired. Add liver metabolism of drugs to this section Pressure sore development Blood clots clotting cascade, platelets do not work increased bleeding Discharge criteria Patient A woke up fully after 20 minutes in the PACU with no complaints of pain, sickness or nausea but thirst. Her temperature was taken again and this was found to be 35.8 °C, a marked improvement on her original recovery temperature. Before the patient is transferred to the ward what scale used observations etc? Urine output from catheter Sats BP

The Joy of Overcoming Pain :: Personal Narrative Essay Example

The Joy of Overcoming Pain Propelled forward by my surging leg muscles, sweat gushing down my face, the harsh reality of this 50-mile bike race has begun to invade my body. My eyes remain intensely focused straight ahead: Grinding away along the racecourse, I see five girls from a different team about 200 yards ahead of me. My team needs a contribution from me, I realize, and I make the decision to pass all three of them. Through the heat rising off the asphalt I can finally see the distant white line proclaiming the finish. My mind propels my legs to their maximum ability. In these last few seconds of exertion, the years of hard work are paying off. Soaring through the finish, I have achieved flight. Biking is a pure sport, requiring little more than a brain ready to conquer pain. It is a sport that calls for commitment and mental toughness. Through testing myself, I increase my resilience and grow stronger. I unleash the power of my mind, and I bike. Some people are born with great biking ability, and others, like myself, are born with the desire to excel at every challenge. I've become the best biker I can through hard work and dedication. Challenging myself with new goals every day, I bike against the forces of gravity and inertia. I love the thrill of competition -- the euphoric feeling I get when mind overcomes pain. As a four-year member of my high school biking team, I have experienced just about every physical infirmity that comes from biking. I have dealt with shin splints, biker's knee, broken toes, and pulled calf mussels. My orthopedic surgeon took one look at my legs and admitted that I'm "not built to be a biker." Yet, I chose to continue biking because of its daily challenges and rewards. I've learned from this sport that by focusing single-mindedly on achieving a goal, I can make any obstacle trivial. I still hear my coach's voice in my head: "If you sacrifice yourself, good things will happen." As much as a bike race requires individual strength physically and mentally, it also requires a team effort to succeed. Like sisters in a family, the girls I bike with understand and respect one another. We remind each other to work harder, eat right, and to accomplish the most we can.

Learning Team New System Proposal Essay

Develop a 3,500- to 4,200-word paper and a Microsoft ® PowerPoint ® slide presentation of the project, due in Week Five. The paper must include the following:  · A full description of the new system, a description of its components, and the benefit it will provide to Riordan  · A discussion of the business requirements driving the need for the system  · A discussion of the information used in the system  · A discussion of any information security and ethical concerns with the system  · A diagram of the information flow and any elements controlling proper access to the information it uses  · A description of any proposed business process changes for the system  along with flow diagrams  · A specific discussion on any Internet and mobile access components of the system  · A description of how specific business requirement would drive the project’s creation and use  · A high-level discussion of how the system will be acquired and maintained  · A discussion of the strategic role the system will play in the company  · An executive summary of the project, succinctly summarizing the rest of the material in the paper  · Four to six references In Week 2, submit the following for grade: Work on your proposal for the new system. . Identify a specific system that would help improve Riordan’s business. Define the system’s business requirements. Discuss of the info†¦ Click this link Now for Complete Course – https://bitly.com/12BkmoW Avoid handing in the first draft of your paper. Make the necessary revisions before turning it in. Write another version of it, rather than just proofreading it. Then, proofread this draft and make any needed changes. This will help you turn in the best paper possible. Computer Science – General CS Learning Team New System Proposal The following is due at the end of Week 5: Propose a new system for Riordan to use to improve its business. Develop a 3,500- to 4,200-word paper and a Microsoft ® PowerPoint ® slide presentation of the project, due in Week Five. The paper must include the following:  · A full description of the new system, a description of its components, and the benefit it will provide to Riordan  · A discussion of the business requirements driving the need for the system  · A discussion of the information used in the system  · A discussion of any information security and ethical concerns with the system  · A diagram of the information flow and any elements controlling proper access to the information it uses  · A description of any proposed business process changes for the system along with flow diagrams  · A specific discussion on any Internet and mobile access components of the system  · A description of how specific business requirement would drive the project’s creation and use  · A high-level discussion of how the system will be acquired and maintained  · A discussion of the strategic role the system will play in the company  · An executive summary of the project, succinctly summarizing the rest of the material in the paper  · Four to six references In Week 2, submit the following for grade: Work on your proposal for the new system. . Identify a specific system that would help improve Riordan’s business. Define the system’s business requirements. Discuss of the information used in the system and any information security and ethical concerns with the system Format your paper and presentation consistent with APA guidelines. Submit a 700- to 1,050-word section of the paperwith the following:  · A full description of the new system, a description of its components, and the b†¦

Differences Between High School And College - 936 Words

There are many distinct similarities and differences between high school and college. Through academics, motivation, independence, distractions, and relationships, the transition from high school to college is a real eye opener for more students. In high school people would only talk to their â€Å"assigned† social group. There was no in between. When someone saw someone from their clique talking to a girl they didn’t like, that’s when drama would occur, as in people would get in their cliques and talk about you in a mean way.. Drama also occurred when people would spread rumors to one another, and of course everyone always believed whatever they heard. High school was one of those childish phases in life, it’s like no one could speak for themselves. Back in high school, you couldn’t even walk alone in the hallway and not feel like you were being judged. People were just so mean and arrogant. All you could feel were eyes just starring at you as you walked across the hallway to your next class, not mentioning that you could hear every word they were saying about you. Everyone lived close together in high school, about a 10-mile radius from one another. This was actually quite nice for when we would meet up with friends to hangout. Plus it was very convenient for all of us to easily figure out where we wanted to go, since we all lived fairly close together. Back in the day, Fairfax Corners was always the number one place to hangout at. When it comes to academics, in highShow MoreRelatedDifferences Between High School And College909 Words   |  4 PagesThe transition from high school to college is a process that can help students to improve themselves and be more independent. Therefore, they would know what they have to do to achieve their goals and learn how to deal with the time that they have. 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