A Laparoscopic Cholecystectomy Was Indicated Nursing Essay

A Laparoscopic Cholecystectomy Was Indicated Nursing Essay Cholecystitis is defined as an inflammation of the gallbladder caused most commonly by the obstruction of the cystic duct Bloom et al., 2012. The gallbladder is a small organ located under the liver that plays a major role in the digestion of fat (Balentine, 2012). Normally bile and digestive enzymes pass out of the gallbladder on their way to the small intestine. If this flow becomes blocked, it will build up inside the gallbladder, causing swelling, upper abdominal pain, and gallstones resulting in liver dysfunction (Bloom et al, 2012; Mackillop Williamson, 2010). Gallstones are solid particles that are formed from bile (Balentine, 2012). Common risk factors in the formation of gallstones include being female of childbearing age, overweight, certain medications such as birth control pills or statins, rapid weight loss, poor dietary habits and pregnancy (Ali, Cahill, Watson, 2004; Balentine, 2012; Mackillop Williamson, 2010). Gallstones can block the outflow of bile and digestive enzymes from the pancreas. If this blockage persists, the gallbladder can become inflamed causing cholecystitis (Balentine, 2012). The initial treatment of cholecystitis includes bowel rest, intravenous hydration, analgesia and antibiotics (Bloom et al., 2012). Outpatient management may be suitable however if surgical treatment is indicated, laparoscopic cholecystectomy represents the gold standard of care (Bignell et al., 2011; Chowbey et al., 2010; Farkas et al, 2012; Tsimoyiannis et al., 2009). In the diagnostic process for surgical interventions an ultrasound scan may be performed however magnetic resonance cholangio-pancreatography (MRCP) is the diagnostic preference for gallstones (Mackillop Williamson, 2010). MRCP is a non-invasive technique used for viewing the bile and pancreatic ducts and gallbladder using magnetic resonance imaging (MRI) (Mackillop Williamson, 2010). Laparoscopic cholecystectomy requires gas to be administered into the peritoneal cavity and thus routinely requires general anaesthesia with intubation (Sherwinter, 2011). The advantage of laparoscopic cholecystectomy results from preserving the integrity of the abdominal wall which reduces operative trauma and complications. It also has been shown to have a greater recovery time decreases postoperative pain and the need for postoperative analgesia, shortens hospital stay and returns the patient to full activity within 1 week (Sherwinter, 2011; Tsimoyiannis et al., 2009). For the operation anaesthesia was induced with fentanyl, midazolam, propfol and rocuronium. Tracheal intubation was facilitated with suxamethonium. Anaesthesia was maintained with a propofol infusion accompanied with a nitrous oxide and oxygen ventilation. Mrs Smith was also given 4mg of ondansetron before the end of surgery for the prevention of post-operative nausea and vomiting and was administered bupivacaine into all trocar wound sites. At the conclusion of the surgery Mrs Smith was administered glycopyrrolate and neostigmine to antagonize the residual neuromuscular blockage and pain relief was given via fentanyl pain protocol. After induction of anaesthesia Mrs Smith was positioned in the reverse Trendelenberg with the right side of the table elevated. Abdominal insufflation was achieved with CO2 and intra-abdominal pressure was maintained at approximately 13 mm Hg (Gupta et al., 2007; Shora et al., 2008; Tsimoyiannis et al., 2009). Intra operative monitoring included electroencephalogram (EEG), pulse oximetry, blood pressure and heart rate via arterial line, and temperature (MacKay, Sleigh, Voss Barnard, 2010; Shora et al., 2008) One clinical issue related to Mrs Smiths perioperative care is strategies to avoid wrong-site surgery. Safe surgery is a world-wide recognised issue (WHO, 2009). Healthcare and surgical care provision encompass such a degree of variation and complexity that it involves an increased risk of errors (Weiser et al., 2010). These increased risks are due to multifaceted issues of human error where there is a breakdown in communication or processes (Brady, 2009). The WHO Surgical Safety Checklist is designed to enhance both communication and teamwork and to safeguard that healthcare professionals deliver evidence based patient care (Anderson 2009). The surgical safety checklist identifies three phases of an operation; the sign in time out and sign out. Each point corresponds to a specific period in the normal flow of work. A checklist coordinator, usually the circulating nurse, ensures that the surgical team has completed the listed tasks before continuing onto the next phase (WHO, 2008) The sign in period is before the induction of anaesthesia (WHO, 2008). This is where the patient confirms to operating room staff, their identity, type and site of operation (in their own words), and confirms their approval for the procedure by acknowledging their signature on the consent form. The anaesthesia safety check is also completed within this phase. This check asks questions relating to allergies, make-up or nail polish, dentures or prosthesis, time bladder last emptied and the time that the last food and fluid where consumed. It likewise checks identification band, and whether the operative site has been marked by doctor (Queensland Health, 2011). The sign in phase allows for the checklist to not merely be a to do list. It ensures that important safety identifiers have been checked and collated correctly (Karl, 2009). It permits a logical and systematic approach aligning with the organizations values, highlighting patient safety and recognising individual roles in ensuring patient safety within the multidisciplinary partnership. This phase also emphasises an institutions regulatory requirements that essentially improves patient care (Conley et al, 2011). The second phase is the time out. This occurs before skin incision (WHO, 2008). Operating staff actively confirm differing team members roles. The surgeon, anaesthesia professional and nurse verbally confirm the patient, type and site of the operation to be performed and visually check for a valid consent. For the nursing team it is also a time to review sterility and equipment (WHO, 2008). Brady (2009) reports that wrong site surgery is the second highest among all sentinel events recorded. He attributes faulty communication and organizational culture as factors contributing to sentinel events and endorses strategies such as surgical safety checklists, that increase the effectiveness of team functioning. The third phase of sign out is initiated before the patient leaves the operating room (WHO, 2008). The checklist coordinator confirms with the team the name of the procedure recorded, that the surgical count is correct, the specimen is labelled accurately and if there were any equipment problems needing to be addressed (WHO, 2008). This period again emphasises improved communication among surgical team members and thus quality of care (WHO, 2012). According to Kao and Thomas (2008, as cited in Jones, 2011) surgical errors such as wrong site surgery can be attributed to individuals as opposed to one individual. By this constant communication and clarification at certain time periods throughout an operation demonstrates improved communication where potential risks where minimised (Jones, 2011). Jones (2011) also claims that with the WHO checklist, interaction between team members have improved and potential risks minimised. Surgical safety checklists not only improve communication and teamwork, but also improve understanding of each others roles (Bell, 2010). This strategy can achieve massive reductions in complications and studies indicate that a checklist works because it is more than just a tick sheet. With the effective adoption it generally requires local system changes and a commitment to teamwork for safety (WHO, 2012). Checklists are acknowledged as an organised system for a safe ending to a task. Research has suggested that at least half of all surgical errors are avoidable (Weiser et al (2010). If used properly the WHO Surgical Safety Checklist, through effective teamwork and communication will result in the right patient, having the right procedure, at the right time in the right area (Donaldson 2008). Sherwinter, D. A. (2011). Laparoscopic Cholecystectomy. Retrieved from http://emedicine.medscape.com/article/1582292-overview Queensland Health (2011). Perioperative Patient Record. Retrieved from http://www.health.qld.gov.au/psq/pathways/docs/pre-op-check-a3-11.pdf

Let’s Be Lefties For a Day

The discussion of the importance of understanding cultural, ethnic, and gender differences by managers and professionals in a business setting begins with defining the key terms. Diversity is defined as â€Å"real or perceived differences among people that affect their interactions and relationships â€Å"(Bell, 2007). According to Week 1 lecture (SOCS 350, 2013), cultural diversity is defined as: â€Å"the existence of a wide variety of cultures and subcultures represented within a community†. This is evident in most work settings across the world. So how do I understand the importance and differences brought to the table by all of the different individuals? In our textbook Diversity in Organizations, it talks about Taylor Cox and Stacy Blake’s research studies on understanding diversity in the workplace. Their studies and explanations have been used in many textbooks and news regarding diversity. They explain how effective management of diversity can benefit organizations in the area of cost, resource acquisition, marketing, creativity, problem solving, and system flexibility. I agree that diversity can bring so much to a workplace. A personal experience of mine occurred at the community hospital near my hometown. The hospital had a predominantly low-income, African American population that used the emergency room. I was a young Caucasian woman who quickly became charge nurse for the night shift. During busy times, which occurs quite often in emergency rooms, I would be yelled at and even called racist if a white person was called back to a room first. I was lucky enough to have the benefit of the mayor of the predominantly African American community work as a LPN in the emergency room with me. He was an older African American, well known throughout the community, and very well respected. I could send him out to talk to unhappy patients because they took better to him, probably due to having the same ethnic/cultural background. He then explained things again and for some reason it was most often taken better, and proved I was not being racist and these are the policies that I followed. In the workplace though, especially a hospital setting, it is extremely beneficial to have all cultural backgrounds employed. Every patient that comes in is not going to be of the same ethnic or cultural background as you and sometimes like in my example it is easier to relate to someone with the same ethnicity. It is a beneficial skill for employees to understand different cultures to communicate effectively. Cox and Blake also proposed that â€Å"an organization’s reputation for valuing all types of workers will also affect its ability to market to different types of consumers. Consumers who appreciate fair treatment for everyone will be more likely to patronize an organization known to value diversity and to treat all workers fairly†. I truly believe that is accurate, and is shown to be proven accurate at my hospital. In our example in class using the ball and sock experiment, I learned how diverse America is. People do things a little bit different, and that is what makes us a culturally diverse country. Just because you do something right-handed and I do it left-handed does not mean I am doing it wrong. I am left-handed, and yes I have become ambidextrous also because of the predominantly right-handed population. This just shows me that people are able to adapt to change, and not one certain way, color, gender, race, age is better than another. There are numerous benefits to valuing diversity, especially in a business setting. With each unique combination of gender, ethnic background, culture, and life experiences, each person brings different sets of strengths, skills, and approaches to problems. I believe all businesses can benefit from a diverse body of talent bringing fresh ideas, perspectives, and views to the workplace.

History Argumentative Essay Topics - Is it a Scam?

History Argumentative Essay Topics - Is it a Scam? Understanding History Argumentative Essay Topics Unlike most of the students, an expert essay writer always studies the company essay topic before beginning their work. You're writing a particular sort of essay, so in case you stray from the particulars, you're risking to alter the intent of your paper, and that's unacceptable. The sort of essay you're looking for will be provided to you within the deadline provided to you. A narrative essay provides the writer the chance to share a story for a student, the introduction includes a definition of organization in regard to the topic. Thus, writing a history paper will definitely be fun, if you only choose a really intriguing history essay topic. A great collection historical analysis essay topic which is going to be suitable to anybody is difficult to find, because everyone has their own preferences. In the event you can't find your subject here, don't hesitate to have a talk with our staff and set an order for a customized history essay on your distinct subject. The student should investigate a topic, evaluate evidence, collect, generate, and set a standpoint on the subject in a powerful and concise way. The Downside Risk of History Argumentative Essay Topics So when you have an essay assigned that you will need help with, you can purchase essay online cheap from us. Consider this issue of the history essay you've already written before. If you would like to write a fantastic history essay you'd better select a topic that is familiar to you. If you have to compose a persuasive essay about the military an d don't know the best places to start, below is a list of topics to take into account. Don't forget that, exactly like with any other paper, there's a particular structure of a persuasive essay that you have to follow. There are a couple of straightforward guidelines to follow to be able to be in a position to compose a great persuasive essay. In order to give an in-depth understanding about the argumentative essay, it is advisable to take a look at some of the greatest examples of argumentative essay. Any superior task finishes with an amazing conclusion and the very best examples of the argumentative essay will arrive in with a conclusion with an overview of all of the points together with a gist of the evidences provided. Each writer ought to be in a position to process the info, gather the essential material and data to make an extensive assignment on argumentative essay topics. It is possible to even outline how you wish to present the ending of the essay. If you wish to compose the essay yourself, we believe it would be best to select a universal subject or issue. Before you commence writing your essay, you should study the sources applicable to the prospective subject, and make certain you have enough evidence to back up your thesis statement. If there's an event or a particular celebration in school, the speech topic you select ought to be about the importance of that particular event. English language classes usually want a lot of writing. There are lots of assortments of topics based on the subject you would decide to compose a paper. Though, make certain the topic you decide to write about is right for that specific class. You don't need to find super technical with legal argumentative essays, but make certain to do your homework on what the recent laws about your favorite topic actually say. If you should do a history project, you must come across an intriguing subject to be able to find the most grade. Yearly driving tests ought to be mandatory over a specific age. The Bad Side of History Argumentative Essay Topics Inspiration to make your own advertising or media argumentative essay topics isn't tough to discover. Writing argumentative essays requires a lot of time to finish, especially when you don't have an assigned topic. Picking the proper essay topic can at times be rather tough. The previous sentence of the essay needs to be inspiring and compelling.

Essay on Job Growth in the United States - 645 Words

The article I selected for my economics project is an intriguing article; which primarily focuses on job growth in the United States. The article is titled â€Å"Job Growth Quickens, But Don’t Expect Fast Fed Taper†. This particular piece was written by Andrea Riquier. The article was written earlier this month on December 6th, 2013 and was published on the website Investors.com. The article discusses job growth in the United States, and how in the recent weeks, the percentage of jobless Americans has actually improved slightly. The article reports that the jobless rate from October to December has dropped from 7.3% to a now 7%. A 7% jobless rate happens to also be a 5-year low for our nation. According to the article, because of the†¦show more content†¦This term is relevant to the article because job growth could potentially lead to a higher consumer confidence. The article reports, â€Å"auto sales are robust†, which indicates an increased con sumer confidence because people are purchasing cars. Cars are expensive and if auto sales are indeed robust, then that is a fairly positive sign for the economy and a strong indication of where consumer confidence is at this given time. Additionally, the article reports that manufacturing growth is at a 2- ½ year high and that home sales are rebounding. With job growth, it only makes sense that there is manufacturing growth going on as well. Manufacturing growth measures if companies are constructing products and the rate at which they are constructing those products. If manufacturing growth is increasing, then that means more products are being released to consumers, which could lead to a healthier economy. The results of manufacturing growth may lead to a healthier economy because since consumer confidence is booming, and companies are increasing their output of products, consumers will most likely purchase products and the result will be a healthier economy. Manufact uring growth and consumer confidence are two economic terms that when involved with each other, can create a very positive result. According to the article, because of the fact that the unemployment rate has aShow MoreRelatedTrade Deficit Grows As Strong Dollar Hurts Exports1280 Words   |  6 PagesTrade Deficit grows as strong Dollar hurts Exports. According to this article â€Å" trade deficit grows as strong Dollar hurts exports† found on the New York Times’ website, the United States trade deficit grew moderately in May of 2015, as reported by commerce department during the week of July 2015. This reflects the decline in sales of American-made Aircraft and Machinery as exports continuously suffer from the strong Dollar. 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