Part 1 Professional
A colleague has removed every second suture from a long wound on the lower leg. She has asked for your assistance to support the patient’s limb while she reapplies a dressing. A small area at the end of the suture line is moist. The wound is being dressed with Melolin ™, Combine and crepe bandage for protection and support. During the dressing your colleague drops a piece of Melolin ™ on the bed and retrieves this placing it back on the dressing tray. She remarks it will be fine up the clean end of the wound. How will you respond to this situation?
Describe in detail your response to your chosen scenario drawing upon your
- knowledge and research of professional regulations and requirements,
- professional behaviour,
- conflict resolution techniques,
- education and provision of feedback.
PART 2, Clinical question
You are caring for a male patient who suffered a fractured shaft of femur 5 days ago. He develops chest pain and shortness of breath. What would your immediate actions be?
Explain your answer in detail including your assessment, hypotheses and rationales for actions. 350 words
Case Study Analysis
I would tell that the Melolin could be compromised and can lead to surgical site infection. I would prompt her to use a non-compromised Melolin. Surgical site infections are a common healthcare-related infection that may cause discomfort and pain and may result in an extended stay of the patient (Anderson et. el., 2014). The extended hospitalization also leads to increase hospital costs. There are certain factors that are essential in reducing the incidences of surgical site infections. These include; early detection of signs and symptoms, surveillance and audit, multidisciplinary team as well as the application of evidence-based guidelines (Anderson et. el., 2014). The nurses handling the patients in the pre, perioperative and post-operative period have a great responsibility of ensuring that the appropriate measures are followed in avoiding the SSIs.
The national Health and Medical Research council guideline (2010) for handling a wound is shown below:
- Application of aseptic, non-touch methodologies to change or remove the dressing
- Avoid regular application of intracavity antibiotic lavage as a technique to reduce SSI (Harrington, 2014).
- The wound should be left untouched for about 48 hours after surgery; sterile saline can be used for cleaning the wound during the period, when necessary.
- Interactive dressing should be applied for surgical wounds that can heal through secondary healing (Farrell & Dempsey, 2014).
- The tissue visibility nurse (or other professionals who are experts in tissue viability) should be engaged for assistance on the correct dressing for surgical wounds that are healing through second healing (Anderson et al., 2014)
- The procedures require that aseptic techniques are observed all through the process, and anything that is compromised is disposed and not used (Awad, 2012).
The colleague seems to suggest that we continue to use the compromised Melolin while I suggest we use a completely new one. This is a conflict that needs to be addressed. There are various ways of handling conflicts in such a setting. According to Ankuda et al. (2015), the main techniques are contention (competition), compromise, collaboration (integration), accommodation (or yielding) and inaction (avoidance). It is not recommended that any conflict is avoided in such a setting; I cannot choose to avoid the conflict. Accommodation is often used when the situation is trivial, and the individual is not a party to the conflict (Fisher, Kelman, & Nan, 2013). In this case, I have a responsibility of ensuring that the procedure becomes a success. According to (Fisher, Kelman, & Nan, 2013, compromise is where one decided to use an alternative means to address the issue causing the conflict (Ankuda et al., 2015). In this case, I would suggest that we sterilize the compromised Melolin, but this is not feasible, thus, cannot be a method to address the issue. Competition is where the issue is seen as a contest (Johansen, 2012). Since we both aim for the same thing, the contest cannot apply. The best way to address this conflict is through collaboration. Here I would share my thoughts and ideologies and allow my colleague to share is thoughts too. We would then assess the strengths and weaknesses of every view point and consider the most appropriate technique.
Since the patient has shown some signs and symptoms linked to diseases like heart disease and pulmonary embolism (PE) among others, it would be critical to carrying out an assessment of their medical history, physical assessment and chest X-rays to remove focus from other causes (Kadous, Abdelgawad & Kanlic, 2012). The electrocardiography and chest radiography should be carried out. Arterial blood gasses can also be done followed by lung scans.
Since PE is suspected the patient can be offered Wells score either:
• An immediate computed tomography pulmonary angiogram (CTPA)
• An immediate interim parenteral anticoagulant therapy and CPPA respectively (Konstantinides et al. 2014).
If CTPA results are negative, a proximal leg vein ultrasound scan is considered to detect DVT (Konstantinides et al. 2014).
Hypothesis: The patients does not suffer from PE
Actions and Rationale
shows that patients with PE have a high mortality rate. There is also a high
rate of reoccurrence of the condition if it is untreated. The anticoagulation
technique reduces the recurrence and mortality rates in patients with acute PE.
As an advanced nurse, it is crucial to plan and set goals for the patient with
pulmonary embolism. The goals, in this case, would be: increasing perfusion,
offering an understanding of the condition, the treatment course as well as the
possible side effects. According to Rathert, Wyrwich, & Boren (2013)
involving the patients in their care positively influences the success of the
interventions. In this case of PE, the nurse should display hemodynamic
stability as recommended by Konstantinides et al. (2014). Blood pressure is a
crucial indicator of clinical instability. An advanced nurse should ensure that
he/she follow the prescribed pharmacologic regime. The nurse should, in this
case, give an anticoagulant such as Heparin, in the correct dosage outlined.
Another critical action would be to report relief of pain, to evaluate the
effectiveness of the intervention being applied. In this case, the stop of
chest pain, as well as shortness of breath, will be an indicator of the
effectiveness of the condition.
Anderson, D. J., Podgorny, K., Berríos-Torres, S. I., Bratzler, D. W., Dellinger, E. P., Greene, L., … & Kaye, K. S. (2014). Strategies to prevent surgical site infections in acute care hospitals: 2014 update. Infection Control & Hospital Epidemiology, 35(06), 605-627.
Ankuda, C. K., Block, S. D., Cooper, Z., Correll, D. J., Hepner, D. L., Lasic, M., … & Bader, A. M. (2014). Measuring critical deficits in shared decision making before elective surgery. Patient education and counseling, 94(3), 328-333.
Awad, S. S. (2012). Adherence to surgical care improvement project measures and post-operative surgical site infections. Surgical infections, 13(4), 234-237.
Farrell, M., & Dempsey, J. (2014). Smeltzer and Bare’s textbook of medical-surgical nursing (Vol. 2). Lippincott, Williams, and Wilkins.
Fisher, R. J., Kelman, H. C., & Nan, S. A. (2013). Conflict analysis and resolution.
Harrington, P. (2014). Prevention of surgical site infection. Nursing Standard, 28(48), 50-58.
Johansen, M. L. (2012). Keeping the peace: Conflict management strategies for nurse managers. Nursing Management, 43(2), 50-54.
Kadous, A., Abdelgawad, A. A., & Kanlic, E. (2012). Deep venous thrombosis and pulmonary embolism after surgical treatment of ankle fractures: a case report and review of literature. The Journal of Foot and Ankle Surgery, 51(4), 457-463.
Konstantinides, S., Torbicki, A., Agnelli, G., Danchin, N., Fitzmaurice, D., Galiè, N., … & Lang, I. (2014). 2014 ESC guidelines on the diagnosis and management of acute pulmonary embolism. European heart journal, ehu283.
Shammas, N. W., Padaria, R., & Ahuja, G. (2015). Ultrasound-assisted lysis using recombinant tissue plasminogen activator and the EKOS EkoSonic Endovascular system for treating right atrial thrombus and massive pulmonary embolism: a case study. Phlebology, 30(10), 739-743.
Rathert, C., Wyrwich, M. D., & Boren, S. A. (2013). Patient-centered care and outcomes: a systematic review of the literature. Medical Care Research and Review, 70(4), 351-379.