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The Case:
John Egan, 53, has a history of Type I diabetes
mellitus, cigarette smoking 40 pack years,
CAD, and PVD. Six weeks ago, he developed
a wound of his left heel which measured 4cm
by 2cm when he discovered it. Despite IV
antibiotics and chemical debridement, the
wound developed a gangrene infection. He is
scheduled for a BKA of the left lower
extremity tomorrow at 10:00am. His meds
include daily insulin, aspirin 325mg/day, Pletal
100mg BID. He has an advanced directive
and NKDA.
Advance Directives
Living wills
Patient is usually a full code for
24 hours following surgery
Allows family to know patient
wishes in the event of serious
intraoperative complication
Durable power of attorney for
healthcare
Latex Allergy/Sensitivity
At Risk:
Genetic predisposition
Children with spina bifida
Urogenital abnormalities
Spinal cord injuries
Hx of multiple surgeries
Health care professionals
Latex Allergy/Sensitivity
S&S
Urticaria
Rhinorrhea
Bronchospasm
Compromised
respiratory
status
Circulatory
collapse & Death
Management
Identify those
at risk
Latex free
environment
Latex free
equipment
Pre-operative Checklist
Time Out
Intra-operative Safety
Maintenance of sterile technique
Continuous patient monitoring
Instrument count
Sponge count
Breaks for personnel
TeamSTEPPS Instructor Guide: Video
Training Tools
Postoperative Assessments
and Interventions
Vital signs
Continuous Pulse ox
Telemetry monitoring
Color and
temperature of skin
Level of
consciousness
Intravenous fluids
Surgical site
management
Other tubes
Comfort
Position and safety
Report on Fluid
intake, output and
estimated blood loss
(EBL)
Monitor lab values
NPO until bowel
sounds return
Interventions to Prevent
Respiratory Complications
Monitoring vital signs
Implementing deep breathing
Coughing
Incentive spirometry
Turning in bed; OOB to chair
Ambulating
Maintaining hydration
Avoiding positioning that decreases
ventilation
Monitoring responses to narcotic analgesics
Prevent Atelectasis
Leg
Exercises
to Prevent
Venous
Stasis
Calcium 9.7
Magnesium 1.8
Phosphorus 3.8
Calcium 9.7
Magnesium 1.8
Phosphorus 3.8
Incident/Occurrence Reports
Used to document any unusual
occurrence that results in or has potential
to result in harm to a patient, employee,
or visitor
Should not be referred to in nursing notes
Used for quality improvement to identify
risks
Records facts about an incident in case of
litigation
May be used in court as evidence
Confidentiality
Protecting & maintain privacy of all
patient information whether spoken,
written or saved in computer
Includes confirmation that a patient is
admitted to institution
Health Insurance Portability and
Accountability Act (HIPAA)
Disclosure requires signed
authorization from patient
HIPAA
Incidental Disclosure
Permitted
Disclosure
Public health
activities for
infectious disease
or danger
Law enforcement
and judicial
proceedings
Deceased
individuals