Discussion Part I: Limitations and Challenges in Perioperative Environments

NURS 6560: Advanced Practice Care of Adults in Acute Care Settings II | Week 2

“A wide range of illnesses and injuries may require treatment that includes some type of surgical intervention. Surgery may be planned or unplanned, major or minor, invasive or noninvasive, and may involve any body part or system”

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Discussion Part I: Limitations and Challenges in Perioperative Environments

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—Pamela Lynn (2008).

As this quotation suggests, advanced practice nurses must be able to provide pre- and post-operative care to patients with various illnesses and injuries. Consider a 17-year-old patient who is injured in a car accident. The patient has severe burns on her legs, and several toes on her right foot require amputation. Her injuries are affecting multiple body systems. As an advanced practice nurse, how might you stabilize and prepare this patient for surgery? What areas of care will be your focus as the patient recovers from surgery?

This week, you examine and discuss limitations and challenges of clinical practice. Then, as you explore the role of the advanced practice nurse in perioperative settings, you examine strategies for assessing, diagnosing, and treating patients in pre- and post-operative care.

Learning Objectives – NURS 6560: Week 2 Discussion Part I: Limitations and Challenges in Perioperative Environments

By the end of this week, students will:

• Analyze limitations and challenges of clinical practice
• Evaluate pre- and post-operative care patients
• Develop differential diagnoses for pre- and post-operative care patients
• Develop treatment plans for pre- and post-operative care patients

Learning Resources

Required Readings

Colyar, M. R. (2015). Advanced practice nursing procedures (1st ed.). Philadelphia, PA: F. A. Davis Company.

• Chapter 1, “Punch Biopsy”
• Chapter 2, “Skin Biopsy”
• Chapter 4, “Abscesses—Incision and Drainage Drainage (Furuncle, Felon, Paronychia, Pilonidal Cyst, Perianal Cyst)”
• Chapter 7, “Burns—Debridement”
• Chapter 8, “Digital Nerve Block”
• Chapter 12, “Sebaceous Cyst Removal”
• Chapter 17, “Soft Tissue Aspiration”
• Chapter 21, “Subungual Hematoma Excision”
• Chapter 22, “Suture Insertion”
• Chapter 23, “Suture Selection”
• Chapter 24, “Suture Removal”
• Chapter 26, “Topical Hemostatic Agent Application”
• Chapter 27, “Ulcer Debridement”

Doherty, G. M. (2015). Current diagnosis and treatment: Surgery (14th ed.). New York, NY: McGraw Hill.

• Chapter 6, “Wound Healing”
• Chapter 8, “Inflammation, Infection, & Antimicrobial Therapy in Surgery”
• Chapter 9, “Fluid & Electrolyte Management & Acid-Base Disorders”
• Chapter 10, “Surgical Metabolism & Nutrition”
• Chapter 13, “Management of the Injured Patient”
• Chapter 14, “Burns & Other Thermal Injuries”

Document: i-Human Patients, Inc. (2014). i-Human patients case player student manual.

Throughout this course, you will be required to complete case study assignments within i-Human Patients. This manual provides guidance on accessing and using these simulation. It is highly recommended that you explore the various training resources offered in this manual in preparation for the upcoming Assignments.Throughout this course, you will be required to complete case study assignments within i-Human Patients. This manual provides guidance on accessing and using these simulation. It is highly recommended that you explore the various training resources offered in this manual in preparation for the upcoming Assignments.

Required Media – NURS 6560: Week 2 Discussion Part I: Limitations and Challenges in Perioperative Environments

Note: You should have received an e-mail with your i-Human Patients login and password information. If you have not received this information, please contact your Instructor.

i-Human Patient Cases. (2014). Retrieved from https://ih2.i-human.com/users/sign_in

Vo, H. (2012). Placement of central venous catheter—NEJM [Video file]. Retrieved from

Optional Resources

University of Michigan Trauma Burn Center. (2015). Fluid resuscitation. Retrieved from http://www.traumaburn.org/referring/fluid.shtml

U.S. Department of Health & Human Services. (2014). Burn triage and treatment: Thermal injuries. Retrieved from http://www.remm.nlm.gov/burns.htm

Discussion Part I: Limitations and Challenges

From providing ongoing assessments to monitoring for complications and facilitating recovery, advanced practice nurses who care for patients in perioperative environments experience a unique set of limitations and challenges. Reflecting on your experiences in this complex and critical environment will help you develop your professional competency and prepare you for your future role as an advanced practice nurse. In this week’s Discussion, you consider limitations and challenges of clinical practice in perioperative care settings.

To prepare:

• Reflect on this week’s clinical experiences.
• Consider one limitation or challenge you encountered.
• Think about how you overcame this limitation or challenge and how this might affect your future practice in pre- and post-operative care settings.

By Day 3

Post a description of at least one limitation or challenge you encountered during your clinical experience this week. Explain how you overcame this limitation or challenge and how this might affect your future practice.

Note: If you refer to a patient in your Discussions or Assignments, be sure to use a pseudonym or other false form of identification. This is to ensure the privacy and protection of the patient.

Read a selection of your colleagues’ responses.

By Day 6

Respond to two colleagues by sharing additional insights or alternative perspectives.

Discussion Part II: Pharmacology

Note: To access this week’s required library resources, please click on the link to the Course Readings List, found in the Course Materials section of your Syllabus.

To prepare:

Read the following articles to enhance your knowledge of commonly prescribed medications:

Ando, S., Yasugi, D., Matsumoto, T., Kanata, S., & Kasai, K. (2014). Serious outcomes associated with overdose of medicines containing barbiturates for treatment of insomnia. Psychiatry Clinical Neuroscience, 68(9), 721.

Serious outcomes associated with overdose of medicines containing barbiturates for treatment of insomnia by Ando, S., et al in Psychiatry Clinical Neuroscience, 68(9). Copyright 2014 by John Wiley & Sons, Inc. Reprinted by permission of John Wiley & Sons, Inc., via the Copyright Clearance Center.

Dassanayake, T. L., Jones, A. L., Michie, P. T., Carter, G. L., McElduff, P., Stokes, B. J., & Whyte, I. M. (2012). Risk of road traffic accidents in patients discharged following treatment for psychotropic drug overdose: A self-controlled case series study in Australia. CNS Drugs 26(3), 269–276.

Kulick, D., & Deen, D. (2011). Specialized nutrition support. American Family Physician, 83(2), 173–183. Retrieved from http://www.aafp.org/afp/2011/0115/p173.html

Martini, D. I., Nacca, N., Haswell, D., Cobb, T., & Hodgman, M. (2015). Serotonin syndrome following metaxalone overdose and therapeutic use of a selective serotonin reuptake inhibitor. Clinical Toxicology 53(3), 185–187.

Serotonin syndrome following metaxalone overdose and therapeutic use of a selective serotonin reuptake inhibitor by Martini, D., in Clinical Toxicology, 53(3). Copyright 2015 by Informa Healthcare. Reprinted by permission of Informa Healthcare via the Copyright Clearance Center.

Robinson, A., & Wermeling, D. P. (2014). Intranasal naloxone administration for treatment of opioid overdose. American Journal of Health-System Pharmacy, 71(24), 2129–2135.

Thomas, D. R. (2013). Total parenteral nutrition (TPN). In The Merck Manual Professional Edition. Retrieved from http://www.merckmanuals.com/professional/nutritional_disorders/nutritional_support/total_parenteral_

All of the following groups of medications are commonly prescribed in the acute care setting. Choose one of the topics below to discuss. If it is a medication group, select a specific drug within that group. (This is a good way for you to prepare for clinical practice, because you will get to know the drugs you will prescribe for patients.). Focus your discussion on the hospital or ICU setting and IV usage.

1. KPhos, bicarb, calcium, magnesium
2. Iron, folic acid, B12
3. Diamox
4. Macrolides
5. Muinolones/mluoroquinolone
6. Cephalosporins, 4th and 5th generation
7. Aminoglycosides
8. Carbapenems
9. Lipopeptide
10. Tigecycline

Note: When sharing your initial post, select a topic that has not yet been discussed. If all topics have been discussed, then you may select that topic again, but select a different drug within the medication group. NURS 6560: Week 2 Discussion Part I: Limitations and Challenges in Perioperative Environments

By Day 3

For this Discussion, address 1 of the following options:

Option 1

Post a description of a patient you have taken care of (inpatient as an RN, or as an NP student) who has been prescribed the medication you selected. Include the scenario, indication, dosing, complications, and outcome. Then explain whether or not you would have ordered the same drug and same dose.

Option 2

Conduct an evidence-based drug search on the drug you selected and post an explanation of any possible issues. Are there any drug interactions? Any black box warnings? To what type of patient would you prescribe this medication?

Option 3

Post an explanation of the properties of the drug you selected, including usages and dosing in the hospital or ICU. Discuss a patient to whom you would prescribe this medication.

Note: To be considered as one of your required responses, your pharmacology rationale must include a supporting reference.

Note: For this Discussion, you are required to complete your initial post before you will be able to view and respond to your colleagues’ postings. Begin by clicking on the “Post to Discussion Question” link and then select “Create Thread” to complete your initial post. Remember, once you click on Submit, you cannot delete or edit your own posts, and you cannot post anonymously. Please check your post carefully before clicking on Submit! NURS 6560: Week 2 Discussion Part I: Limitations and Challenges in Perioperative Environments