Wound Infection post total knee replacement surgery

Wound Infection post total knee replacement surgery Nursing practice is the actual provision of nursing care. In providing care, nurses are implementing the nursing care plan which is based on the clients initial assessment. This is based around a specific nursing theory which will be selected as appropriate for the care setting. In providing nursing care the nurses uses both nursing theory and best practice derived from nursing research. Nursing is practice profession which is depends on a variety of skills which are strongly related to ethical and social aspect in healthcare. There are lists of contemporary issue exist, in an effort to fulfill modern health care system in Malaysia. These contemporary issues provide a challenge in this practice discipline and other health care teams. Contemporary issues defined as present or current issues which is happening, existing, living or coming into being during the same period of time. Contemporary issue in professional practice is closely related to ethical component of practice also competing ideologies and practice realities. This assignment will explore contemporary issue on infection control. Im interested to present about increasing rate of wound infection post total knee replacement (TKR) surgery. TKR or knee arthroplasty is surgical procedures in which the worn, damage surfaces of the knee joint are replaced with metal and high-density plastic. TKR may result in general pain relief, deformity correction and resumption of normal activity. As Im working in orthopedic ward for the 10 years, wound infection especially post TKR complications commonly affect patients. Wound infection can give a big impact in patient recovery and indirectly public can question the quality of care delivered. Therefore I have decided to discuss about the infection control surveillance and ongoing for patient health care programmed also organization action and strategies undertaken. In this paper I will critically discuss, how it occur and about how to decrease wound infection of post TKR. This paper also will provide critical knowledge and understanding patients needs during hospitalization via reflection upon nurses responsibility in health care. BODY Total knee replacement is a common surgical procedure done routinely around the world on patients with severe arthritis. The surgery has a high rate of success and complications are rare. Most post operative complications are anticipated and prophylactic medications or therapies are administered on a preventative basis. It is a major procedure and recovery will not occur overnight. Post operative care following knee replacement begins immediately and involves basic wound care, a step- wise activity regimen and prevention of complications. TKR is the most devastating and challenging complication for both the surgeon and the patient to face. According to Bengston and Fitzgerald (1991) although surgical techniques and treatment operation have improved the overall risk for deep infection after TKR still remains 1-2 %. In case of infection, it is of great importance to quickly identify the problem and treat it adequately to minimize the risk of complications. A straight forward management algorithm is the only way of dealing with infected implants properly. Post TKR infection which is a result of treatment in a hospital or a healthcare service unit, but secondary to the patients original condition. According to Fehring et al (2000), the diagnosis of infection depends on the clinical appearance of the patient is generally based on joint aspirates and cultures, laboratory results. [Erythrocyte sedimentation rate (ESR), C-reactive protein (CRP)], radiography and clinical examination. The knee joint can present inflamed, red, swollen, tender on palpation, feeling warm and the patient can show clinical signs of systematic infection like fever, shivering, night sweating, etc. Sometimes the only complaint patients have is continuous pain. This should be considered as an infection until proven otherwise. Zimmerli W (2004) present most commonly cultured microorganisms are coagulase- negative staphylococci (30-43% of cases) and Staphylococcus aureus (12-23%), and followed by mixed flora (10-11%), streptococci (9-10%), Gram- negative bacilli (3-6% ), enterococci (3-7%) and anaerobes (2-4%). No microorganism is detected in about 11% of apparent infection. Polymicrobial infections are reported in 12-19% of cases. Many medical procedures bypass the bodys natural protective barriers. Routine use of anti-microbial agents in hospitals creates selection pressure for the emergence of resistant strains. According to Rutala et al (1983), investigating on Methicilin Resistant Staphylococcus Aureus (MRSA) outbreak, found that MRSA comparised 16% of all bacterial isolates sampled from the air and 31% of the isolates from elevated surfaces. After knee surgery, infection is a major concern. A standard treatment protocol must be followed. All patients post TKR must treated with intravenous flucloxacillin and benzyl penicilin (erythromycin for penicillin allergic patients) for a minimum of 6 weeks. According to Lewis G (2006) antibiotic -loaded cement were also found to be efficient in reduced the risk of infection in the early post operative period. However, Joseph TN (2003) states high doses of antimicrobial agents may result in the bone cement has lower mechanical properties and there are also concerns regarding the allergic reaction to impregnated antibiotics and the potential for the emergence of antibiotic-resistant bacteria. Knowledge is one factors contribute of infection. Barriers to good hand hygiene include poor knowledge of infection control, time pressure, poor technique, inadequate facilities and inappropriate clothing and hand adornments. (NOA 2004: Department of Health (DH) 2005). Professional healthcare staff must have a good knowledge hand washing follow by standard precaution to prevent infection. It can decrease infection via hand among them. Gould et al (2008) thinks that infections in healthcare setting are spread by direct contact (cross infection) of health workers. Normally in crowded with full patients orthopedic ward with 3-4 staff nurses per shift, this can cause the workload. It a high was too heavy and they have not enough time to carry out their job properly. Its difficult to practice good hand washing hygiene before and after touch every patient. Infection can cause by the nurses while practicing nursing interventions via poor hygiene control and failure to maintain sterility in procedure especially do dressing to post TKR patient. When hand washing facilities are poor, it contributes to infection. Clinical hand wash sink are required in all areas where clinical activities are performed. Provision of adequate and appropriate facilities could be improved hand washing compliance. According to Harris et al (2000) stated that hindering factors and good and hand washing are lack of time, poor facilities and materials. From one study of compliance with hand washing (Girou and Oppein, 2001) state that 50% of healthcare workers did not wash thei r hands after procedure. A nation review of nursing workforce predicts the demand for nurses will increases in hospital admissions. With many nurses hearing retirement, a national shortage of up to 40,000 nurses is predicted by 2010. Therefore recommend that the Department of Health require all hospitals to use the general workload calculation tool to assess the number of nurses needed in appropriate wards. A compounding factor and one that is the cause of many post TKR infection in hospital, staff especially nurses they not able to practice proper hand washing technique as they have too many procedures to be settle before end of the shift staff nurses are always running out the time to manage all about patients including orders from doctor, they must manage pre and post operative patients too. Among crowded hospital populations and where poor infections control practices exits it may facilitate bacteria transmission. A commonly in ward, nurses have to follow ward round and carry out order from doctors such as taking blood, do dressing and sent patient for x-ray or physiotherapy. During ward round, staffs unable to wear proper mask, glove and apron before enter isolation room patient post TKR as an action from doctor which wants it to be fast. In this situation, nurses must be the best way to perform nursing role in whatever situation no matter it is a busy day, emergency situations or lack of staff. It is important the nurse to analyze and utilize the situation in work management. The Infection Control Nurses Association (1998) mention that commitments by managers to improved resources are important to prevent poor hand hygiene among healthcare and patients. During ward round, staffs unable to wear proper mask, glove and apron before enter isolation rooms post TKR patient as an action from doctor which it to be fast. In this situation nurses must be the best way to perform nursing role in whatever situation no matter it is a busy day, emergency situation or lack of staff. It is important for the nurse to analyze and utilize the situation in work management. According to Hanssen AD et al (1999) the incidence of infection as cause of prosthetic failure varies depending on the joint involved with the rate of arthroplastis becoming infected being 1.7% of primary and 3.2% of non primary hip arthroplasties, 2.5% of primary and 5.6% of non primary knee arthoplasties and 1.3% of shoulder arthoplasties. A nation review of nursing workforce predicts the demand for nurses will increase by over two percent a year due to expected increases in hospital admissions. With many nurses hearing retirement, a national shortage of up to 40,000 nurses is predicted by 2010. Therefore recommend that the Department of Health require all hospitals to use the general workload circulation tool to assess the number of nurses in appropriate ward. Learning through reflection is more potent if there is an understanding of frameworks that encourage a structural process to guide the act of reflection. In this paper I would like to reflect about one cases happened in my work place. One old male patient about 80 years old develops deep infection after a two stage revision of an infection post TKR. The ideal definitions of post operative wound infection remain problematic. A substantially higher audited rate of wound infection is produced by applying the clinical definition proposed by the Surgical Infection Study Group (SISG). After apparent early post operative wound infection in to patients, only three (4%) had definite ongoing wound problem or deep sepsis at 1 year. As an experienced nurse, I feel upset if the infection is cause by the lacking of staffs knowledge in wound management. Patient might be depressed as the result from infection and complication and need longer hospitalization period. They also must waiting and have maintain period of healing process. Regarding this situation, I applying Gibbs Reflective Cycle, Nurses play a crucial role in the management of wounds. So they need to have good current knowledge and be more aware of their own wound care practice so to bring about more effective wound management. Professional Development in Nursing Time, (1994,p1), describes the nurses to be more observant of their patients wounds, increased their knowledge and skills on wound care and assisted them in acquiring more experience and skills in nursing research and get up on going frame work for improvements in wound management. Im as a staff nurses, I give moral support to built patient confidence level and avoid depression. Health education also might be useful for the patient facing with their condition. Nurses should foster better work among the many disciplines, improved the nurses reflection on their clinical and ultimately procedure better nurse practitioners. Once patient can be discharge, some of them though they are fully recovered, therefore they neglected the proper hygiene in daily living activities in other habit for patients are not coming for the appointment and did not taken antibiotics as ordered. Before patients discharge from hospital, decisions will be made about their continuing health needs. Information will be provided on the need further medical care including any necessary medicine, or services such as home nursing and delivered meals can be obtained. Educational strategies need to be specifically targeted to meet the needs of different professional groups and levels of expertise to maximize effectiveness. An example of this would be the appropriate preparation of clinical leaders such as specialist nurses so that they are equipped with the skills, knowledge and implement evidence-based wound care locally. According to Lucker and Kenrick, (1995), is also helps to create effective role models as health professionals are more likely to implement the good practice demonstrated by a colleague than good practice read about in a journal. In recent years it has become common for education to work in collaboration with clinicians, industry and wound organizations to provided more effective educational initiatives that provided an opportunity to network, while keeping abreast of current opinions and developing critical thinking skills. Although hand washing may see a simple process, it is often performed incorrectly. Healthcare settings must continually remind a practitioner especially nurses and visitors and the proper procedure in washing the hand to comply with responsible hand washing. Elliott (1996) believes that education and training adequate about hand washing is important safe practice for professional healthcare workers. Therefore all visitors must follow the same procedures as hospital staff to adequately control to spread of infection especially before entered and after leaving an isolation rooms post TKR patient. In this situation, patient and family members also must learn how to do proper hand washing whether at home to promote safety life. Many patients treated in hospital develop infections after discharge, for example 50-70% of surgical wounds infections become apparent after discharge but these are not monitored NAO (2004). Knowledgeable are important among healthcare professional of preventing infection. Goulds (1995) mention that nurses theoretical and knowledge of universal precautions is useful to prevent infection and ability assimilate theoretical knowledge into practice. Knowledge followed by standard precaution can give a best treatment to the patients, therefore it can decrease infection problem. The nurse with limited background knowledge will lack the tools needed from experience and the scope of practice will be limited by background the nurse to the clinical situation (Banner 1984). Guidelines and policies should clear to describe wound care dressing. Gould (2002) says that a general rules was recommended for healthcare workers to breaking the chain of infection. New protocol and guidelines may lead to clearer definitions of terms being developed. Educating healthcare works on protocol and guidelines may be equally and beneficial in encouraging to them. Infection control nurses or their link nurses could undertake this teaching at ward level as this is viewed as best place to teach good clinical practice (Gould 1996). However, this could be lacking and vague in evidence based guidelines and a clear documented standard principle are needed. Pratt et al (2000) mentions that The Epic Projects was designed to develop guidelines and standard principles for preventing Healthcare associated infection (HAIs). Therefore, failure technique of dressing among the healthcare workers especially staff nurse cause of failure of guidelines. From the literature it is clear that poor wound dressing care by healthcare workers increase the risk of infection. Most infections in hospitals and other settings where health and social care are delivered are transmitted to patients directly via the hand of health workers (Gould et al 2008). Evidence indicates that many factors to contribute infection among healthcare staff. Confidential Enquire into Stillbirth and Deaths in Infancy CESDI (1999) study that around 5% of the death analyses cause of infection. Factors influence to infection such as lack of knowledge, lack of attitude, lack of facilities, lack of technique and lack of times. An intervention to promote wound dressing care plays an important role in the prevention of infection in hospitals. CONCLUSION As a conclusion, this assignment show that wound infections are preventable via integrated and collaborative effort among patient as a client, nurses as professional health care services. Therefore all medical staff must follow prevention of wound infection and improved their knowledge and training to know what it is, thus allowing workers to create a safe environment. However the setting of the work place needs to be conducive to allow workers to be empowered to do this. In nursing practices reflection are important thing to nurses and management. Nurses must take accountability in practice setting and work efficiently through integrated self awareness, descriptive and critical reflection also evaluation reflection toward excellent patients care. Modification of work practice such an appropriate handling of wound infection, the adoption of the concept of universal precaution and compliance with use of personal protective barriers should be emphasized. The primary goal of Infection Control is to educate all staff and family members to practice good infection prevention technique to protect patients from spreading infection. Guidelines and protocols should therefore be clear to encourage universal compliance to best practice. This topic becomes important in view of its ramifications to the accountability and accreditation of hospitals and staff. Therefore self awareness about the important of standard nursing skill is priority in whatever condition appears. Using a few strategies discussed in this paper it helpful to reduced wound infection. Therefore patients are safe and receive quality care and can save cost of treatment because they do not stay in hospital for long period of time. Hospital and staff also get good image from public and this can improving productivity among medical workers.

Abraham Lincoln Essay -- essays research papers fc

Abraham Lincoln Why I chose to research Abraham Lincoln’s life. Ever since I was a small boy in elementary school, and all throughout my grade school days, there were many great names that were spoken of and taught about. Names such as George Washington, (our first president) John Hancock, John Adams, and Mark Twain were among many others who contributed to the betterment of our great country, the United States of America. Yet there was one name that resounded in my classrooms, and in my ears. That name was Abraham Lincoln. As a child, I had heard of great things this man had done, and wonderful things he had said. Of the many great things said by Abraham Lincoln, I recall most vividly the Gettysburg address, given on November 19, 1863.   Ã‚  Ã‚  Ã‚  Ã‚  Listening to the words of my teachers and reading from my textbooks about this great man who had done great things, made me curious. I wanted to know in more detail exactly what it was that made this man so revered by teachers, political leaders, students, and everyday people. What was it about Abraham Lincoln that made him who he was? And how did this have an affect on how he ran the country? These are some questions that I have, and throughout this research, I hope to answer them.   Ã‚  Ã‚  Ã‚  Ã‚     Ã‚  Ã‚  Ã‚  Ã‚  Abraham Lincoln was born in Larue County, which is in Kentucky, February 12, 1809 on a Sunday morning. He, as well as most other people in those days, was born in a log cabin that was not necessarily the most well built. The Lincoln cabin, as stated on page 5 in vol. one of The Life of Abraham Lincoln, by William E. Barton, â€Å"was lacking in all modern conveniences and most modern comforts.† Abraham Lincoln was not born into a rich family who had achieved great social and political power, but instead, a common, rather poor family, who was content with what they had. Thomas Lincoln (Abraham’s father) was a carpenter and a farmer, and he met his wife Nancy through a co-worker. Nancy was the sister of Joseph Hanks, who worked with Thomas Lincoln as a carpenter, and it is believed that through this acquaintance, Thomas and Nancy met, and were married. Nancy and Thomas Lincoln were the parents of Abraham Lincoln, and were both born in Virginia. When Nancy Lincoln got pregnant for the first time, both she and Thomas wanted to have a baby boy, however, their ... ...nd by a very large margin. Lincoln was placed on the Committee of Public Accounts and Expenditures on what was called the Ninth General Assembly. Lincoln made no marked impression on this legislative body.   Ã‚  Ã‚  Ã‚  Ã‚  In May of 1860, Abraham Lincoln was nominated for the republican presidential candidate. Lincoln was nominated by three hundred and sixty four votes, where only two hundred and thirty-four were required.   Ã‚  Ã‚  Ã‚  Ã‚  In his presidency, Lincoln achieved many goals, some preconceived, and some not. He was a great man, and a great president, due to his honesty and integrity. The questions that I had about Abraham Lincoln, (What was it about Abraham Lincoln that made him who he was? And how did this have an affect on how he ran the country?) Were more than answered. Lincoln was a man who rose above his circumstances and chose to do the right thing. I think that this unique president draws so many people’s attention to himself because of his honesty and integrity. Where have all the presidents run off to who will walk in the footsteps of Abraham Lincoln? Works Cited 1) The life of Abraham Lincoln, by William E. Barton. vol. One and Two.

Environment Human Health

A few solutions that has already been implemented is recycling (the reduce and reuse affect), use sees chemicals such as coal, or gasoline, and to educate more people about what is going on with our planet. When did our planet create recycling? Recycling dates back to BBC to current day. Over the centuries we have grown and matured in how to recycle. This includes how we collect rainwater to how we dispose of our bowels. During and after the World War II, the United States became more involved in recycling.Instead of constantly dumping waste into landfills or into our water source we started to make our oils and gasoline more economically safe. In our gasoline and oils we took out chemical that killed most children and that chemical was lead. Lead was very common in homes dated before the late ass's. It was used in paint. Most children are attracted to color and are prone to putting things into their mouths. In older homes when paint started to chip and children saw it they would pul l it and put it into their mouths.This caused a lot of deaths and poisonings. The United States helped to reduce this by banning the use of lead paint in the early ass's late ass's (Wendy Koch LISA, Today 5/18/2012). In order to inform our nation of what was happening to young children, we had o educate them. The United States communities have provided education programs that are active in the community to help establish problems such as the lead poisonings and air pollution.Problems such as this will only be addressed to areas where resources such as television, Internet or newspapers are available. If a country lacks these supplies they will not know what can harm them or what is harming our planet. This video The Link between Air Pollution, Lead Poisoning and Aggressive Behaviors stood out to me the most because this is something that concerns me the most. The fact that a lot of people around the globe are not educated about what happens in our environment can become detrimental to our planet.

Demonic Child essays

Demonic Child essays In Hawthornes novel the Scarlet Letter the character Pearl is the product of sin. Everyone in town thought of pearl as abnormal, unnatural, a demon child, and a symbol of adultery committed by her mother Hester Prynne and Father Dimmsdale (which people did not know of yet). This is Pearl and she is the outcast child. Pearl is never going to be able to be seen as normal child, since birth she was always thought to be different, abnormal, and as a demonic child. Pearl was a born outcast of the infantile world. An imp of evil, emblem and product of sin she had no right among christened infants (95).Pearl was different from other children because she was born by a sin of adultery and without a father. Its said that some children like pearl were demon offspring from their mothers sin. Growing up she did not get along with the other children. She would speak in a witchs anathemas in some unknown tongue(96) when kids would gather around her, she would also use violence toward them unlike puritan children, which kept things inside. Pearl is a constant reminder of sin to her mother. For example when the government tried taking little Pearl from Hester one reason she was able to stay because every time Hester looked at her she was reminded of her sin. Pearl also isnt as religious or as serious about reli gion as other puritans in the colony. An example of this from first the first chapter when Hester said that the heavenly father sent us pearl says she has no heavenly father. ...

Free Essays on Holes And Number The Stars

I chose essay topic number three in comparing Number the Stars main character Annemarie Johansen and Holes main character Stanley Yelnat’s and taking a look at how both helped others and made a difference in some way. These two books are very different from one another, but demonstrate how a lead character is so important. In Number the Stars, Annemarie is a typical young girl (ten-years old) that deals with the difficulties of growing up- getting along with a sibling, understanding the way the adult world works. But these difficulties play out in a complicated and frightening way. Annemarie has been made very thoughtful and introspective due to the war. She spends much of her time reflecting on what she sees around her. In that respect, throughout the book Annemarie realizes to help save the lives of close friends and family she must risk her own. Annemarie strives to help out her best friend Ellen and her family along with many other Jews by taking a chance and helping the Jews escape to Sweden to be free. Annemarie does this by hiding many secrets from the Nazi’s throughout the book because she was taught from her family and Peter that this was the noble thing to do from the family point of view. She helps out Ellen and her family many times. Her first encounter came about when the Johansens received a late night visit from Peter Nielsen, a member of the resistance, who came to warn the Rosen’s that they must flee before the Nazi’s captured them and take them away. So Ellen is then left with Annemarie and her family to pose as a sister. Annmarie also attempts a secret operation of carrying an important package along with cheese and bread that was left behind to her uncle Henrik who at his boat smuggling Jews to Sweden. On her way, she is stopped by soldiers who torment her and search her basket and discover the package. But when they rip it open it contains only a handkerchief, and they let her go. Annemarie makes it to th... Free Essays on Holes And Number The Stars Free Essays on Holes And Number The Stars I chose essay topic number three in comparing Number the Stars main character Annemarie Johansen and Holes main character Stanley Yelnat’s and taking a look at how both helped others and made a difference in some way. These two books are very different from one another, but demonstrate how a lead character is so important. In Number the Stars, Annemarie is a typical young girl (ten-years old) that deals with the difficulties of growing up- getting along with a sibling, understanding the way the adult world works. But these difficulties play out in a complicated and frightening way. Annemarie has been made very thoughtful and introspective due to the war. She spends much of her time reflecting on what she sees around her. In that respect, throughout the book Annemarie realizes to help save the lives of close friends and family she must risk her own. Annemarie strives to help out her best friend Ellen and her family along with many other Jews by taking a chance and helping the Jews escape to Sweden to be free. Annemarie does this by hiding many secrets from the Nazi’s throughout the book because she was taught from her family and Peter that this was the noble thing to do from the family point of view. She helps out Ellen and her family many times. Her first encounter came about when the Johansens received a late night visit from Peter Nielsen, a member of the resistance, who came to warn the Rosen’s that they must flee before the Nazi’s captured them and take them away. So Ellen is then left with Annemarie and her family to pose as a sister. Annmarie also attempts a secret operation of carrying an important package along with cheese and bread that was left behind to her uncle Henrik who at his boat smuggling Jews to Sweden. On her way, she is stopped by soldiers who torment her and search her basket and discover the package. But when they rip it open it contains only a handkerchief, and they let her go. Annemarie makes it to th...

Week 8 705 Assignment Example | Topics and Well Written Essays - 250 words

Week 8 705 - Assignment Example This requires knowledge on budgeting and components of budgets so that a DNP can collaborate with line personnel and inform them to ensure availability of resources for meeting patients’ needs. Ordering of tests and prescription of medicines originates from DNPs and the professionals are the right source of information for budgeting for the necessary resources. DNPs’ knowledge on budgeting can facilitate accuracy in resource allocation and availability of the required resources. In addition, ability to identify each of the direct costs such as personnel, equipments, supplies, and training expenses and to allocate expected costs to them facilitates budgeting within a DNP’s department and informs a facility’s budgeting (Loyns & Gitlin, 2008). Personnel are critical to service delivery and understanding workload volume informs DNPs on the required human resource base. The most common volume and peak volume are important to estimating extreme ends of a facility’s needs that can ensure economic, but sufficient, allocation of resources. Reliance on most common workload, together with further analysis then informs DNPs roles in budgeting for their departments and their facilities. As a leader, a DNP needs to understand human resource planning concepts for informing human resource management on appropriate human resource composition and for ensuring optimal personnel output in a DNP’s department through motivational factors (Waxman, 2012; Loyns & Gitlin,

Should there be a minimum age for driving Essay Example | Topics and Well Written Essays - 500 words

Should there be a minimum age for driving - Essay Example Statistics show that teenagers have higher chances of being involved in car accidents and the rates are equally high for death rates caused by such accidents. America, for example has the highest number of teenagers in car accidents. Therefore, the government made it a policy that teenage drivers should have more practice hours, attend seminars about driving and take a written exam before they get licensed. Drivers aged 15-17 are also required to drive with an adult who knows how to drive however, it is known that this is not always practiced. There are teenage drivers who insist on driving alone because they want to reiterate their abilities and capabilities. Most often, parents would give in because they cannot control their children or simply because they are very busy that they do not have time to attend to their children-- which is actually the reason why they are letting their children drive, so that they do not have to drive them to and from school. Left alone in a car, the teenage driver is also left with decisions he oftentimes immaturely acts upon. For instance, once a teenage driver is left with the freedom to use the car, he could also let his friends ride with him which can eventually lead to drinking and doing drugs. These are dangerous paths for teenage drivers because it is known that alcohol and drugs alter a person’s perceptions. Considering that they do not drink or do drugs, driving with a group of friends can lead to joking or even fighting which will affect the driver and could lead to a dangerous accident. Moreover, there is the issue on the use of cellphones among teenagers. Since they oftentimes communicate with their friends, there is a greater tendency for teenagers to be texting or calling while driving. This increases the risk of teenage drivers to be involved in a car accident. One might argue that such circumstances can also be true among adults. Indeed. However,