Pub Date : 2015-11-01DOI: 10.1097/01.ORN.0000472832.89433.b9
Kimberly L. Meacham, Margaret Odhner, L. Norsen, E. Schmidt, Karess Rowe
32 OR Nurse2015 November www.ORNurseJournal.com General surgery carries a risk for undesirable sequela including infection, pain, thromboembolic events (such as pulmonary embolus and deep vein thrombosis), and extended hospital stay. Colorectal surgery shares many of these risks in addition to unique complications, including delayed return of bowel function, anastomotic leak, nutritional deficit, and psychological stress.1 Enhanced recovery after surgery (ERAS), also referred to as fast track, was implemented by Professor Henrik Kehlet in the 1990s.2 It is a pathway intended to optimize a patient’s perioperative course by reducing the stress of surgery, decreasing surgical complications, and accelerating postoperative recovery. The outcomes of ERAS programs have been extensively studied and are considered safe and effective.3 The role of the perioperative nurse is to initiate the pathway, including encouraging the patient to take sips of liquids and become mobile as soon as possible after surgery. Perioperative nurses are patient advocates and reinforce the principles of ERAS by educating patients regarding pain control, diet, mobilization and ostomy.
32 OR Nurse2015年11月www.ORNurseJournal.com普通外科手术有不良后遗症的风险，包括感染、疼痛、血栓栓塞事件(如肺栓塞和深静脉血栓形成)和延长住院时间。结直肠手术除了独特的并发症外，还有许多风险，包括肠功能恢复延迟、吻合口漏、营养缺乏和心理压力加速术后恢复(ERAS)，也被称为快速通道，是由Henrik Kehlet教授在20世纪90年代实施的这是一种旨在通过减少手术压力、减少手术并发症和加速术后恢复来优化患者围手术期的途径。ERAS项目的结果已被广泛研究，并被认为是安全有效的围手术期护士的作用是启动这一途径，包括鼓励患者在术后尽快饮水和活动。围手术期护士是患者的倡导者，通过教育患者关于疼痛控制、饮食、活动和造口术来加强ERAS的原则。
{"title":"Implementing enhanced recovery after surgery","authors":"Kimberly L. Meacham, Margaret Odhner, L. Norsen, E. Schmidt, Karess Rowe","doi":"10.1097/01.ORN.0000472832.89433.b9","DOIUrl":"https://doi.org/10.1097/01.ORN.0000472832.89433.b9","url":null,"abstract":"32 OR Nurse2015 November www.ORNurseJournal.com General surgery carries a risk for undesirable sequela including infection, pain, thromboembolic events (such as pulmonary embolus and deep vein thrombosis), and extended hospital stay. Colorectal surgery shares many of these risks in addition to unique complications, including delayed return of bowel function, anastomotic leak, nutritional deficit, and psychological stress.1 Enhanced recovery after surgery (ERAS), also referred to as fast track, was implemented by Professor Henrik Kehlet in the 1990s.2 It is a pathway intended to optimize a patient’s perioperative course by reducing the stress of surgery, decreasing surgical complications, and accelerating postoperative recovery. The outcomes of ERAS programs have been extensively studied and are considered safe and effective.3 The role of the perioperative nurse is to initiate the pathway, including encouraging the patient to take sips of liquids and become mobile as soon as possible after surgery. Perioperative nurses are patient advocates and reinforce the principles of ERAS by educating patients regarding pain control, diet, mobilization and ostomy.","PeriodicalId":76746,"journal":{"name":"Today's OR nurse","volume":"2000 1","pages":"32–38"},"PeriodicalIF":0.0,"publicationDate":"2015-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"89498150","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2015-09-27DOI: 10.1097/01.orn.0000470785.57103.c5
L. Burrows
{"title":"Having the fire safety talk","authors":"L. Burrows","doi":"10.1097/01.orn.0000470785.57103.c5","DOIUrl":"https://doi.org/10.1097/01.orn.0000470785.57103.c5","url":null,"abstract":"","PeriodicalId":76746,"journal":{"name":"Today's OR nurse","volume":"117 1","pages":"48"},"PeriodicalIF":0.0,"publicationDate":"2015-09-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"86193319","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2015-05-01DOI: 10.1097/01.ORN.0000464750.00568.bb
Jennifer L. Fencl, F. Wood, Sat Gupta, Vangela Swofford, M. Morgan, D. Green
28 OR Nurse2015 May www.ORNurseJournal.com For any patient about to undergo a surgical procedure, the possibility of developing a surgical site infection (SSI) is an ever-present risk. SSIs continue to represent the most common type of harm for the surgical population, estimated to occur in 2%-5% of all surgical procedures performed in the United States.1-9 SSIs also represent 14% to 31% of all hospital-acquired infections and account for almost 77% of all deaths in patients with a hospital-acquired infection.3,7, 10-12 The consequences of acquiring an SSI for the patient and family can be overwhelming, as an SSI significantly impacts the patient’s morbidity and mortality.1,4,5,7,9,11,13-19 As professional and regulatory agencies challenge and hold organizations accountable for a critical assessment of their prevention efforts, SSIs are a true public health concern and their elimination must be a priority for organizations to improve patient safety and the quality of care delivered.8,20
{"title":"Avoiding surgical site infections in neurosurgical procedures","authors":"Jennifer L. Fencl, F. Wood, Sat Gupta, Vangela Swofford, M. Morgan, D. Green","doi":"10.1097/01.ORN.0000464750.00568.bb","DOIUrl":"https://doi.org/10.1097/01.ORN.0000464750.00568.bb","url":null,"abstract":"28 OR Nurse2015 May www.ORNurseJournal.com For any patient about to undergo a surgical procedure, the possibility of developing a surgical site infection (SSI) is an ever-present risk. SSIs continue to represent the most common type of harm for the surgical population, estimated to occur in 2%-5% of all surgical procedures performed in the United States.1-9 SSIs also represent 14% to 31% of all hospital-acquired infections and account for almost 77% of all deaths in patients with a hospital-acquired infection.3,7, 10-12 The consequences of acquiring an SSI for the patient and family can be overwhelming, as an SSI significantly impacts the patient’s morbidity and mortality.1,4,5,7,9,11,13-19 As professional and regulatory agencies challenge and hold organizations accountable for a critical assessment of their prevention efforts, SSIs are a true public health concern and their elimination must be a priority for organizations to improve patient safety and the quality of care delivered.8,20","PeriodicalId":76746,"journal":{"name":"Today's OR nurse","volume":"40 1","pages":"28–38"},"PeriodicalIF":0.0,"publicationDate":"2015-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"77727474","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2014-09-01DOI: 10.1097/01.ORN.0000453447.23567.14
Kaz Sobczak
September OR Nurse2014 33 HHypothermia is a serious issue for healthcare organizations when it comes to surgery. Researchers have found that 70%-77% of surgical patients become hypothermic, with a body core temperature of less than 96.8° F (36° C), with 22% having a body core temperature of less than 95° F (35° C) during surgery.1-9 Evidence links unplanned perioperative hypothermia to adverse reactions on various organs, including serious complications to the heart, lungs, and liver, as well as blood coagulation and wound healing.3,6-14 As unplanned hypothermia is recognized as a common occurrence during surgery and anesthesia,4 managing hypothermia poses a challenge not only because of its frequency, but also due to the risk of deleterious effects, such as heat loss, that often accompany it and may lead to intraoperative and postoperative complications and threaten patient recovery.10-20 Unplanned hypothermia affects approximately 70% of the patients scheduled for surgeries in the United States, and is associated with serious medical risks.10,21-23 By Kaz Sobczak, MS, RN, CNOR The temperature of I.V. fluids and the OR can lead to hypothermia. Complications of perioperative hypothermia
{"title":"Complications of perioperative hypothermia: The temperature of I.V. fluids and the OR can lead to hypothermia","authors":"Kaz Sobczak","doi":"10.1097/01.ORN.0000453447.23567.14","DOIUrl":"https://doi.org/10.1097/01.ORN.0000453447.23567.14","url":null,"abstract":"September OR Nurse2014 33 HHypothermia is a serious issue for healthcare organizations when it comes to surgery. Researchers have found that 70%-77% of surgical patients become hypothermic, with a body core temperature of less than 96.8° F (36° C), with 22% having a body core temperature of less than 95° F (35° C) during surgery.1-9 Evidence links unplanned perioperative hypothermia to adverse reactions on various organs, including serious complications to the heart, lungs, and liver, as well as blood coagulation and wound healing.3,6-14 As unplanned hypothermia is recognized as a common occurrence during surgery and anesthesia,4 managing hypothermia poses a challenge not only because of its frequency, but also due to the risk of deleterious effects, such as heat loss, that often accompany it and may lead to intraoperative and postoperative complications and threaten patient recovery.10-20 Unplanned hypothermia affects approximately 70% of the patients scheduled for surgeries in the United States, and is associated with serious medical risks.10,21-23 By Kaz Sobczak, MS, RN, CNOR The temperature of I.V. fluids and the OR can lead to hypothermia. Complications of perioperative hypothermia","PeriodicalId":76746,"journal":{"name":"Today's OR nurse","volume":"1 1","pages":"33–39"},"PeriodicalIF":0.0,"publicationDate":"2014-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"84005421","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2013-11-01DOI: 10.1097/01.ORN.0000437572.59679.93
M. VanGelder, Elaine Coulter
Mayo Clinic Hospital, Phoenix, AZ, is an academic medical center and is one of three campuses located throughout the United States. The facility includes 268 acute care beds with 65 medical/surgical specialties. Approximately 90,000 Medicare and commercial patients receive services annually.1 In 2011, there were 12,491 surgical procedures performed in 18 operating rooms (ORs), representing a 5% increase over 2010. Three new ORs were opened in January 2012. The number of daily surgeries averaged 51. In addition, 171 cardiac catheterizations, 60 interventional radiology, and 2,326 gastrointestinal (GI) endoscopy patients were recovered in the postanesthesia care unit (PACU).2 The Centers for Medicare & Medicaid Services (CMS) instituted specific reimbursement requirements regarding same-day surgical procedures for the CMS population.3 A list of inpatient-only procedures is compiled by the CMS annually from the Current Procedural Terminology (CPT) codes mandated by the American Medical Association. The Medicare Strategy Unit at Mayo Clinic Hospital updates this list annually, and care management conforms to these regulations.4 Any procedure on the inpatient-only list An Innovative Case Management
{"title":"An innovative case management: Gatekeeper model for Medicare surgeries","authors":"M. VanGelder, Elaine Coulter","doi":"10.1097/01.ORN.0000437572.59679.93","DOIUrl":"https://doi.org/10.1097/01.ORN.0000437572.59679.93","url":null,"abstract":"Mayo Clinic Hospital, Phoenix, AZ, is an academic medical center and is one of three campuses located throughout the United States. The facility includes 268 acute care beds with 65 medical/surgical specialties. Approximately 90,000 Medicare and commercial patients receive services annually.1 In 2011, there were 12,491 surgical procedures performed in 18 operating rooms (ORs), representing a 5% increase over 2010. Three new ORs were opened in January 2012. The number of daily surgeries averaged 51. In addition, 171 cardiac catheterizations, 60 interventional radiology, and 2,326 gastrointestinal (GI) endoscopy patients were recovered in the postanesthesia care unit (PACU).2 The Centers for Medicare & Medicaid Services (CMS) instituted specific reimbursement requirements regarding same-day surgical procedures for the CMS population.3 A list of inpatient-only procedures is compiled by the CMS annually from the Current Procedural Terminology (CPT) codes mandated by the American Medical Association. The Medicare Strategy Unit at Mayo Clinic Hospital updates this list annually, and care management conforms to these regulations.4 Any procedure on the inpatient-only list An Innovative Case Management","PeriodicalId":76746,"journal":{"name":"Today's OR nurse","volume":"79 1","pages":"39–46"},"PeriodicalIF":0.0,"publicationDate":"2013-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"72934757","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2013-05-10DOI: 10.1097/01.ORN.0000429405.68531.11
AA patient presents at the hospital for his scheduled abdominal surgery: A resection of the colon. A surgical time out is conducted, general anesthesia is administered, and the patient is intubated and placed on a mechanical ventilator. Sponges are counted by the circulating RN and the scrub person. The surgeon makes an incision, and blood vessels are clamped. The surgery progresses normally but extends through a shift change for the scrub person. At the arrival of the second shift, sudden blood loss occurs, and packs of sponges are rapidly counted into the surgery. As the surgeons focus on identifying the cause of the blood loss, the nurses are also called to order backup blood supply. Once a clamp malfunction is identified, surgery proceeds and is completed. The surgeon is ready for close and is already suturing the patient’s incision. The only problem now is an unreconciled sponge count. The surgery resulted in twice the normal number of sponges, and one is missing. Where is it? Deep within the patient’s abdominal cavity? Was it discarded with the linens? Was the sponge count incorrect? Conducting another count yields the same result. How does the staff know that the in-count was correct? Isn’t that the responsibility of the earlier shift? An X-ray to rule out sponge location in the patient’s abdomen is ordered. While waiting for an update from the radiology department, the nurses search the surgical area, the trash, and the kick-bucket for the missing sponge. Every minute the surgical site stays open is an increased infection risk. The surgeon is aware of this and presses the nurses to call the radiology department again. Due to the blood loss complications, the OR schedule is already off by half an hour. The surgeon and nurses know that OR delays will be brought up by hospital administration during the next OR efficiency meeting. With healthcare costs rising and the added pressures of healthcare reform, every extra minute used in the OR is under scrutiny. The X-ray doesn’t show a sponge. Staff members are confident that the radio-opaque thread would have appeared if the sponge was inside the patient, so the patient is sutured and heals normally. Because the patient doesn’t present to the hospital again with infection or other complications, it’s determined that the sponge wasn’t in the body, but it’s never found. The surgical team discusses the incident at the next patient safety meeting. The question remains: What can be done about this problem?
{"title":"Hunt Regional: A community hospital leads the way in technological innovation","authors":"","doi":"10.1097/01.ORN.0000429405.68531.11","DOIUrl":"https://doi.org/10.1097/01.ORN.0000429405.68531.11","url":null,"abstract":"AA patient presents at the hospital for his scheduled abdominal surgery: A resection of the colon. A surgical time out is conducted, general anesthesia is administered, and the patient is intubated and placed on a mechanical ventilator. Sponges are counted by the circulating RN and the scrub person. The surgeon makes an incision, and blood vessels are clamped. The surgery progresses normally but extends through a shift change for the scrub person. At the arrival of the second shift, sudden blood loss occurs, and packs of sponges are rapidly counted into the surgery. As the surgeons focus on identifying the cause of the blood loss, the nurses are also called to order backup blood supply. Once a clamp malfunction is identified, surgery proceeds and is completed. The surgeon is ready for close and is already suturing the patient’s incision. The only problem now is an unreconciled sponge count. The surgery resulted in twice the normal number of sponges, and one is missing. Where is it? Deep within the patient’s abdominal cavity? Was it discarded with the linens? Was the sponge count incorrect? Conducting another count yields the same result. How does the staff know that the in-count was correct? Isn’t that the responsibility of the earlier shift? An X-ray to rule out sponge location in the patient’s abdomen is ordered. While waiting for an update from the radiology department, the nurses search the surgical area, the trash, and the kick-bucket for the missing sponge. Every minute the surgical site stays open is an increased infection risk. The surgeon is aware of this and presses the nurses to call the radiology department again. Due to the blood loss complications, the OR schedule is already off by half an hour. The surgeon and nurses know that OR delays will be brought up by hospital administration during the next OR efficiency meeting. With healthcare costs rising and the added pressures of healthcare reform, every extra minute used in the OR is under scrutiny. The X-ray doesn’t show a sponge. Staff members are confident that the radio-opaque thread would have appeared if the sponge was inside the patient, so the patient is sutured and heals normally. Because the patient doesn’t present to the hospital again with infection or other complications, it’s determined that the sponge wasn’t in the body, but it’s never found. The surgical team discusses the incident at the next patient safety meeting. The question remains: What can be done about this problem?","PeriodicalId":76746,"journal":{"name":"Today's OR nurse","volume":"22 4 1","pages":"1–4"},"PeriodicalIF":0.0,"publicationDate":"2013-05-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"78242468","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2013-01-01DOI: 10.1215/9780822377566-007
N. Girard
If you’re reading West Virginia Wildlife, chances are you’re interested in fi nding out more about the diverse and incredible animals living and thriving in the Mountain State. You probably have also had a chance to check out the Division of Natural Resources’ West Virginia Wildlife segments on WCHS/WVAH-TV. That’s my gig. In addition to anchoring Good Morning West Virginia, I spend a good chunk of my time traveling with DNR Wildlife Resources Section biologists putting together segments on everything from hellbenders to Virginia big-eared bats. You see the fi nished, edited pieces that are put together by our awardwinning photojournalist Brad Rice. What you don’t see is the cool, behind-the-scenes stuff that really makes my job fun. One of the many awesome adventures took us to Lewisburg in search of barn owls. Initial research showed these beautiful birds were not very plentiful in our state. In fact, the birds are showing up more and more as farmers are doing their part to let biologists know they have barn owls roosting in their silos. Rob Tallman has been tracking one particular pair for several years. We went to an abandoned silo where
{"title":"Lights, camera, action!","authors":"N. Girard","doi":"10.1215/9780822377566-007","DOIUrl":"https://doi.org/10.1215/9780822377566-007","url":null,"abstract":"If you’re reading West Virginia Wildlife, chances are you’re interested in fi nding out more about the diverse and incredible animals living and thriving in the Mountain State. You probably have also had a chance to check out the Division of Natural Resources’ West Virginia Wildlife segments on WCHS/WVAH-TV. That’s my gig. In addition to anchoring Good Morning West Virginia, I spend a good chunk of my time traveling with DNR Wildlife Resources Section biologists putting together segments on everything from hellbenders to Virginia big-eared bats. You see the fi nished, edited pieces that are put together by our awardwinning photojournalist Brad Rice. What you don’t see is the cool, behind-the-scenes stuff that really makes my job fun. One of the many awesome adventures took us to Lewisburg in search of barn owls. Initial research showed these beautiful birds were not very plentiful in our state. In fact, the birds are showing up more and more as farmers are doing their part to let biologists know they have barn owls roosting in their silos. Rob Tallman has been tracking one particular pair for several years. We went to an abandoned silo where","PeriodicalId":76746,"journal":{"name":"Today's OR nurse","volume":"6 9 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2013-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"66038620","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2012-07-01DOI: 10.1097/01.ORN.0000415632.48555.E8
S. Mikos-Schild, R. W. Schild
{"title":"Perioperative management of anesthetic waste exposure","authors":"S. Mikos-Schild, R. W. Schild","doi":"10.1097/01.ORN.0000415632.48555.E8","DOIUrl":"https://doi.org/10.1097/01.ORN.0000415632.48555.E8","url":null,"abstract":"","PeriodicalId":76746,"journal":{"name":"Today's OR nurse","volume":"1 1","pages":"18–24"},"PeriodicalIF":0.0,"publicationDate":"2012-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"82843624","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2012-05-01DOI: 10.1097/01.ORN.0000414184.11122.69
C. Walsh
C, a 72-year-old White female, was outside walking her dog on a leash when it suddenly lunged toward a squirrel in an attempt to chase it. Mrs. C was pulled forward, tripped on the uneven sidewalk, and began to fall, her right side leaning forward. She instinctively stretched her right arm forward to break her fall and landed on the heel of her hand. She immediately felt severe pain in her right wrist and was unable to get up. A neighbor witnessed the fall and ran to assist her. The neighbor noticed that Mrs. C’s wrist looked grossly deformed and called 911. The emergency medical services (EMS) ambulance arrived several minutes later. Mrs. C was alert and oriented to person, time, and place, and her vital signs were: pulse 112 and regular, respirations 22, and BP 156/90. She complained of severe pain and a “pins and needles” sensation in her wrist. The emergency medical technicians noted that she was unable to fully move her fingers and her right radial pulse was diminished when compared to her left. She was placed in a posterior splint with a bandage wrap and transported to her local community hospital. The physical exam in the ED revealed a thin, anxious, frail, elderly woman with a “dinner fork” deformity of the right wrist. Her range of motion (ROM) of the wrist and fingers was difficult to determine due to pain. Her hand was warm and pink, and the right radial pulse amplitude equaled the left radial pulse. Mrs. C complained of numbness in her palm and middle finger. Anteroposterior (AP) radiographs revealed a distal radius fracture (see AP wrist fracture) and the lateral (L) radiographs revealed dorsal displacement of the distal fragment (see Lateral view right wrist). After the orthopedic surgeon evaluated her, Mrs. C was diagnosed with a right Colles fracture (see Colles fracture of the wrist and hand). Because her past medical history included hypertension, type 2 diabetes mellitus, and moderate chronic obstructive pulmonary disease due to long-standing asthma, the surgeon attempted a nonsurgical closed reduction of the fracture in the ED. 2.3 ANCC CONTACT HOURS
{"title":"Wrist fractures in the young and elderly","authors":"C. Walsh","doi":"10.1097/01.ORN.0000414184.11122.69","DOIUrl":"https://doi.org/10.1097/01.ORN.0000414184.11122.69","url":null,"abstract":"C, a 72-year-old White female, was outside walking her dog on a leash when it suddenly lunged toward a squirrel in an attempt to chase it. Mrs. C was pulled forward, tripped on the uneven sidewalk, and began to fall, her right side leaning forward. She instinctively stretched her right arm forward to break her fall and landed on the heel of her hand. She immediately felt severe pain in her right wrist and was unable to get up. A neighbor witnessed the fall and ran to assist her. The neighbor noticed that Mrs. C’s wrist looked grossly deformed and called 911. The emergency medical services (EMS) ambulance arrived several minutes later. Mrs. C was alert and oriented to person, time, and place, and her vital signs were: pulse 112 and regular, respirations 22, and BP 156/90. She complained of severe pain and a “pins and needles” sensation in her wrist. The emergency medical technicians noted that she was unable to fully move her fingers and her right radial pulse was diminished when compared to her left. She was placed in a posterior splint with a bandage wrap and transported to her local community hospital. The physical exam in the ED revealed a thin, anxious, frail, elderly woman with a “dinner fork” deformity of the right wrist. Her range of motion (ROM) of the wrist and fingers was difficult to determine due to pain. Her hand was warm and pink, and the right radial pulse amplitude equaled the left radial pulse. Mrs. C complained of numbness in her palm and middle finger. Anteroposterior (AP) radiographs revealed a distal radius fracture (see AP wrist fracture) and the lateral (L) radiographs revealed dorsal displacement of the distal fragment (see Lateral view right wrist). After the orthopedic surgeon evaluated her, Mrs. C was diagnosed with a right Colles fracture (see Colles fracture of the wrist and hand). Because her past medical history included hypertension, type 2 diabetes mellitus, and moderate chronic obstructive pulmonary disease due to long-standing asthma, the surgeon attempted a nonsurgical closed reduction of the fracture in the ED. 2.3 ANCC CONTACT HOURS","PeriodicalId":76746,"journal":{"name":"Today's OR nurse","volume":"6 1","pages":"28–37"},"PeriodicalIF":0.0,"publicationDate":"2012-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"73209933","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
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