A Patient with Musculoskeletal Limitations Complicated by a Medical Illness

he M6A4: case study counts as 10% of your grade for this course.

We suggest that you develop and outline and use the following time-line as your guide for completing your paper:

Week 1: Review the requirements for the paper.
Week 2: Begin developing an outline for your paper.
Week 3: You should have your outline completed.
Week 4: You should be using your outline to write your paper.
Week 5: Continue work on your paper.
Week 6: Finalize your paper and submit by the end of the week.
Information on how to use the Excelsior College Library to help you research and write your paper is available through the Library Help for AD Nursing Courses page.

Information on using an outline and writing a scholarly paper is available through the Excelsior College Online Writing Lab (OWL).

If you have questions, reach out to your instructor via My Messages.

linked item M6A4: A Patient with Musculoskeletal Limitations Complicated by a Medical Illness
The Surgical Care Improvement Project (SCIP), was implemented as a commitment to improving the safety of surgical patients by reducing post-operative complications. Although some surgical complications are unavoidable, surgical care can be improved through better adherence to evidence based practice.

Case Study: A 60-year old patient with a long standing history of right knee pain has been diagnosed with osteoarthritis, and has been recommended a total left knee arthroscopy to improve chronic discomfort and improve mobility.

The patient’s past medical history includes hypertension and an irregular heart rate. The patient denies any allergies.

The patient reports to the hospital at 1 p.m. for a left knee replacement. A medication reconciliation is completed, and the patient reports taking the following medications with a sip of water at 8:00 p.m.:

• Lisinopril 10 mg PO daily

• Toprol 25 mg PO daily

• Celebrex 200 mg PO daily

While in the pre-operative holding area, vital signs are taken and are within normal limits. No hair removal was performed. The patient was ordered and received Ancef 1 gram IV mini bag, at 2:30 p.m. The patient was transferred to the operating room, where anesthesia monitoring began at 3:00 p.m., a urinary catheter was placed, and a forced air warming device was placed to maintain the patient’s temperature.

After recovering in the post anesthesia care unit (PACU), the patient was transferred to a surgical floor. Post-operative orders included:

• Ancef 1 gram IV mini bag every 8 hours

• Long leg TED hose and sequential compression stockings to right leg while in bed

• Lovenox 30 mg subcutaneously every morning, starting the following morning

• Urinary catheter to be discontinued at 3:00 p.m. on post-operative day 1

The patient progressed well, both with pain control and mobility. TED hose and sequential compression stockings were worn while in bed. On the first post-operative day, the first dose of Lovenox was administered at 1000 a.m. and the last dose of Ancef was received at 2:30 p.m. The patient was able to void after removal of the urinary catheter. The patient progressed well and was discharged home on post- operative day 5.

Evidence shows that more than 45 million operative procedures are performed in the United States each year. Approximately 40% of operative procedures result in a surgical complication. The Surgical Care Improvement Project (SCIP) was implemented to improve quality of care of surgical patients, by reducing surgical complications. Nurses play an important role in this process by following and adhering to evidence based and best practice protocols.

Using evidence based practice from two professional nursing journals, and/or your nursing textbooks, answer the following questions:

1. Explain one of the SCIP core measures, and how it has impacted the prevention of surgical complications. 2. Explain why no hair removal was required for the surgical procedure. If hair removal were ordered, explain the appropriate technique.

3. What methods were used to ensure that the recommended VTE/DVT prophylaxis was implemented, and why is the timing important? Explain your rationale with evidence.

Using APA format, write a two (2) to three (3) page paper (excluding the cover and reference page) that addresses the case study. A minimum of two (2) current professional references must be provided. Current references include professional nursing publications dated within five (5) years, and/or a textbook(s) used for the course that is no more than one (1) edition old. Websites are not to be used as professional resources or references.

Compose your work using a word processor (or other software as appropriate) and save it frequently to your computer. Use a 12 font size, double space your work and use APA format for citations, references, and overall format. Information on how to use the Excelsior College Library to help you research and write your paper is available through the Library Help for AD Nursing Courses page. Assistance with APA format, grammar, and avoiding plagiarism is available for free through the Excelsior College Online Writing Lab (OWL). Be sure to check your work and correct any spelling or grammatical errors before you submit your assignment.

You are required to submit your paper to Turnitin (a plagiarism prevention service) prior to submitting the paper in the course submission area for grading. Access is provided by email to the email address on record in your MyExcelsior account during week 2 of the term. Once you submit your paper to Turnitin check your inbox in Turnitin for the results. After viewing your originality report correct the areas of your paper that warrant attention. You can re-submit your paper to Turnitin after 24-hours and continue to re-submit until the results are acceptable. Acceptable ranges include a cumulative total of less than 15% for your entire paper, and no particular area greater than 2% (excluding direct quotes and/or references).

See the videos below for instructions on how to submit your paper to Turnitin and view your Originality Report.
Video – Submitting a Paper
Video – Viewing Your Originality Report

When you’re ready to submit your work for grading, click Browse My Computer and find your file. Once you’ve located your file click Open and, if successful, the file name will appear under the Attached files heading. Scroll to the bottom of the page, click Submit and you’re done.

This activity will be assessed according to the NUR213 M6A4: Case Study Rubric.