Debbie Petersen, RN, MSN Sandra Bond, RN, BSN. Objectives Understanding why prevention is key to the...
-
Upload
chloe-mcdowell -
Category
Documents
-
view
214 -
download
2
Transcript of Debbie Petersen, RN, MSN Sandra Bond, RN, BSN. Objectives Understanding why prevention is key to the...
![Page 1: Debbie Petersen, RN, MSN Sandra Bond, RN, BSN. Objectives Understanding why prevention is key to the success and management of a rehabilitation patient.](https://reader038.fdocuments.net/reader038/viewer/2022110402/56649e4c5503460f94b42382/html5/thumbnails/1.jpg)
Debbie Petersen, RN, MSNSandra Bond, RN, BSN
![Page 2: Debbie Petersen, RN, MSN Sandra Bond, RN, BSN. Objectives Understanding why prevention is key to the success and management of a rehabilitation patient.](https://reader038.fdocuments.net/reader038/viewer/2022110402/56649e4c5503460f94b42382/html5/thumbnails/2.jpg)
ObjectivesUnderstanding why prevention is key to the
success and management of a rehabilitation patient.
Understanding key interventions to assist the rehabilitation patient who has complications.
Understanding why complications directly impact progress and discharge to home.
![Page 3: Debbie Petersen, RN, MSN Sandra Bond, RN, BSN. Objectives Understanding why prevention is key to the success and management of a rehabilitation patient.](https://reader038.fdocuments.net/reader038/viewer/2022110402/56649e4c5503460f94b42382/html5/thumbnails/3.jpg)
Catheter Associated Urinary Tract Infections (CAUTI) Why Prevent
Never EventPain/lethargySepsisPermanent damageIncreased LOSUse of antibioticsQuality Measure- considered a Hospital
Acquired Condition (HAC)
![Page 4: Debbie Petersen, RN, MSN Sandra Bond, RN, BSN. Objectives Understanding why prevention is key to the success and management of a rehabilitation patient.](https://reader038.fdocuments.net/reader038/viewer/2022110402/56649e4c5503460f94b42382/html5/thumbnails/4.jpg)
Catheter Associated Urinary Tract Infections (CAUTI) Interventions to preventHand washingInsert foley catheter using aseptic technique
and sterile equipmentClosed System
No leg bag Sample thru sampling port only after
cleansing with disinfectant and using sterile syringe
Smallest catheter possible to minimize urethral trauma
![Page 5: Debbie Petersen, RN, MSN Sandra Bond, RN, BSN. Objectives Understanding why prevention is key to the success and management of a rehabilitation patient.](https://reader038.fdocuments.net/reader038/viewer/2022110402/56649e4c5503460f94b42382/html5/thumbnails/5.jpg)
Catheter Associated Urinary Tract Infections (CAUTI) Interventions to prevent
Limited use of Foley cathetersExternal cathetersIntermittent catheterizationTimed voiding scheduleRemove as soon as possible
Maintain unobstructed urinary flowProperly secured to prevent urethral tractionCDC Guideline for Prevention of Catheter
Associated Urinary Tract InfectionsMonitor CAUTIs Identify problems and areas for
improvement
![Page 6: Debbie Petersen, RN, MSN Sandra Bond, RN, BSN. Objectives Understanding why prevention is key to the success and management of a rehabilitation patient.](https://reader038.fdocuments.net/reader038/viewer/2022110402/56649e4c5503460f94b42382/html5/thumbnails/6.jpg)
Catheter Associated Urinary Tract Infections (CAUTI) Barriers to progress and discharge homeLethargy- unable to participate and benefit
from therapyLong term antibioticsLong term damage to urinary tract
IncontinencePain with voidingObstruction
![Page 7: Debbie Petersen, RN, MSN Sandra Bond, RN, BSN. Objectives Understanding why prevention is key to the success and management of a rehabilitation patient.](https://reader038.fdocuments.net/reader038/viewer/2022110402/56649e4c5503460f94b42382/html5/thumbnails/7.jpg)
Deep Vein Thrombosis/Pulmonary EmbolusWhy PreventPainTherapy limited for a period of timeRisk for further complications
Pulmonary Embolus-In 90% of the cases of PE the thrombosis originates in the deep veins of the legs www.dvt.org
Death- 80% of the PEs occur without signs and 2/3 of the deaths occur within 30 minute www.dvt.org s
Anticoagulant medications- Long term up to 3 months
IVC filter- procedure riskVessel Wall damage
![Page 8: Debbie Petersen, RN, MSN Sandra Bond, RN, BSN. Objectives Understanding why prevention is key to the success and management of a rehabilitation patient.](https://reader038.fdocuments.net/reader038/viewer/2022110402/56649e4c5503460f94b42382/html5/thumbnails/8.jpg)
Deep Vein Thrombosis/Pulmonary EmbolusInterventions to preventInitial assessment to identify risk
MobilityType of surgery/injury/disease processAgeBMIProlonged bed restHistory of DVT/PE
![Page 9: Debbie Petersen, RN, MSN Sandra Bond, RN, BSN. Objectives Understanding why prevention is key to the success and management of a rehabilitation patient.](https://reader038.fdocuments.net/reader038/viewer/2022110402/56649e4c5503460f94b42382/html5/thumbnails/9.jpg)
Deep Vein Thrombosis/Pulmonary EmbolusInterventions to preventAppropriate intervention
Pharmacological prophylaxis Already on- stay on same/change Need to start
Heparin Coumadin LMW heparin: Lovenox Other pharmacological intervention: Dextran; Aspirin
Contraindicated GI bleed/hemorrhage Recent surgery Bleeding disorder History of HIT
![Page 10: Debbie Petersen, RN, MSN Sandra Bond, RN, BSN. Objectives Understanding why prevention is key to the success and management of a rehabilitation patient.](https://reader038.fdocuments.net/reader038/viewer/2022110402/56649e4c5503460f94b42382/html5/thumbnails/10.jpg)
Deep Vein Thrombosis/Pulmonary EmbolusInterventions to preventOther methods of prophylaxis
SCDsFoot pumpsTEDs- knee hi is preferred
MobilityExercises while in bed/sittingEARLY detection
![Page 11: Debbie Petersen, RN, MSN Sandra Bond, RN, BSN. Objectives Understanding why prevention is key to the success and management of a rehabilitation patient.](https://reader038.fdocuments.net/reader038/viewer/2022110402/56649e4c5503460f94b42382/html5/thumbnails/11.jpg)
Deep Vein Thrombosis/Pulmonary EmbolusInterventions to preventDaily assessment for:
Calf tendernessPositive Homans’ sign- resistance in the
calf/popliteal area with dorsiflexionSwellingIncreased LE painDyspneaPleurtitic chest painCoughHemoptysis
![Page 12: Debbie Petersen, RN, MSN Sandra Bond, RN, BSN. Objectives Understanding why prevention is key to the success and management of a rehabilitation patient.](https://reader038.fdocuments.net/reader038/viewer/2022110402/56649e4c5503460f94b42382/html5/thumbnails/12.jpg)
Deep Vein Thrombosis/Pulmonary EmbolusInterventions to preventEarly diagnosis with any Signs and symptoms
UltrasoundD-DimerV/Q scan; Spiral CT
Start intervention timely if DVT identifiedIV Heparin gtt
Transfer to acute care if PE identified
![Page 13: Debbie Petersen, RN, MSN Sandra Bond, RN, BSN. Objectives Understanding why prevention is key to the success and management of a rehabilitation patient.](https://reader038.fdocuments.net/reader038/viewer/2022110402/56649e4c5503460f94b42382/html5/thumbnails/13.jpg)
Deep Vein Thrombosis/Pulmonary EmbolusBarriers to Discharge HomeDelay in progress due to Medical Hold or
acute care admissionLong Term medications that require ongoing
managementPotential for surgical intervention
![Page 14: Debbie Petersen, RN, MSN Sandra Bond, RN, BSN. Objectives Understanding why prevention is key to the success and management of a rehabilitation patient.](https://reader038.fdocuments.net/reader038/viewer/2022110402/56649e4c5503460f94b42382/html5/thumbnails/14.jpg)
ContracturesWhy PreventLimits functionPainPermanent shortening of a muscleDeformityJoints immobileSwellingPoor circulationPressure ulcersDifficult transfers
![Page 15: Debbie Petersen, RN, MSN Sandra Bond, RN, BSN. Objectives Understanding why prevention is key to the success and management of a rehabilitation patient.](https://reader038.fdocuments.net/reader038/viewer/2022110402/56649e4c5503460f94b42382/html5/thumbnails/15.jpg)
ContracturesInterventions to PreventResults from unmoved jointsPrevention begins on the day of the injuryPrevention is critical- muscle not used loses
10-15% of its strength each week (Contractures; The Research and Training Center on Independent Living)
At least daily Range of Motion movements of each muscle
![Page 16: Debbie Petersen, RN, MSN Sandra Bond, RN, BSN. Objectives Understanding why prevention is key to the success and management of a rehabilitation patient.](https://reader038.fdocuments.net/reader038/viewer/2022110402/56649e4c5503460f94b42382/html5/thumbnails/16.jpg)
ContracturesInterventions to PreventProlonged stretch to reverse or “treat” a
developing contractureSerial castingSplintingHeat helps
Proper postureGood back supportProper joint positioning
![Page 17: Debbie Petersen, RN, MSN Sandra Bond, RN, BSN. Objectives Understanding why prevention is key to the success and management of a rehabilitation patient.](https://reader038.fdocuments.net/reader038/viewer/2022110402/56649e4c5503460f94b42382/html5/thumbnails/17.jpg)
ContracturesInterventions to PreventIf spasticity is a problem include weight
bearing exercise to strengthen the musclesAvoid skin breakdownSurgery to lengthen tendons but will not
lengthen the thickest part of the muscle
![Page 18: Debbie Petersen, RN, MSN Sandra Bond, RN, BSN. Objectives Understanding why prevention is key to the success and management of a rehabilitation patient.](https://reader038.fdocuments.net/reader038/viewer/2022110402/56649e4c5503460f94b42382/html5/thumbnails/18.jpg)
ContracturesBarriers to discharge homeIncreased difficulty with transfersIncreased difficulty with all careDecreased independence
![Page 19: Debbie Petersen, RN, MSN Sandra Bond, RN, BSN. Objectives Understanding why prevention is key to the success and management of a rehabilitation patient.](https://reader038.fdocuments.net/reader038/viewer/2022110402/56649e4c5503460f94b42382/html5/thumbnails/19.jpg)
InfectionsInfections that most impact the rehabilitation
patientMRSAC-DiffPneumoniaWoundUTI and CAUTICLABSISepsisCRE
![Page 20: Debbie Petersen, RN, MSN Sandra Bond, RN, BSN. Objectives Understanding why prevention is key to the success and management of a rehabilitation patient.](https://reader038.fdocuments.net/reader038/viewer/2022110402/56649e4c5503460f94b42382/html5/thumbnails/20.jpg)
InfectionsWhy preventPainLethargyLimits participation in therapyAntibiotic treatmentIncreased LOS
![Page 21: Debbie Petersen, RN, MSN Sandra Bond, RN, BSN. Objectives Understanding why prevention is key to the success and management of a rehabilitation patient.](https://reader038.fdocuments.net/reader038/viewer/2022110402/56649e4c5503460f94b42382/html5/thumbnails/21.jpg)
InfectionsInterventions to preventHand washingPPEIsolationMRSA surveillanceEarly identificationPatient/Family education
![Page 22: Debbie Petersen, RN, MSN Sandra Bond, RN, BSN. Objectives Understanding why prevention is key to the success and management of a rehabilitation patient.](https://reader038.fdocuments.net/reader038/viewer/2022110402/56649e4c5503460f94b42382/html5/thumbnails/22.jpg)
VISITORS
1CHECK with the NURSE before entering the room
2NO Children in the room
3Wash hands before leaving the room
STAFF
Wash hands before/after pt.
contact
Gown/Gloves when in contact with body fluids
Mask when in room- if necessary-check with nurse
Patient
Wash hands before leaving room
Gown/Mask when leaving room if necessary
Meals and therapy in room if draining wound/incontinent; check with nurse
![Page 23: Debbie Petersen, RN, MSN Sandra Bond, RN, BSN. Objectives Understanding why prevention is key to the success and management of a rehabilitation patient.](https://reader038.fdocuments.net/reader038/viewer/2022110402/56649e4c5503460f94b42382/html5/thumbnails/23.jpg)
InfectionsInterventions to preventAseptic technique
Wound careFoley cathetersCentral Line care
Good perineal careQuickly identify signs and symptoms of sepsis
ConfusionFeverTachycardiaLow blood pressure
![Page 24: Debbie Petersen, RN, MSN Sandra Bond, RN, BSN. Objectives Understanding why prevention is key to the success and management of a rehabilitation patient.](https://reader038.fdocuments.net/reader038/viewer/2022110402/56649e4c5503460f94b42382/html5/thumbnails/24.jpg)
InfectionsBarriers to Discharge homeIncreased LOSLong Term IV AntibioticsDecreased strengthDecrease Independence
![Page 25: Debbie Petersen, RN, MSN Sandra Bond, RN, BSN. Objectives Understanding why prevention is key to the success and management of a rehabilitation patient.](https://reader038.fdocuments.net/reader038/viewer/2022110402/56649e4c5503460f94b42382/html5/thumbnails/25.jpg)
Wound Care ComplicationsWhy Prevent
Decreased MobilityPainIncrease LOSIncreased FatigueIncrease Morbidity and Mortality
![Page 26: Debbie Petersen, RN, MSN Sandra Bond, RN, BSN. Objectives Understanding why prevention is key to the success and management of a rehabilitation patient.](https://reader038.fdocuments.net/reader038/viewer/2022110402/56649e4c5503460f94b42382/html5/thumbnails/26.jpg)
Wound Care ComplicationsInterventions to prevent
Early recognition- assess skin frequently Immobility Neuropathic Disease Arterial Inflow Disease End stage Renal Disease Systemic Infection
![Page 27: Debbie Petersen, RN, MSN Sandra Bond, RN, BSN. Objectives Understanding why prevention is key to the success and management of a rehabilitation patient.](https://reader038.fdocuments.net/reader038/viewer/2022110402/56649e4c5503460f94b42382/html5/thumbnails/27.jpg)
Wound Care ComplicationsInterventions to prevent
Early Intervention Positioning every 2 hours Prevent friction injury Get patient out of bed as soon as possible Float heels Perform range of motion exercises Keep skin dry, decrease moistureDevices such as heel boots, air mattress
![Page 28: Debbie Petersen, RN, MSN Sandra Bond, RN, BSN. Objectives Understanding why prevention is key to the success and management of a rehabilitation patient.](https://reader038.fdocuments.net/reader038/viewer/2022110402/56649e4c5503460f94b42382/html5/thumbnails/28.jpg)
Wound Care ComplicationsInterventions to prevent
Infection Control Medical Management
Nutritional Management High Protein foods will promote healing Adequate Hydration
![Page 29: Debbie Petersen, RN, MSN Sandra Bond, RN, BSN. Objectives Understanding why prevention is key to the success and management of a rehabilitation patient.](https://reader038.fdocuments.net/reader038/viewer/2022110402/56649e4c5503460f94b42382/html5/thumbnails/29.jpg)
Wound Care ComplicationsBarriers to progress and discharge homeWound complications can result in delay of
patient getting home.Wound vacuum can result in Skilled Facility
PlacementPain Increase LOSLong Term IV Antibiotic Use
![Page 30: Debbie Petersen, RN, MSN Sandra Bond, RN, BSN. Objectives Understanding why prevention is key to the success and management of a rehabilitation patient.](https://reader038.fdocuments.net/reader038/viewer/2022110402/56649e4c5503460f94b42382/html5/thumbnails/30.jpg)
HypotensionHypotension is defined as abnormally low
blood pressureCauses
DehydrationBeta BlockersDecreased Cardiac OutputDiureticsHemorrhage
![Page 31: Debbie Petersen, RN, MSN Sandra Bond, RN, BSN. Objectives Understanding why prevention is key to the success and management of a rehabilitation patient.](https://reader038.fdocuments.net/reader038/viewer/2022110402/56649e4c5503460f94b42382/html5/thumbnails/31.jpg)
HypotensionWhy Prevent
ComplicationsDecrease ImmobilityDizzinessSeizuresFainting
![Page 32: Debbie Petersen, RN, MSN Sandra Bond, RN, BSN. Objectives Understanding why prevention is key to the success and management of a rehabilitation patient.](https://reader038.fdocuments.net/reader038/viewer/2022110402/56649e4c5503460f94b42382/html5/thumbnails/32.jpg)
HypotensionInterventions to prevent
Increase fluid intakeIV fluidsTilt TableMedical Management
![Page 33: Debbie Petersen, RN, MSN Sandra Bond, RN, BSN. Objectives Understanding why prevention is key to the success and management of a rehabilitation patient.](https://reader038.fdocuments.net/reader038/viewer/2022110402/56649e4c5503460f94b42382/html5/thumbnails/33.jpg)
HypotensionBarriers to progress and discharge home Increased LOS Inability to participate in therapy treatments Increase fatigue Decreased strength
![Page 34: Debbie Petersen, RN, MSN Sandra Bond, RN, BSN. Objectives Understanding why prevention is key to the success and management of a rehabilitation patient.](https://reader038.fdocuments.net/reader038/viewer/2022110402/56649e4c5503460f94b42382/html5/thumbnails/34.jpg)
Central Line Catheters ComplicationsWhy Prevent (What to Prevent)
Migration of Catheter Tip into the heartPinch-off Syndrome
The anatomic, mechanical compression of a catheter as it passes between the clavicle and first rib at the costoclavicular space
OcclusionsInfections
Increased LOSIncrease incidence in severe medical
complications
![Page 35: Debbie Petersen, RN, MSN Sandra Bond, RN, BSN. Objectives Understanding why prevention is key to the success and management of a rehabilitation patient.](https://reader038.fdocuments.net/reader038/viewer/2022110402/56649e4c5503460f94b42382/html5/thumbnails/35.jpg)
Center Line Catheters Complications
Pinch-Off Syndrome
Image from Oncology Nursing Society, Access Device Guidelines, 2011
![Page 36: Debbie Petersen, RN, MSN Sandra Bond, RN, BSN. Objectives Understanding why prevention is key to the success and management of a rehabilitation patient.](https://reader038.fdocuments.net/reader038/viewer/2022110402/56649e4c5503460f94b42382/html5/thumbnails/36.jpg)
Central Line Catheters ComplicationsInterventions to prevent
MigrationNon-invasive: Patient repositionInvasive: Remove catheter, Surgical reposition
port, fluoroscopic catheter guidance.Pinch-off Syndrome
Surgical Intervention – Removal of Catheter
![Page 37: Debbie Petersen, RN, MSN Sandra Bond, RN, BSN. Objectives Understanding why prevention is key to the success and management of a rehabilitation patient.](https://reader038.fdocuments.net/reader038/viewer/2022110402/56649e4c5503460f94b42382/html5/thumbnails/37.jpg)
Central Line Catheters ComplicationsInterventions to prevent
OcclusionsAdequate flushes with normal saline and
locking with low dose heparin solution routinely and after catheter use.
Oral low-dose warfarin has been shown to decrease the rate of catheter related thrombosis but may increase the patient’s risk of bleeding (Currently this is not recommended.
Routine locking with thrombolytics such as high-dose heparin and tissue plasminogen activator (tPA) requires more research.
![Page 38: Debbie Petersen, RN, MSN Sandra Bond, RN, BSN. Objectives Understanding why prevention is key to the success and management of a rehabilitation patient.](https://reader038.fdocuments.net/reader038/viewer/2022110402/56649e4c5503460f94b42382/html5/thumbnails/38.jpg)
Fibrin TailFibrin tail with “initial” attachment on the outside of catheter, allowing for “trap door” effect and demonstration of partial withdraw occlusion; ability to flush easily but no blood return when attempting to aspirate
![Page 39: Debbie Petersen, RN, MSN Sandra Bond, RN, BSN. Objectives Understanding why prevention is key to the success and management of a rehabilitation patient.](https://reader038.fdocuments.net/reader038/viewer/2022110402/56649e4c5503460f94b42382/html5/thumbnails/39.jpg)
Central Line Catheters ComplicationsInterventions to prevent
OcclusionsFlush the catheter with normal saline gently
using the push-pull method.Reposition the patient.Ask the patient to cough and deep breathPerform tPA treatmentPerform fibrin sheath removal in interventional
radiology.
![Page 40: Debbie Petersen, RN, MSN Sandra Bond, RN, BSN. Objectives Understanding why prevention is key to the success and management of a rehabilitation patient.](https://reader038.fdocuments.net/reader038/viewer/2022110402/56649e4c5503460f94b42382/html5/thumbnails/40.jpg)
Central Line Catheters ComplicationsInterventions to prevent
InfectionsFrequent hand washing before and after all Catheter
care.Routine surveillance for infectionPatient and caregiver educationAdministration of pre-placement antibiotic is not
effective in preventing catheter-related infections (CDC, 2007)
Co-morbid diseases such as diabetes or chronic obstructive pulmonary disease or those on corticosteroid therapy can be predispose a patient to infection.
Treatment includes IV antibotics and catheter removal.
![Page 41: Debbie Petersen, RN, MSN Sandra Bond, RN, BSN. Objectives Understanding why prevention is key to the success and management of a rehabilitation patient.](https://reader038.fdocuments.net/reader038/viewer/2022110402/56649e4c5503460f94b42382/html5/thumbnails/41.jpg)
Central Line CathetersBarriers to Discharge
Invasive Medical TreatmentIV antibioticsPainIncrease LOS
![Page 42: Debbie Petersen, RN, MSN Sandra Bond, RN, BSN. Objectives Understanding why prevention is key to the success and management of a rehabilitation patient.](https://reader038.fdocuments.net/reader038/viewer/2022110402/56649e4c5503460f94b42382/html5/thumbnails/42.jpg)
Constipation
Constipation is defined at going longer than three days without a bowel movement.
Constipation is a preventable side effect of medication and immobility.
![Page 43: Debbie Petersen, RN, MSN Sandra Bond, RN, BSN. Objectives Understanding why prevention is key to the success and management of a rehabilitation patient.](https://reader038.fdocuments.net/reader038/viewer/2022110402/56649e4c5503460f94b42382/html5/thumbnails/43.jpg)
Constipation Why Prevent
Causes Medicines (Narcotics, Antidepressants, or iron
pills)Spinal Cord InjuryImmobilityDehydration
Neurological Conditions (Parkinson’s Disease) Complications
PainIncreased ImmobilityLoss of Appetite
![Page 44: Debbie Petersen, RN, MSN Sandra Bond, RN, BSN. Objectives Understanding why prevention is key to the success and management of a rehabilitation patient.](https://reader038.fdocuments.net/reader038/viewer/2022110402/56649e4c5503460f94b42382/html5/thumbnails/44.jpg)
Constipation Interventions to Prevent
Diet and Lifestyle ChangesHigh-Fiber DietRegular exerciseAdequate fluid intake
LaxativesFiber Supplements, Stimulants, Lubricants,
Stool softeners, Osmotics, Saline laxatives Procedures
Manual ProceduresSurgical Procedures
![Page 45: Debbie Petersen, RN, MSN Sandra Bond, RN, BSN. Objectives Understanding why prevention is key to the success and management of a rehabilitation patient.](https://reader038.fdocuments.net/reader038/viewer/2022110402/56649e4c5503460f94b42382/html5/thumbnails/45.jpg)
Constipation Barriers to Discharge
Increase LOSPain
![Page 46: Debbie Petersen, RN, MSN Sandra Bond, RN, BSN. Objectives Understanding why prevention is key to the success and management of a rehabilitation patient.](https://reader038.fdocuments.net/reader038/viewer/2022110402/56649e4c5503460f94b42382/html5/thumbnails/46.jpg)
SummaryComplications can result in multiple Length
of Stay delays for rehabilitation patients.Early Recognition and Early Intervention can
reduced overall impact of a complication.
![Page 47: Debbie Petersen, RN, MSN Sandra Bond, RN, BSN. Objectives Understanding why prevention is key to the success and management of a rehabilitation patient.](https://reader038.fdocuments.net/reader038/viewer/2022110402/56649e4c5503460f94b42382/html5/thumbnails/47.jpg)
![Page 48: Debbie Petersen, RN, MSN Sandra Bond, RN, BSN. Objectives Understanding why prevention is key to the success and management of a rehabilitation patient.](https://reader038.fdocuments.net/reader038/viewer/2022110402/56649e4c5503460f94b42382/html5/thumbnails/48.jpg)
Thank You
![Page 49: Debbie Petersen, RN, MSN Sandra Bond, RN, BSN. Objectives Understanding why prevention is key to the success and management of a rehabilitation patient.](https://reader038.fdocuments.net/reader038/viewer/2022110402/56649e4c5503460f94b42382/html5/thumbnails/49.jpg)
Questions