Week 1 Respond to 2 students post

Week 1: Pre-Operative Assessment, Post-Operative Care, and Hospital Admission
Tutor look for the 2 students post at the end of the attach, my discussion is sent in another attach apart.
Respond to at least two of your colleagues on two different days by sharing what the patient education needs and informed consent for one of the planned procedures would be.

Learning Objectives

Students will:
• Develop risk stratification for patients undergoing invasive procedures
• Diagnose and intervene with perioperative complications
• Explain the impact of risk stratification on patient education and informed consent

For this Assignment help – Discussion, student will consider risk stratification in the preoperative environment.

To prepare:
• Review the risk stratification video in this week’s Learning Resources. Check the links below, please.

Barkley, T. W., Jr. (2021). Practice considerations for adult-gerontology acute care nurse practitioners (3rd ed.). Barkley & Associates.
• Ch. 85, “Hospital Admission Considerations”
• Ch. 86, “Managing the Surgical Patient”

https://depts.washington.edu/bhdept/ethics-medicine/bioethics-topics/detail/67

https://depts.washington.edu/bhdept/ethics-medicine/bioethics-topics/detail/67

You will receive a set of patient scenarios from your Instructor. Review each of the three patient scenarios provided. Identify each patient as high, intermediate, or low risk.
• Consider patient education needs and strategies for each patient, as well as what the informed consent for each procedure would be.

By Day 3 of Week 1
Post your assessment of which level of risk each patient in the case scenarios corresponds with (high, intermediate, or low). Explain the rationale for your decision-making.

Make your post using the 3 scenarios below
SCENARIOS BEGIN HERE: PLEASE REVIEW FOR THE DISCUSSION:

Please review the (3) case scenarios to use for the Week 1 Assignment help – Discussion:

• A 60-year-old female with no previous cardiac history, except for preoperative for stratification for a new murmur, is sent to you. An echocardiogram is performed demonstrating an ejection fraction of 60%, and severe aortic stenosis. Her proposed surgery is a total knee replacement.
• A 25-year-old male is sent to you for preoperative risk stratification. His proposed surgery is an emergency cholecystectomy. He is active and has no exertional symptoms playing basketball for over an hour 3 times weekly. He has no previous cardiac, medical, or surgical history.
• A 75-year-old female with history of coronary artery disease with previous CABG and PCI, hypertension, and hyperlipidemia is sent to you for preoperative risk stratification. Her proposed surgery is hip replacement. You are unable to assess her functional status due to hip pain, which renders her mobility challenged. Her previous echocardiogram demonstrates an ejection fraction of 55–60% with no wall motion abnormality. She has no active anginal or exertional symptoms.
Assignment help – Discussion: Risk Stratification

Risk stratification is an important technique that allows patients to be classified according to their health risk status, taking into consideration many factors, such as diagnosis, age, BMI, comorbidities, labs and other assessment scores, health behaviors and health literacy, and social and caregiver support needs, to name a few. Utilizing such a framework or model can be used not only to identify patient-specific risks to refine treatment plants, but can also be applied to improve workflows, better manage population health, and effectively use resources.
For this Assignment help – Discussion, you will consider risk stratification in the preoperative environment.
To prepare:
• Review the risk stratification video in this week’s Learning Resources.
• You will receive a set of patient scenarios from your Instructor. Review each of the three patient scenarios provided. Identify each patient as high, intermediate, or low risk.
• Consider patient education needs and strategies for each patient, as well as what the informed consent for each procedure would be.
By Day 3 of Week 1
Post your assessment of which level of risk each patient in the case scenarios corresponds with (high, intermediate, or low). Explain the rationale for your decision-making.

Rubric Detail for grading

Select Grid View or List View to change the rubric’s layout.
Name: NRNP_6560_Week1_Assignment help – Discussion_Rubric

• Grid View
Excellent
Point range: 90–100 Fair
Point range: 70–79 Poor
Point range: 0–69
Main Posting:

Response to the discussion question is reflective with critical analysis and synthesis representative of knowledge gained from the course readings for the module and current credible sources. 40 (40%) – 44 (44%)
Thoroughly responds to the discussion question(s).

Is reflective with critical analysis and synthesis representative of knowledge gained from the course readings for the module and current credible sources.

No less than 75% of post has exceptional depth and breadth.

Supported by at least 3 current credible sources. 31 (31%) – 34 (34%)
Responds to some of the discussion question(s).

One to two criteria are not addressed or are superficially addressed.

Is somewhat lacking reflection and critical analysis and synthesis.

Somewhat represents knowledge gained from the course readings for the module.

Post is cited with fewer than 2 credible references. 0 (0%) – 30 (30%)
Does not respond to the discussion question(s).

Lacks depth or superficially addresses criteria.

Lacks reflection and critical analysis and synthesis.

Does not represent knowledge gained from the course readings for the module.

Contains only 1 or no credible references.
Main Posting:

Writing 6 (6%) – 6 (6%)
Written clearly and concisely.

Contains no grammatical or spelling errors.

Further adheres to current Help write my thesis – APA manual writing rules and style. 4 (4%) – 4 (4%)
Written somewhat concisely.

May contain more than two spelling or grammatical errors.

Response exhibits critical thinking and application to practice settings.

Responds to questions posed by faculty.

The use of scholarly sources to support ideas demonstrates synthesis and understanding of learning objectives. 7 (7%) – 7 (7%)
Response is on topic, may have some depth. 0 (0%) – 6 (6%)
Response may not be on topic, lacks depth.
First Response:

Writing 6 (6%) – 6 (6%)
Communication is professional and respectful to colleagues.

Response to faculty questions are fully answered, if posed.

Provides clear, concise opinions and ideas that are supported by two or more credible sources.

Response is effectively written in Standard, Edited English.
First Response:

Timely and full participation 5 (5%) – 5 (5%)
Meets requirements for timely, full, and active participation.

Posts by due date.
Second Response:

Post to colleague’s main post that is reflective and justified with credible sources. 9 (9%) – 9 (9%)
Response exhibits critical thinking and application to practice settings.

Responds to questions posed by faculty.

The use of scholarly sources to support ideas demonstrates synthesis and understanding of learning objectives.
Second Response:

Writing 6 (6%) – 6 (6%)
Communication is professional and respectful to colleagues.

Response to faculty questions are fully answered, if posed.

Provides clear, concise opinions and ideas that are supported by two or more credible sources.

Response is effectively written in Standard, Edited English.
Second Response:
Timely and full participation 5 (5%) – 5 (5%)
Meets requirements for timely, full, and active participation.

Posts by due date.
Total Points: 100
Name: NRNP_6560_Week1_Assignment help – Discussion_Rubric

Student #1 J H ‘discussion tutor to respond

The main topic of conversation this week is risk stratification for three patients who need different kinds of surgery. Each of these patients’ risk levels will be figured out, and their learning needs will be talked about, so that they can give “informed consent” for their surgeries.
The first patient is a 60-year-old woman who has never had heart problems before. She wants a total knee replacement, but an echocardiogram showed that she has a new heart murmur that is caused by severe aortic stenosis (AS). With an ejection fraction of 60%, the echocardiogram did show that her heart is working well as a whole. But severe aortic stenosis can cause sudden death syndrome and other terrible problems during anesthesia and recovery. This person has a high risk of complications during surgery (ACC/AHA, Class III). Even though a total knee replacement is a surgery with a moderate risk, the patient’s severe AS makes it a high-risk surgery. Sing and Zelster (2021) say that a patient’s procedure shouldn’t be put off because of severe aortic stenosis. However, the patient should be told about the risks of getting anesthesia with a tight aortic valve. No one knows how bad this patient’s AS symptoms are, but the stress of anesthesia and the huge fluid shifts that can happen between the vascular system and tissue during and after surgery mean that this patient is at a high risk for complications with this moderate-risk surgery. This writer would tell the patient about the risks of an elective knee replacement with a stenosed aortic valve and suggest that a transcatheter aortic valve replacement (TAVR) be done before the knee surgery. Due to the need for dual antiplatelet therapy after the valve replacement, TAVR would delay the patient’s knee surgery by six months. However, it would prevent death from AS. The patient would also be told that if they want to go on without fixing their aortic valve, there is a good chance that the anesthesia team would refuse to do the surgery because of her severe AS. For the patient to give informed consent, he or she needs to know all of this.
The second person is a man who is 25 years old and needs a cholecystectomy right away. The patient has an active lifestyle, which includes playing basketball for more than an hour three times a week. The patient has no history of heart problems, medical problems, or surgeries. This patient is very active. He can play basketball for more than an hour a day, three times a week, which gives him a functional class I rating (Williams et al., 2017). With a score of 0 on the Lees Revised Cardiac Risk Index, this person has a low risk of surgery and heart problems. Also, ACC/AHA Guidelines say that this person is in Class I, which means that the benefits of surgery outweigh the risks. This patient’s (likely laparoscopic) cholecystectomy is considered to have an intermediate risk because it is an emergency surgery that goes into the peritoneum. This person doesn’t need any more tests before they can have surgery. The patient would be told about the risks of the surgery, such as the risks of general anesthesia and the risks of the surgery itself. They would also be told about the risks of not having the surgery, such as a possible rupture, infection, and severe pain from an inflamed gall bladder.
The third person who might need surgery is a 75-year-old woman who has had a CABG and a PCI in the past. She has a lot of hip pain and wants hip replacement surgery. No one knows when these heart procedures were done on this person. Still, because of this history, the patient is at intermediate risk for surgery and a Class IIa ACC/AHA risk for surgery, meaning that it is reasonable to perform. Given the patient’s heart history, this provider would make sure that this person is taking a statin and a beta-blocker before their surgery. There isn’t enough information about this patient to know if he or she is healthy enough for surgery or if more testing needs to be done. This provider would recommend further testing, including a chemical cardiac stress test as this patient’s functional capacity cannot be evaluated due to this patient’s hip pain and inability to walk. If the patient’s cardiac history is remote and they are genuinely asymptomatic, and their echocardiogram recent, a stress test would not be needed (Garner, Pomery & Arnold, 2017) but this information is unknown. This patient is at an intermediate risk for surgery given her cardiac history. The surgery itself is an intermediate-risk surgery. This patient should be educated on the risks including her 0.9% risk of a myocardial infarct, pulmonary embolism, ventricular fibrillation, cardiac arrest or complete heart block or MACE event which is based off of her history and could be higher if her creatine level and diabetes status where known (Cohn & Fleisher, 2021). This provider would educate this patient to the risks of this intermediate risk procedure and encourage this patient to have a creatinine drawn and undergo a chemical stress test to ensure that the patient’s body can withstand the 4 METs of work it takes to survive anesthesia as this patient appears to be very deconditioned from their hip pain and their cardiac history. After that testing, the patient would have a clearer idea of the risks for this elective hip surgery. The stress test would also provide vital information for the anesthesia team to use in caring for this patient intraoperatively.
The three patients discussed here all have different surgical risk factors and require different education and considerations. Ultimately, it is the patient’s decision if they want to assume the risk of surgery in most cases but it is the provider’s job to ensure that they are informed of the risks versus the benefits so they can provide truly informed consent.

Resources
Cohn, S., & Fleisher, L. (2021). Evaluation of cardiac risk prior to noncardiac surgery.
Retrieved from https://www.uptodate.com/contents/evaluation-of-cardiac-risk-prior-to-
noncardiac-surgery
Garner, K. K., Pomeroy, W., & Arnold , J. J. (2017). Exercise Stress Testing: Indications and
Common Questions. Am Fam Physician, 95(5), 293-299. Retrieved from
https://www.aafp.org/afp/2017/0901/afp20170901p293.pdf
Singh, S, & Zeltser, R. Cardiac Risk Stratification. (2021). In: StatPearls [Internet]. Treasure
Island (FL): StatPearls Publishing; 2021 Jan-. Available
from: https://www.ncbi.nlm.nih.gov/books/NBK507785/
Williams, B. A., Doddamani, S., Troup, M. A., Mowery, A. L., Kline, C. M., Gerringer, J. A., &
Faillace, R. T. (2017). Agreement between heart failure patients and providers in
assessing New York Heart Association functional class. Heart & Lung – The Journal of
Acute and Critical Care, 46(4), 293–299. https://doi-
org.ezp.waldenulibrary.org/10.1016/j.hrtlng.2017.05.001

Student # 2 S J Assignment help – Discussion tutor to respond
COLLAPSE

A 60-year-old female with no previous cardiac history, except for preoperative for stratification for a new murmur, is sent to you. An echocardiogram is performed demonstrating an ejection fraction of 60%, and severe aortic stenosis. Her proposed surgery is a total knee replacement.
The American College of Cardiology/American Heart Association (ACC/AHA) valvular heart disease recommendations for 2020 categorized valvular heart disease into stages A through D based on valve structure, the prevalence or absence of symptoms, the hemodynamic severity of the illness, and the implications of the valve disease on left ventricular function. According to the recommendations of the ACC/AHA, asymptomatic individuals with severe AS who do not exhibit indications of left ventricular failure may have moderate-risk procedures with careful anesthetic and postoperative supervision (Eagle & Kohnstamm, 2021).
This patient is at an intermittent risk for knee replacement surgery due to no prior cardiac history; a heart murmur was found on preop examination, which prompted the proper testing of an echocardiogram showing severe aortic stenosis with an average ejection fraction.
A knee replacement is completed in the hospital under general anesthesia. Patient education would include preop and post-op instructions as well explanation of the procedure. A nerve block may be given before surgery to enhance pain control post-surgery. After surgery, most patients spend one or two nights in the hospital. During your stay, you will be given pain relievers to assist you in coping with any discomfort caused by the surgery. Non-opioid medications will be utilized to help reduce pain wherever feasible. Some narcotic medications may be required for a few weeks, especially before physical therapy and sleep. After knee replacement surgery, blood clots in the legs are a typical risk. Get up and exercise as soon as possible to lessen the danger of blood clots – Work with your physical therapist to attempt to get up the day of or the day following surgery. Learn how to perform workouts in bed. You will take a blood thinner as a pill or an injection to avoid clots. Most patients keep taking this medication for a few weeks following surgery. You will be given compression devices to w ear that wrap around your legs and regularly inflate when resting down as well as your doctor may advise you to wear anti-embolism stockings. These stockings wrap securely around the foot, ankle, lower leg, and knee to avoid blood clots.
Another significant risk is an infection; you will be given antibiotics within an hour of the surgery and up to 24 hours after that. Eating a nutritious diet, avoiding obesity, regulating blood sugars if diabetic, and quitting smoking are all beneficial in lowering infection risk (Martin, 2022, May 17).
• A 25-year-old male is sent to you for preoperative risk stratification. His proposed surgery is an emergency cholecystectomy. He is active and has no exertional symptoms playing basketball for over an hour 3 times weekly. He has no previous cardiac, medical, or surgical history.

Although this patient is a healthy 25-year-old male with no medical or surgical history, laparoscopic cholecystectomies are considered an intermediate-risk procedure. Patient education would include explaining the procedure. There are two primary techniques for removing the gallbladder. Laparoscopic cholecystectomy involves using an extended, thin scope with a light and a tiny camera at the end to investigate the body. The surgeon makes small incisions through which the scope is introduced, while other tools are placed through the other incisions. The surgeon then performs the procedure using the scope and surgical equipment. The second option is an open procedure, occasionally necessary when the gallbladder and bile duct are too inflamed or scarred for laparoscopic surgery to be conducted safely. In open surgery, the surgeon makes a big enough incision in the belly to execute the procedure successfully (Crowley & Martin, 2022).
• A 75-year-old female with a history of coronary artery disease with previous CABG and PCI, hypertension, and hyperlipidemia is sent to you for preoperative risk stratification. Her proposed surgery is hip replacement. You are unable to assess her functional status due to hip pain, which renders her mobility challenged. Her previous echocardiogram demonstrates an ejection fraction of 55–60% with no wall motion abnormality. She has no active anginal or exertional symptoms.
A hip replacement is an arthroscopic procedure that is considered low risk. This patient has an extensive heart history with hypertension and hyperlipidemia. Her ejection fraction is within normal limits; however, you cannot access her activity tolerance due to her mobility challenges. Hip replacements are considered elective surgery. Depending on when this patient had her CABG and PCI procedures, it may be prudent to wait the appropriate amount of time before hip surgery. According to Eagle and Mukherjee, individuals who have had PCI should have elective surgeries postponed for at least six weeks, preferably 6 to 12 months, as advised by the current American College of Cardiology recommendations (2017). The patient taking blood thinners must stop before surgery due to the risk of bleeding. If the patient has had a new PCI with a stent placement procedure, they are at a greater risk of a thrombus event post-surgery. However, suppose the timeframe is appropriate and the patient can stop blood thinners. In that case, her other medications for hypertension and hyperlipidemia may be continued unless she takes an ACE or ARB inhibitor. These medications must be stopped 24 hours before surgery to prevent intraoperative hypotension (Eagle et al., 2021).
Patient education would include information preop, intra-op, and post-op. Preop instructions would consist of what medications to take and stop before surgery, when to arrive for surgery and what to expect on the day of surgery and post-op. Hip replacement surgery is conducted under general anesthesia in a hospital operating room. Your surgeon will make an incision between your outer hip and thigh. They will replace your hip joint with a prosthesis, an artificial metal hip joint. Post-op instructions include two to four days of hospital stay after surgery. Throughout your hospital stay, you will be given pain relievers, antibiotics to avoid infection, stockings, medications to prevent blood clots in the legs, and physical therapy – most patients can stand and walk with assistance within one day of surgery. The physical therapist will guide you through exercises to enhance your hip muscles. They will help you bend, walk, and climb stairs to move normally (Crowley and Martin, 2022).
References

Crowley, K., & Martin, K. A. (2022). Patient education: Gallbladder removal (cholecystectomy) (The Basics). UpToDate. https://www.uptodate.com/contents/gallbladder-removal-cholecystectomy-the-basics?search=cholecystectomy+patient+education&source=search_result&selectedTitle=1~150&usage_type=default&display_rank=1
Crowley, K., & Martin, K. A. (2022). Patient education: Hip replacement (The Basics). UpToDate. https://www.uptodate.com/contents/hip-replacement-the-basics?search=Patient%20education%20for%20hip%20replacement%20&source=search_result&selected.
Eagle, K. A., & Kohnstamm, S. (2021, September 10). Noncardiac surgery in adults with aortic stenosis. UpToDate. https://www.uptodate.com/contents/noncardiac-surgery-in-adults-with aorticstenosis?search=risk+stratification+for+patients+with+aortic+stenosisin+surgery+non+cardiac&topicRef=94539&source=see_link
Eagle, K. A., & Mukherjee, D. (2017). Prior coronary revascularization and risk of noncardiac surgery. JACC: Cardiovascular Interventions, 10(4), 339-341.
Eagle, K. A., Devereaux, P. J., & Cohn, S. L. (2021). Management of cardiac risk for noncardiac surgery. UpToDate. Retrieved from https://www.uptodate.com/contents/management-of-cardiac-risk-for-noncardiac-surgery?search=ace+inhibitors+and+surgery&source=search_result&selectedTitle=3~150&usage_type=default&display_rank=3
Martin, G. M. (2022, May 17). Patient education: Total knee replacement (Beyond the Basics). UpToDate. https://www.uptodate.com/contents/total-knee-replacement-beyond-the-basics?search=Patient+education+for+total+knee+replacement&source=search_result&selectedTitle=1~139&usage_type=default&display_rank=1#H8

Published by
Essays
View all posts