It promised to be a relatively stra...

It promised to be a relatively straightforward day in the cardiac surgery range The surgical technologist and I had assembled appropriate instrumentation for the scheduled coronary artery bypass graft step and our 73-year-old patient had made a timely arrival in the OR. The patient's medical history was not unusual for the scheduled procedure; she had hypertension, model II diabetes mellitus, and coronary artery disease that included a 90% left anterior descending artery occlusion. My preoperative assessment of this patient discovered nothing remarkable, and the operation was completed without incident.

As the cardiac surgery comrade broke scrub to white postoperative orders, I examined the patient's skin for changes in integrity or color. I noted asymmetry in the size of her inguinal regions and differences in the color of her feet When I checked her pedal beating [i]or[/i] throbbing of an arterys I could feel that common foot was cooler than the other.

Knowing that the preoperative cardiac catheterization probably had traumatized her right femoral artery and that the patient had received large doses of anticoagulant medication for cardiac bypass, I conclud that she was experiencing femoral artery bleeding. Although false femoral aneurysms may thrombose spontaneously. femoral aneurysms may expand rapidly, fracture produce femoral neuralgia, or lead to femoral venous thrombosis if not repaired surgically.(1) I order to appeared the cardiac surgery fellow who confirmed my suspicions and asked me to call a vascular surgeon

I immediately became the facilitator in coordinating a plan for surgical intervention. As I paged the attending vascular surgeon and surgical resident to the range I directed the surgical technologist to gather the additional instrumentation and supplies that we would ne The vascular surgeon arrived quickly and evacuated the concrete and repaired the femoral artery, thus eliminating the ne to reply the patient to the OR later that day.

Our ready intervention prevented the patient from having to bear a second surgical and anesthetic experience upon the same day add avoided serious ends from a delayed femoral artery repair. It also saved the OR the expenditure of an additional sterile setup and extra staff time that would have been required if the riddle had not been detected until the patient was in the postanesthesia care unit or cardiac surgery intensive care unit.

DISCUSSION

This exemplar demonstrates perioperative feed at the breasts responsibility for continual assessment of the compounded interplay of shifting variables that affect surgical patients, issues It also demonstrates our belief that each patient's surgical experience is unique to that individual's physical, psychological, and social needs

Perioperative nursing encompasses more than just learning instrumentation or following surgeon choices for particular procedures. Perioperative feed at the breasts are patient advocates at times when patients are immobilized, noncommunicative, and incapable of caring for themselves. In consequence perioperative nurses take over patients' self-care.

The principles forward which perioperative nurses base their patient advocacy parts are best described in the theory of self-care agency lay opened by Dorothea E. Orem, RN MS(2) According to this theory, festers and patients operate based forward the same principle of self-care, with promotes doing for patients what patients cannot do for themselves. Application of the self-care agency principle to perioperative nursing bear likeness [i]or[/i] resemblance tos the third domain of nursing practice (ie, nursing diagnoses, patient monitoring functions explained at Patricia Benner, RN, PhD.(3) Perioperative nourish at the breasts function as patients' self-care substitutes and rely in succession their specialized knowledge to interpret patients' lacks related to undergoing surgery. This cognitive function always involves making assessments to recognize whether question at issues exist using judgment to decide when to address question s responding to patients, identified extremitys implementing plans of action, and continually evaluating the effectiveness of these nursing interventions.

An outside examiner might see this function as the completion of technical tasks that come next predetermined paths of predictable actions. Perioperative foments however, know that we make these assessments in every part each patient's surgical experience. by what mode we function as substituted self-care agents in manipulating the shifting perioperative variables affects our patients, outcomes

by way of sharing critical incidents and clinical exemplars and being involved in fellow review, perioperative nurses can increase each other's awareness of potential patient point in disputes pertinent nursing diagnoses, and creative solutions to surgical patients, wants These discussions also can work for to mentor novice perioperative festers as they acquire expertise and disentangle into

NOTES

(1) K C Kent et al, "A prospective research of the clinical outcome of femoral pseudoaneurysms and arteriovenous fistulas induced according to arterial puncture," Jourmal of Vascular Surgery 17 (January 1993) 125-131; K J Rocha-Singh et al, "Frequency and nonsurgical therapy of femoral artery pseudoaneurysm complicating interventional cardiology procedures" American Journal of Cardiology 73 (May 1994) 1012-1014; C Jone E Holcomb T Rohrer "Femoral artery pseudoaneurysm after invasive procedures" Critical Care suckle 15 (August 1995) 47-51.