Medical Specialties Commons^™

A Systematic Analysis On Opioid-Free General Anesthesia Versus Opioid-Based General Anesthesia For Bariatric Surgery, Ina Basha

Nurse Anesthesia Student Capstones

One-third of the American adult population is considered overweight, a figure that is still on the rise. Obesity negatively impacts every organ system in the human body. When minimally invasive strategies such as life style changes fail, bariatric surgery procedures have become the other option. The purpose of this systemic analysis is to look at the outcomes of post-operative pain, post-operative nausea and vomiting (PONV), and the length of stay required in the postanesthesia care unit (PACU) in obese adults undergoing bariatric surgery using opioid-free general anesthesia compared to opioid-based general anesthesia. The studies included in this systematic analysis conclude …

Prophylactic Phenylephrine Infusion Versus Bolus Regimens During Spinal Anesthesia For Cesarean Section, Safira Iddriss

Nurse Anesthesia Student Capstones

Hypotension is a well-recognized phenomenon associated with any spinal anesthesia. It is most particularly evident in the parturients as a higher block is required for cesarean section (C-section) (Nagelhout, 2014). These populations are also more prone to the effect of sympathectomy because of decreased sensitivity to endogenous vasoconstrictors in addition to increased synthesis of endothelium vasodilators (Miller, 2009). Sympathectomy results in hypotension and other adverse effects such as nausea and vomiting. Many studies over the decades have examined the best management option for the hypotension. This review seeks to determine the best management regimen for the use of the vasopressor …

The Effects Of Pain On Informed Consent, Bryan Aja

Nurse Anesthesia Student Capstones

It is common for providers to withhold pain medication as opposed to treating pain prior to obtaining informed consent due to the concern of invalid informed consent. Pain’s influence on cognition can significantly impact the cognitive domains required to obtain valid informed consent. Determining if a patient has the capacity or competence to participate in the informed consent process has medical, ethical, and legal implications. The medical use of competence and capacity is not equivalent to the legal use of the same terminology. Legal implications concerning consent include signing consent while in duress or pain, signing under the influence of …

Utilizing Tranexamic Acid To Reduce Blood Transfusion In Hip Fractures, Katherine Balzano-Cowan, Morgan Guerrette

Nurse Anesthesia Student Capstones

Minimizing perioperative blood loss during orthopedic surgery has proven challenging for providers. Perioperative utilization of antifibrinolytic pharmacologic interventions, such as tranexamic acid (TXA), has been demonstrated as a safe and effective technique for decreasing blood loss and allogenic blood transfusion rates. Currently, the Food and Drug Administration (FDA) approved on-label indications of TXA are for use in short-term treatment of hemophilia patients undergoing dental extractions and in management of patients experiencing menorrhagia (Mayeux, Alwon, Collins, & Hewer, 2016). Despite the current limited scope of FDA approval for TXA, use in elective surgery with otherwise clotting-uncompromised patients is not a new …

Clinical Performance And The Student Registered Nurse Anesthetist, Alyson Cronan

Nurse Anesthesia Student Capstones

The clinical component of graduate nurse anesthesia programs continues to be the key factor in evaluating and ensuring student success. Clinical experience has a direct correlation on student development in areas of self-awareness, psychomotor proficiency, critical thinking and professionalism. To effectively create a positive and motivating learning environment for the student registered nurse anesthetist (SRNA), the literature recommends instructors theoretically adapt to the individual learning style of the student, and incorporate various teaching techniques and modalities clinically. The overall goal of the clinical rotation is to establish an atmosphere where an individual can modify learning and skills. Positive, respectful and …

Decreasing Cost In The Gi Endoscopy Suite By Utilizing Best Sedation Practices, Casey Brianne Mancini

Doctoral Projects

Colorectal cancer is a leading cause of cancer death in the United States (Mandel, Tanner, Lichtenstein, Metz, Katzka, Ginsberg, & Kochman, 2008; Siegel, DeSantis, & Jemal, 2014). Because this lethal disease claims lives of many people every year, more patients are undergoing screening colonoscopies, which have greatly aided in decreasing the number of colorectal cancer deaths (Siegel et al., 2014). The most common form of sedation for colonoscopies is moderate sedation with a benzodiazepine and an opioid (Cohen, Hightower, Wood, Miller, & Aisenberg, 2004; Lera dos Santos, et. al., 2013). However, sedation by anesthesia providers using propofol is becoming more …

Exploring The Effects Of Caring For Congestive Heart Failure Patients On Caregiver Well-Being: A Descriptive Study, Hanna S. Curtis

The Eleanor Mann School of Nursing Undergraduate Honors Theses

Background: As the incidence of heart failure (HF) quickly becomes the leading cause of disability among older adults, the need for non-professional, in-home caregivers increases as well. Many caregivers are family members who receive no compensation for their efforts, but all are an invaluable tool in the fight against a debilitating disease. Patients with caregivers experience an improved quality of life and lower mortality rates than patients with little social support. The caregiver of a patient with HF may be responsible for everyday activities such as housekeeping and shopping, as well as more complex disease-related necessities as managing medication …

Emergency Preparedness Competencies Among Nurses In Northwest Arkansas, Taylor A. Matlock

The Eleanor Mann School of Nursing Undergraduate Honors Theses

Despite years of training and experience, evidence suggests nurses report wide gaps in emergency competencies and disaster preparedness. Further, nurses report low levels of familiarity in competencies related to planning for disasters, implementing disaster guidelines, and assessing patients exposed to biological and chemical agents. This research sought to establish the self-reported level of emergency preparedness competencies of nurses in Northwest Arkansas, an area that faces a diverse set of potential disasters ranging from nuclear accidents to pandemic disease. Additionally, differences between of the level of preparedness by education level or work specialty were studied. The results are alarming in that …

Interprofessional Collaboration To Prevent Hospital-Acquired Pneumonia (Hap), Jessica Cooper, Amber Manning, Morgan Miller, Megan Mustard, Haleigh Pike, Suzi White

Celebration of Student Scholarship Poster Sessions Archive

No abstract provided.

The Effect Of Routine Adult Phq-2 Depression Screen And Scheduled Follow-Up Protocol In The Primary Care Setting, Alex F. Bikowski

Evidence-Based Practice Project Reports

Healthy People has projected depression to be the primary cause of disability by 2020; therefore routine depression screening has been prioritized as a national healthcare initiative. The purpose of this Evidence-Based Practice (EBP) project is to demonstrate that routine implementation of the 2-item Patient Health Questionnaire (PHQ-2) depression screener, along with a scheduled follow-up protocol for adults in the primary care setting, can improve current mental health practices regarding the identification of depression by clinicians. The evidence supports use of the PHQ-2 for routine adult depression screening, as long as a scheduled follow-up protocol is available for positive screens. This …

The Effects Of Continuous Insulin Pump Therapy On Glycemic Control In Pregnant Type 1 Diabetics, Kimberly Kelsey

Scholarly and Creative Works Conference (2015 - 2021)

Type 1 Diabetes Mellitus accounts for approximately 5% of the diabetic population (CDC, 2015). Numerous complications must be avoided when a diabetic is insulin dependent. Women who are diabetic who are planning to conceive a family have special considerations. Little research has been focused into how to best manage Type 1 diabetics during pregnancy. Since Type 1 diabetes is predominantly diagnosed between birth and 30 years of age, many Type 1 diabetics have potential to become pregnant without knowing how to best manage their diabetes. Poor glycemic control in diabetics has been related to miscarriages, stillbirths, malformations, and macrosomia (Lapolla, …

A Retrospective Analysis Of Surgeon Estimated Time And Actual Operative Time To Develop An Efficient Operating Room Scheduling System, Pearly T. Brown, Dnp, Rn, Cnor

Doctor of Nursing Practice Projects

Problem: Surgical departments account for sizable budgets in hospitals. To ensure efficiency, optimal processes need to be maintained. The current practice for posting a surgical case is using surgeon estimated times (SETs), which only includes the reporting points of component 2 (C2) “incision” to “dressing.”

Objective: To analyze if there was a significant difference in minutes between actual operative times (AOT) and SET in patients undergoing outpatient general laparoscopic and inpatient orthopedic total joint surgery.

Methods: The facility is a level one trauma teaching center, with 371 beds, and a yearly surgical volume of 17,000 cases. This retrospective …

Effects Of A Comprehensive Bariatric Program Implementation On 30-Day Readmission And 30-Day Er/Infusion Clinic Visit Rates Due To Dehydration, Azra Kukic, Dnp, Rn, Cbn, Acm

Doctor of Nursing Practice Projects

Background: Program accreditation requires adherence to MBSAQIP standards to assist patient in making needed changes to his/her diet and lifestyle. However, literature provides conflicting information regarding the value of a comprehensive bariatric program accreditation and its effects on 30-day readmission and 30-day ER/infusion clinic visit due to dehydration development.

Objectives: To examine the effects of implementing a comprehensive bariatric surgical program on 30-day readmission rates, and 30-day emergency room (ER) and infusion clinic visit rates due to dehydration for bariatric surgical patients.

Methods: Our study was a retrospective separate sample pre-post intervention chart review. The data were collected before and …

Cerebrovascular Accident Survival: Strategies Of Flight Nursing And Aeromedical Transport, Alexis Caudle

Senior Honors Theses

Cerebrovascular accidents (CVA), known as strokes, are a leading cause of death worldwide. The delivery and timing of treatment for CVAs is a critical factor in restoring health to the patient. One of the variables in recovery is the method of transport used in bringing the patient to a health care facility. Aeromedical transport remains a valuable resource to achieve full recovery in stroke patients. An ongoing debate of risk versus benefit of helicopter emergency services will be included as well as examination of variables including location, time, physiology of the flight, and the patient’s condition to be scrutinized. In …

Relationship Of Exposure To Heart Failure Discharge Teaching To Readmission Within 30 Days, Becky Ann Pogacar

Dissertations (1934 -)

Heart Failure (HF) patients are at increased risk for higher rates of hospital readmission within 30 days. Previous studies have demonstrated educational interventions delivered by nurses reduce readmission but the relationship of the dose of teaching to HF readmission or ED utilization remains unclear. A retrospective correlational design framed by the General Outcomes Effectiveness Model was utilized to (1) establish a relationship between the dose of discharge teaching documented by acute care nurses and the outcomes of hospital readmission and ED utilization within 30 days of a previous hospital discharge and (2) identify the teaching components included in an evidence-based …

Journal Of Mind And Medical Sciences: Translational And Integrative Mission, David L. Rowland, Ion G. Motofei

Journal of Mind and Medical Sciences

Initiated four years ago, Journal of Mind and Medical Sciences (J Mind Med Sci.) established the mission to publish papers on mental and medical topics in distinct but closely interrelated domains. The editorial policy especially encourages interdisciplinary and integrative perspectives, being equally focused on basic research and clinical investigations and short reports.

The journal adheres to the philosophy that high quality, original ideas and information should be readily accessible and freely shared within and amongst the scientific community. Accordingly, J Mind Med Sci. is an online, open access, non-for-profit journal which, because of individual/ private support, has levied no charges …

Provider Referral Of Patients With Acute Low Back Pain To Physical Therapy: Implications For Outcomes And Costs, Corinne Griggs

DNP Projects

Because most patients with an acute episode of low back pain (LBP) enter the health care system through primary care, it is important primary care providers consider the effects of their decisions on patient outcomes and costs. Although guidelines for primary care management of acute LBP do not place emphasis on physical therapy, they have not been updated since 2007, and more recent evidence supports the use of timely physical therapy in acute LBP patients without “red flags.” Additionally, many studies indicate specialist or surgical consultation is over-utilized, inflating costs and delaying physical therapy. The aim of this project was …

Determinants Of Neonatal Mortality In Rural And Urban Nigeria: Evidence From A Population-Based National Survey, Emmanuel O. Adewuyi, Yun Zhao

Research outputs 2014 to 2021

Background

Significant reduction in the global burden of neonatal mortality was achieved through the millennium development goals. In Nigeria, however, only a marginal reduction was realized. This study assesses the rural–urban differences in neonatal mortality rate (NMR) and the associated risk factors in Nigeria.

Methods

The dataset from the 2013 Nigeria demographic and health survey (NDHS), disaggregated by rural–urban residence (n = 20 449 and 9935, respectively), was explored using univariate, bivariate, and multivariable analysis. Complex samples analysis was applied to adjust for the unequal selection probabilities due to the multi-stage cluster sampling method used in the 2013 NDHS. The …

Disability In Long-Term Care Residents Explained By Prevalent Geriatric Syndromes, Not Long-Term Care Home Characteristics: A Cross-Sectional Study, Natasha E. Lane, Walter P. Wodchis, Cynthia M. Boyd, Thérèse A. Stukel

Dartmouth Scholarship

Self-care disability is dependence on others to conduct activities of daily living, such as bathing, eating and dressing. Among long-term care residents, self-care disability lowers quality of life and increases health care costs. Understanding the correlates of self-care disability in this population is critical to guide clinical care and ongoing research in Geriatrics. This study examines which resident geriatric syndromes and chronic conditions are associated with residents’ self-care disability and whether these relationships vary across strata of age, sex and cognitive status. It also describes the proportion of variance in residents’ self-care disability that is explained by residents’ geriatric syndromes …

Characteristics Of Primary Care Physicians In Patient-Centered Medical Home Practices: United States, 2013, Esther Hing, Ellen Kurtzman, Denys Lau, Andrew Bindman

Nursing Faculty Publications

Objective—This report describes the characteristics of primary care physicians in patient-centered medical home (PCMH) practices and compares these characteristics with those of primary care physicians in non-PCMH practices.

Methods—The data presented in this report were collected during the induction interview for the 2013 National Ambulatory Medical Care Survey, a national probability sample survey of nonfederal physicians who see patients in office settings in the United States. Analyses exclude anesthesiologists, radiologists, pathologists, and physicians in community health centers. In this report, PCMH status is self-defined as having been certified by one of the following organizations: Accreditation Association for Ambulatory Health Care, …

Infection Control In Labor And Delivery Room, Learning From The Small Hospital Based Project, Savera Aziz Ali, Sumera Aziz Ali

School of Nursing & Midwifery

Background: It has been estimated that around 36% of the neonatal deaths occur due to infection in the lower and middle income countries. Infection control is a more substantial area of concern, particularly in Labor and delivery room. Multiple factors can cause infection in the labor room, therefore it is important to assess various factors of maternal and neonatal infection. Hence we explored multiple factors through this project and developed the action plan to address those factors effectively.
Methods: During our Leadership and Management course, we conducted a project in Labor room pertaining to a prevalent issue. The whole process …

"Can You Keep It Real?": Practical, And Culturally Tailored Lifestyle Recommendations By Mexican American Women Diagnosed With Type 2 Diabetes: A Qualitative Study, Sandra Benavides-Vaello, Sharon Brown, Roxanne Vandermause

Nursing Faculty Works

Background The purpose of this article is to engage clinicians in a dialogue about ideas on how to provide more specific, contextually relevant, practical and culturally tailored diabetes self-management recommendations as suggested by Mexican-American women diagnosed with type 2 diabetes. Current diabetes self-management recommendations, targeting Mexican Americans in particular, remain largely broad (“reduce your calorie intake” or “cut back on carbs”), overly ambitious (“stop eating tortillas”), and relatively ineffective (Svedbo Engström et al., BMJ Open 6(3):e010249, 2016; Johansson et al., Int J Qual Stud Health Well-being 11, 2016; Oomen et al., The Diabetes Educ 25:220-225, 1999; Franek, Ont Health Technol …

Developing Morally Sensitive Policy In The Nicu: Donation After Circulatory Determination Of Death, Michael Van Manen, Nicole Kain

The Qualitative Report

Policy development is an important activity for the practice of healthcare. Policies, after all, may cultivate common practices and ensure that best available evidence is employed in clinical decision making. Qualitative research and individuals with expertise in qualitative research methods have much to offer policy makers. We were confronted with the situation of developing policy for donation after circulatory death (DCD) for our newborn intensive care program. Due the moral-ethical complexities surrounding DCD, and the limited experience with DCD in this context, we approached policy development from an iterative design perspective employing qualitative methods. We describe our experience in employing …

Reduced Cost And Decreased Length Of Stay Associated With Acute Ischemic Stroke Care Provided By Nurse Practitioners: A Single Primary Stroke Center Experience, Leah Roering Np, Michelle Peterson Np, Muhammad Shah Miran Md, Melissa Freese, Kenneth Shea Md, M Fareed K. Suri Md

Nursing Posters

Nurse practitioner (NP) have a wider role in modern stroke centers providing quality evidence based care to patients with both in and outpatient settings for acute ischemic stroke (AIS) and transient ischemic attack (TIA) patients. We studies the outcome measures, length of stay (LOS) and cost before and after implementation of nurse practitioners as the primary medical provider in a community based stroke center.

Intraoperative Administration Of Intravenous Acetaminophen At Induction Or End Of Surgery And Its Relationship With Opioid Consumption And Pain Scores, Spencer Davis Greenwood

Theses, Dissertations and Capstones

Obesity has become increasingly prevalent in the United States. Bariatric surgeries have increased as the prevalence of obesity has risen, providing an effective alternative to weight loss. Intravenous acetaminophen (IVA) is a safe and effective non-opioid medication that can be given without the risk of respiratory or cardiac complications. Research has shown that the use of IVA during surgery can improve postoperative pain scores, reduce opioid requirements, and improve patient satisfaction.

A retrospective cohort study of 200 patients (100 per group) undergoing laparoscopic bariatric surgery (LBS) was performed. Statistical analysis was used to determine the relationship between those who received …

What Is The Relationship Of Increased Intraocular Pressure And Body Mass Index In Patients Undergoing Robotic Prostatectomy In Sleep Trendelenburg Position?, Seth Parsons

Theses, Dissertations and Capstones

Introduction: Robotic Prostatectomy is a common procedure performed in surgery centers all over the world, but these procedures can be long and difficult to manage for Anesthesia providers. This study examined the relationship between increased intraocular pressure (IOP) and Body Mass Index (BMI) during Robotic Prostatectomies in Steep Trendelenburg (ST) position. Other variables studied were length of procedure, age, and ASA physical classification.

Methodology: The study was a retrospective cross-sectional design of 100 patients with a BMI over 30 and 100 patients with a BMI under 30 who have undergone Robotic Prostatectomies at Charleston Area Medical Center (CAMC) between …

Childhood Obesity: Physiological And Psychological Implications And Ethical Responsibilities, Connie S. Lewis

Journal of Health Ethics

Childhood obesity continues to be a health concern in the United States with physiological and psychological consequences. Research conducted in schools may address the physiological effects and exacerbate negative psychological effects, including weight bias and stigmatization. In the home, children are dependent on parents/caregivers to provide a healthy diet and exhibit a healthy lifestyle.The ethical theory, ethics of care, emphasizes dependence and interdependence on others, and ethical and moral responsibilities in the parent/child relationship. The assurance of ethical considerations involving children in research and parental provision for healthy dietary provision is of utmost importance. Any action or inaction that results …

Does Perioperative Angiotensin-Converting Enzyme Inhibitor Therapy Correlate With Increased Use Of Vasopressors During Posterior Lumbar Interbody Fusion Versus Those Not Receiving Angiotensin-Converting Enzyme Inhibitor Therapy: A Retrospective Study, Joshua Ross

Theses, Dissertations and Capstones

Abstract: The purpose of this study was to evaluate if patients who took Angiotensin Converting Enzyme (ACE) inhibitors the morning of surgery for Posterior Lumbar Interbody Fusion (PLIF) required more treatment for intraoperative hypotension.

Introduction: PLIF is a surgical procedure used to correct spinal disorders that include compression, instability, pathological lesions, deformities, and pain. PLIF is completed utilizing the prone position for optimal access to the lumbar spine. Complications associated with prone position have included Post-Operative Vision Loss (POVL), compression of abdominal vessels, and head and neck venous compression resulting in neurologic injury. Currently, there are no set recommendations …

The Association Between Intraoperative Single-Dose Dexamethasone And Postoperative Pain In Patients Undergoing Laparoscopic Cholecystectomy, Sara Hatfield

Theses, Dissertations and Capstones

Abstract: The purpose of this study was to examine the association between a single dose of intraoperative dexamethasone in patients undergoing outpatient laparoscopic cholecystectomy surgery and postoperative pain scores and the amount of postoperative opioid administration.

Introduction: Pain is one of the most common complaints in the postoperative period and the days following a patient’s procedure. While opioids are commonly used for treating intraoperative and postoperative pain, anesthesia providers can lessen their use by adopting multimodal analgesia techniques. This study attempts to fill the research gap related to the association of a single dose of intravenous dexamethasone intraoperatively …

The Influence On Morbidity And Mortality When Blood Products Are Transfused Using Conventional Coagulation Tests Versus Teg Or Rotem In Trauma Patients Perioperatively, Teresa Diana Kelley

Theses, Dissertations and Capstones

Abstract: Coagulopathy in trauma patients occurs due to tissue injury, hemodilution (dilution of hematocrit and clotting factors), infusion of hypo-coagulable blood products (e.g., packed red blood cells), acidosis, hypothermia, continued blood loss, and depletion of clotting factors. The onset of coagulopathy begins with the initial tissue injury and evolves rapidly. Many factors need consideration when determining resuscitative treatment for the trauma victim. These factors include the amount of time for extraction from the field, transport time to a trauma center, associated weather, and treatment provided in route. This study compared two clinical laboratory pathways (Conventional Coagulation test and Rotational Thromboelastometry …