The Future Of Cognitive Dysfunction In Elderly Patients: A Clinical Perspective With Recommendations, Laura Taylor

Doctor of Nursing Practice Final Manuscripts

Background: The U.S. Census Bureau projects the number of Americans age 65 years and older will more than double between 2010 and 2050. The geriatric patient population will likely require the use of surgical services at a higher rate than ever before. To best care for the elderly undergoing procedures with anesthesia, it is imperative to follow the most up to date evidence to avoid post-operative complications, and more specifically post-operative cognitive dysfunction.

Purpose: The purpose of this DNP evidence-based practice project is to identify patients that are at high risk for post-operative cognitive dysfunction prior to undergoing anesthesia. Post-operative …

Enriching The Perioperative Enhanced Recovery After Surgery (Eras) Program For Patients Undergoing Whipple Procedure For Pancreatic Cancer, Natalie E. Fisher

Doctor of Nursing Practice Final Manuscripts

Pancreatic cancer remains one of the most complex and lethal diseases worldwide with surgical resection as a major treatment choice. Although surgery may be one of the only options for advanced pancreatic cancer, it is not without a lengthy hospital stay, a long list of possible postoperative complications, and an increased risk for readmission after discharge. Enhanced recovery after surgery (ERAS) programs have been implemented for years in other surgical services for cancer care. These programs have now been extended and researched to include patients undergoing surgery for pancreatic cancer. These programs are designed to assist patients and their families …

Interventional Radiology Procedures Without Sedation: The Nurse Experience, Catherine De Leon

Dissertations

Background: Many IR procedures offer a less invasive and economical alternative to some open or laparoscopic surgeries. Patients undergoing a procedure without moderate sedation are awake, alert, with heightened sensory perceptions, and vulnerable to their surroundings. There is a gap in the current body of literature relating to the IR nurse’s experience of caring for patients during procedures without the use of moderate sedation.

Purpose/Aims: The purpose of this study was to explore the lived experience of Interventional Radiology (IR) nurses caring for conscious patients undergoing a procedure without the use of sedation. This phenomenological study aimed to describe the …

Frailty And Post-Operative Outcomes In Adult Hip Fracture Patients, Melissa Yager

Dissertations

Abstract

Background/ Purpose: The majority of adult hip fracture patients never return to their pre-fracture functional level and have a poor quality of life (Kistler, Nicholas, Kates, & Friedman, 2015; Pioli et al., 2016; Sheehan et al., 2018). The prevalence of frailty in adult hip fracture patients is estimated at 51%. Frail patients with hip fractures are twice as likely to have a complication (Kistler et al., 2015). Extant studies have examined frailty and hip fractures independently, nonetheless, a gap in the literature exists with few investigations of the connection between frailty and post-operative outcomes after hip fracture. The purpose …

Patient-Specific Factors Associated With Surgical Delay In A Large Academic Hospital, Natalie Meyers

Dissertations

The high cost of healthcare is driving the search for more efficient practice, especially in high-stakes locations like the operating room. In addition to financial losses, patients suffer physical and emotional distress, including an increased risk of morbidity or mortality when surgical cases are delayed due to inefficiency. While patient-related causes of delay have been implicated, it is unclear which specific factors are most significant. This study aimed to identify specific patient factors correlated with surgical delay and develop a predictive risk algorithm that describes the relationship between patient-specific factors and surgical delay.

A retrospective review of 36,543 patients’ charts …

Delirium In Long Term Care Rehabilitation Residents: A Correlational Retrospective Study, Rebecca Lerma-Kjonegaard

Dissertations

Abstract Background: Delirium is associated with devastating outcomes, cognitive loss,

decreased function and an increase risk of mortality which affects patients and places a heavy burden on family and the healthcare system. The purpose of this study was to describe the relationship between select demographics, clinical characteristics, CHART- DEL-derived delirium diagnosis and ICD-10 coded discharge delirium diagnoses among Long Term Care (LTC) rehabilitation residents.

Method: A retrospective correlational design from174 LTC rehabilitation residents age 65 years or older using EMR and hard copy charts. The setting was a Southern California community hospital-based 100-bed LTC. Abstracted data included demographic characteristics (age, …

Reducing Ed Re-Admissions In Post-Op Neuro Patients Utilizing A Np Telephone Follow-Up Protocol, Katherine Curran

Doctor of Nursing Practice Final Manuscripts

Reducing ED Re-admissions in Post-Op Neuro Patients utilizing a NP Telephone Follow-up Protocol

Background

Post craniotomy patients discharging from the hospital to home, commonly present to the emergency department (ED) with incisional concerns. Complaints stem from minimal post-op education, poor incision management, and lack of knowledge relational to infection. Unanswered questions prior to discharge lead to unnecessary ED visits, anxious calls after discharge, and poor patient satisfaction. ED admissions lead to fortuitous costs that can be prevented through evidenced based interventions.

Purpose/Aim

Post craniotomy patients at a large hospital system in Southern California will have decreased ED visits correlated to …

Timing Is Everything: Discharge Teaching To Parents In Pediatric Outpatient Surgery, Kate Boulder Dnp Candidate, Ccrn, Joseph Burkard Dnsc, Crna

Doctor of Nursing Practice Final Manuscripts

Background: Over 50 years of literature support the nursing “golden rule” that discharge teaching begins upon admission. Parents’ poor understanding of pediatric post-operative instructions following outpatient day surgery can put their child at risk for some preventable complications after arriving home.

Purpose: To improve parents’ understanding of discharge education using earlier initiation of post-operative teaching to best meet the needs of adult learners caring for a child under age 18 after surgery.

Process Used: Parents were educated using four cardinal strategies: early initiation of instructions, reinforcement of key points throughout the length of stay, optimal timing in a distraction-free environment, …

Obstructive Sleep Apnea: Emphasis On Discharge Education After Surgery, Arbert Almoite Nazareno, Cresilda Newsom, Esther Lee, Joseph Burkard

Doctor of Nursing Practice Final Manuscripts

Purpose: The purpose of this evidence-based practice project is to evaluate the effectiveness of discharge education (DCE) on obstructive sleep apnea (OSA) for increasing continuous positive airway pressure (CPAP) compliance after surgery among adult surgical patients diagnosed with OSA, who use CPAP.

Background & Evidence for Problem: In the United States, the prevalence of OSA in the adult population is approximately 20%. Over half of the surgical patients with OSA are predisposed to increased incidence of perioperative complications. Based on recent evidence, obstructive events are at the highest on the third day after surgery, which predisposes them for postoperative complications. …

Preoperative Assessment Clinic Reduces Total Joint Arthroplasty Case Cancellations, Angelica Adriano

Doctor of Nursing Practice Final Manuscripts

The purpose of this evidence-based project was to reduce the rate of elective total joint arthroplasty case cancellations by implementing a nurse practitioner-led Preoperative Assessment Clinic (POAC), in the orthopedic department of a major southern California Veterans Affairs (VA) hospital. Retrospective data collected in a 12-month time period showed a surgical cancellation rate of 22%. Reasons for delays or cancellations included: medical instability, abnormal labs and/or studies, patients requiring referral to specialists, dental clearance, patient-initiated cancellations, and active infections. The POAC reduced the rate of case cancellations at 1 year to 17% and at 2 years to 9%. Lost revenue …