13468 research outputs found
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The Importance of Being Earnest
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Natasha, Pierre and the Great Comet of 1812
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The Importance of Being Earnest
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9 to 5 (2024)
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University Presidential Update- January 2024
Get PDFThis is an Otterbein University presidential update to the staff and faculty, informing them on changes to campus
Viscoelastic Monitoring in Major Hepatic Surgery: An Evidence-Based Practice Project
Get PDFPatients undergoing major hepatic surgery are at high risk for intraoperative transfusion of allogenic blood products. These patients are at increased risk due to pre-existing hepatic pathology, surgical stress, and the complexity of surgical procedures. While blood product transfusion may be necessary to support hemostasis and hemodynamics, it is not without risk. Current literature states that viscoelastic monitoring is superior to traditional laboratory values when guiding transfusion during major hepatic surgery. Viscoelastic monitoring is a term used to describe the measurement of change in viscoelastic properties of whole blood during clot formation. There are two readily available point-of-care types – thromboelastography (TEG) and rotational thromboelastometry (ROTEM). For the purpose of this project, ROTEM will be referred to as viscoelastic monitoring. Although the literature supports the use of viscoelastic monitoring during major hepatic surgery, some facilities’ guidelines and policies may not be up-to-date with the most current evidence. The lack of an evidence-based approach to standardize transfusion utilization may lead to misinterpretation of viscoelastic monitoring, which may result in over- or under-resuscitation. This Doctor of Nursing Practice (DNP) project aims to develop an evidence-based practice guideline, utilizing the Rosswurm and Larrabee conceptual model, to assess a need for change, identify gaps in practice, implement the guideline, and evaluate the outcome. Successful implementation and dissemination of this DNP project could lead to changes in the standard of practice, hospital policy, or a revision of current guidelines. The work of this DNP project will be limited to the perioperative setting. Further scholarly work can explore the utility of viscoelastic monitoring in the pre-and postoperative settings
General Anesthesia Clinical Practice Guidelines for Patients with Posttraumatic Stress Disorder
Get PDFGeneral anesthesia is an induced state of unconsciousness administered by anesthesia providers to obtain patient amnesia, analgesia, and akinesia. Adult patients with posttraumatic stress disorder (PTSD) are at risk for general anesthesia-related complications throughout the perioperative setting. Emergence delirium is a clinically significant postoperative complication that patients with PTSD have an increased risk of developing. Postoperative complications of emergence delirium include patient or medical staff injury, surgical site damage, prolonged postanesthesia care unit (PACU) stay, and increased medical care costs. Evidence demonstrates that implementing preventive interventions decreases the incidence of emergence delirium. There are no standardized, evidence-based general anesthesia guidelines for adult patients with PTSD. This project aimed to develop an evidence-based practice guideline for adult patients receiving general anesthesia with PTSD or at-risk for developing emergence delirium. A comprehensive literature search utilizing a PICO question was implemented to analyze and synthesize available evidence to develop the evidence-based guideline. Utilizing the Plan-Do-Study-Act (PDSA) quality improvement model, this project outlines a plan for implementing and evaluating the evidence-based practice guideline
Preprocedural Ultrasound for Labor Neuraxial Anesthesia: Evidence-Based Practice Recommendations
Get PDFCentral neuraxial blockade (CNB) is the most widely used method of anesthesia provided to laboring patients and includes epidural, spinal, combined spinal-epidural, and caudal techniques. Studies have shown that using preprocedural ultrasound is a safe and effective tool to facilitate the placement of neuraxial needles, especially in patients with predicted difficulty. With the prevalence of obesity increasing, laboring patients with predicted difficulty of neuraxial needle placement is increasing as well. In addition, the traditional method of palpation and visualization of anatomical landmarks to place neuraxial needles can produce inaccurate results due to inconsistencies between patients. Use of preprocedural ultrasound to facilitate neuraxial anesthesia is low despite evidence found in the literature describing its benefits. The project’s main objective is the development and implementation of evidence-based practice (EBP) recommendations for using preprocedural ultrasound to facilitate neuraxial anesthetics provided to laboring patients. If implemented, the project has the potential to increase first-pass success rates of needle placement and decrease adverse events such as unintentional dural puncture, post dural puncture headache, and failed neuraxial block. Additional objectives for the project include developing EBP recommendations for using preprocedural ultrasound when providing neuraxial anesthesia to the laboring patient, a comprehensive plan to implement the EBP recommendations, and a method to monitor and measure the EBP recommendations. The theoretical framework for this project is the John Hopkins Evidence-Based Practice Model (JHEBP) for Nursing and Healthcare Professionals
Development of Evidence-Based Practice Anesthesia Guidelines for Brain-Dead Organ Donors
Get PDFOrgan donation is a gift of life for both donors and recipients that can come from living donors, donors after cardiac death, or brain-dead donors (BDDs). Treating the donors with optimal care throughout the entire donation process is crucial due to organ supply shortages. Organs from BDDs are a large contributor to the number of organs donated each year and require critical care from the time of admission, declaration of brain death, and throughout the organ procurement surgery. Although each BDD requires meticulous care for successful retrieval and donation, there is a lack of evidence-based practice (EBP) guidelines for anesthesia for BDDs during organ procurement surgery. This project encompasses the development, implementation, and evaluation plan of EBP anesthesia guidelines for BDDs. The problem was identified through an introduction to and background information regarding the organ donation process, from the declaration of brain death to organ procurement surgery, organ rejection, financial impact, and the significance of the problem to anesthesia. Next, a clinical person, intervention, comparison, outcomes, and time (PICOT) question was introduced which drove the objectives of the project and facilitated a thorough literature review. With the results from the literature search and recommendations from the Lifeline of Ohio Organ Procurement Agency (LOOP), guidelines for anesthesia for BDDs were created. The Johns Hopkins Nursing Evidence-Based Practice (JHNEBP) Model was used to guide the development of and plan to implement the EBP anesthesia guidelines. Monitoring of outcomes will be completed by the QI department. Barriers, limitations, guideline improvement strategies, project timeline, and project budget are discussed, followed by a dissemination of the findings
13. Garden Setting for 1001 Nights
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