Nursing Qsen Essays

Nursing Qsen Essays
In October 2005 the Quality and Safety Education for Nursing program was established. This
program is funded by the Robert Wood Johnson Foundation. QSEN was developed specifically for
future nurses to understand and be aware of key challenges such as the knowledge, skills, and
attitudes that are essential to constantly advance the quality and safety of the way healthcare
systems work. The goal for QSEN is to reshape the identity of nursing so it includes the
recommendations by the Institute of Medicine so there is a commitment to the quality and safety
proficiency (Dycus, 2009). QSEN has strived to place initiatives in pre–licensure programs so when
licensed, they are up to date and educated on necessary skills. For pre–licensure ... Show more
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Teamwork and collaboration with other healthcare providers is very important. To function
effectively there needs to be mutual respect, open communication, and shared decision making in
the best interest of the patient. As a member of a team it is vital to know ones own strengths and
limitations, this way patients receive the best care. Evidence based practice is when recent research
is integrated into the clinical setting for maximum delivery of health care. A lot of evidence based
practice was developed from research studies conducted by nurses such as decubitis ulcer
prevention. Knowing and demonstrating the scientific methods and processes will help to advance
nursing care by providing better interventions for patient care. Patient care plans should be
developed based on evidence (Dycus, 2009). With monitoring outcomes from evidence based
practice it can be determined if the care caused improvement in the healthcare setting. Using quality
measures such as charts and diagrams to understand performance. If care provided to a patient is not
safe, than the intervention is ineffective and therefore not helping to improve that patient's quality of
life. To help provide a safe environment, observation and communication are extremely important.
Inform the patient and family of any interventions before proceeding with them to insure the patient
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Cauti
Urinary tract infections (UTIs) are the most common nosocomial infection; accounting for up to
40% of infections reported by acute care hospitals. Up to 80% of UTIs are associated with the
presence of an indwelling urinary catheter. Catheter associated urinary tract infections (CAUTIs)
represent the largest proportion of healthcare associated infections (HAI). Catheter–associated
urinary tract infection (CAUTI) increases hospital cost and is associated with increased morbidity
and mortality .CAUTIs are considered by the Centers for Medicare and Medicaid Services to
represent a reasonably preventable complication of hospitalization. As such, no additional payment
is provided to hospitals for CAUTI treatment–related costs.CAUTIs can lead to ... Show more
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Not maintaining a sterile technique during insertion and closed drainage system after insertion.
4. The drainage bag of the bacteriuric patient is a reservoir for organisms that may contaminate the
environment and be transmitted to other patients. 5.Outbreaks of infection with resistant gram–
negative organisms attributable to bacteriuria in catheterized patients have also been reported.
PREVENTION
1. Limiting catheter use and, when a catheter is indicated, minimizing the duration the catheter
remains in situ are primary strategies for CAUTI prevention.
2. Ensure that only trained, dedicated personnel insert urinary catheters.
3. Implement a system for documenting the following information in the patient record: indications
for catheter insertion, date and time of catheter insertion, individual who inserted catheter, and date
and time of catheter removal
a. Include documentation in nursing flow sheet, nursing notes, or physician orders. Documentation
should be accessible in the patient record and recorded in a standard format for data collection and
quality improvement purposes.
4. Ensure that there are sufficient trained personnel and technology resources to support surveillance
of catheter use and outcomes.
5. Educate healthcare personnel involved in the insertion, care and maintenance of urinary catheters
about CAUTI prevention, including alternatives to indwelling catheters and procedures for catheter
insertion, management, and removal.
6. Maintain

TAVR Report: Cardiac Catheterization Lab
This past Friday in the cardiac catheterization lab I began my day with continuing the work that I
was previously assigned to do last week where I collected the data of patient's Cardiothoracic
surgery. I continued to familiarize myself with the different types of Cardiothoracic surgery
procedures, however, the specific reports I was working with, they are called TAVR report
(Transcatheter Aortic Valve Replacement). I later learned and was explained to, the TAVR multiple
procedures and its causes, which is aortic stenosis. As for the procedures, a valve needs to be placed
in the heart and each procedure delivers it a different way. The three ways the valve can be placed in
the heart is through the heart's femoral artery (the transfemoral approach),

Urinary Tractinfection
An APIC Guide 2008
Guide to the Elimination of Catheter–Associated Urinary Tract Infections (CAUTIs)
Developing and Applying Facility–Based Prevention Interventions in Acute and Long–Term Care
Settings
About APIC APIC's mission is to improve health and patient safety by reducing risks of infection
and other adverse outcomes. The Association's more than 12,000 members have primary
responsibility for infection prevention, control and hospital epidemiology in healthcare settings
around the globe. APIC's members are nurses, epidemiologists, physicians, microbiologists, clinical
pathologists, laboratory technologists and public health professionals. APIC advances its mission
through education, research, consultation, collaboration, ... Show more content on Helpwriting.net
...
Of these patients, approximately 3% will develop bacteremia. The 1997 APIC/SHEA position paper
on urinary tract infections in long–term care (LTC) identifies CAUTI as the most common infection
in LTC residents, with a bacteriuria prevalence without indwelling catheters of 25% to 50% for
women, and 15% to 40% for men. Therefore, usage of indwelling urinary catheters in residents of
LTC facilities can be expected to
ASSOCIATION FOR PROFESSIONALS IN INFECTION CONTROL AND EPIDEMIOLOGY
5
Guide to the Elimination of Catheter–Associated Urinary Tract Infections (CAUTIs)
result in higher CAUTI rates with an associated risk of CAUTI–related bacteremia, unless
appropriate prevention efforts are implemented. The 2008 SHEA/APIC Guideline "Infection
Prevention and Control in the Long–term Care Facility"3 notes that "guidelines for prevention of
catheter–associated UTIs in hospitalized patients are generally applicable to catheterized residents
in LTCFs." Strategies contained in this resource will be helpful in any healthcare setting, when the
facility's infection risk assessment identifies CAUTI as an infection prevention priority.
Legislative Mandates and CAUTI Risk Assessment
The impact of external factors is germane to facility

The National Patient Safety Goal
This paper, will discuss the National Patient Safety Goal NPSG 0.7.06.01 entitled " Use proven
guidelines to prevent infection of the urinary tract that are caused by catheter" (The Joint
Commission, 2015). It will identify reasons why this National Patient Safety Goal was chosen as
well as the type of organizations that utilize urinary catheters. It will look into financial implications
of implementing educational process versus the hospital cost of Catheter–Associated Urinary
Infections (CAUTI). The Advanced Practice Nurse (APN) will demonstrate method on how to
gather data, design educational tool, implement standard practice and create a committee by
collaborating with other health care discipline. Effectiveness of the educational process will be
evaluated through data collection. Finally, future health care delivery implications will be explored.
Description of Goal
The National Patient Safety Goal NPSG 0.7.06.01 entitled " Use proven guidelines to prevent
infection of the urinary tract that are caused by catheter." was selected (The Joint Commission,
2015). Gould et al. (2010) reported that in an acute care hospital, a urinary catheter is the most
commonly used medical devices (as cited in Acker, 2014). What is a urinary catheter? Urinary
catheter is a thin tube inserted into the bladder to drain urine. A collection system bag is connected
to the catheter (Centers for Disease Control and Prevention, 2010). Gokula et al. (2014) asserted,
short–term and long–term

Patient Dissatisfaction Of Piv Catheter Replacements
Introduction
In a local San Diego County hospital, on a 28 bed progressive care unit specializing in cardiac
telemetry, the current protocol for replacing peripherally inserted intravenous catheter is every 72
hours or less if clinically indicated. The average daily census of patients on the unit is roughly 23
patients with an increase of 5% during the winter months. There are nearly 50,000 patients admitted
annually to this unit with 47,670 discharged home. The hospital is located in Serra Mesa and serves
the residents of this region as well as the surrounding area with a mean age of the patient being 52.
The patients seeking care are mostly English or Spanish speaking, but represent a wide variety of
cultures. The RNs on this unit are working with patients in a 4:1 ratio leading to a fast–paced
workflow and heavy workload for the nurses.
Staff nurses on the unit expressed their frustration with the current practice regarding the frequency
of PIV catheter replacements, stating that it was "time–consuming" and contributed to "patient
dissatisfaction." The process of replacing a PIV can often be time consuming and may take multiple
attempts in order to successfully insert a new PIV. Research supports a change in practice that
address these concerns. A pilot study performed in 2012, by Rickard, Webster, Wallis, Marsh,
McGrail, French and Whitby indicated that replacing PIV catheters only when clinically indicated
did not lead to catheter–related complications, as previously

Catheter Associated Urinary Tract Infection
Catheter Associated Urinary Tract Infection (CAUTI) is defined as the occurrence of a urinary tract
infection (UTI) in patients with a urinary catheter in the past 48 hours. Published guidelines by the
Infectious Diseases Society of America (IDSA) further defines CAUTI by the presence of
significant bacteriuria of ≥ 103 CFU/ml found in the urinalysis and signs and symptoms of a UTI
without the presence of another cause for these findings. Signs and symptoms of CAUTI could
include: altered mental status, fever, chills, flank pain, costovertebral angle tenderness, and
hematuria. If the catheter has been removed in the past 48 hours the symptoms could also include
urgency and frequency (Fakih et al., 2016).
A2. Significance of the problem
The most common health care associated infection (HAI) is CAUTI. Forty percent of all hospital–
acquired infections are UTIs and 80% of these are directly linked to having an indwelling urinary
catheter in place (Underwood, 2015). Urinary catheters are required in up to 25% of hospitalized
patients and bacteriuria results in about 25% of patients with a catheter for greater than 5 days and
this number increases by 1 to 5% for each day the catheter is in place after that. The harmful
consequences of CAUTI include increased length of stay, higher health care cost, and increased
mortality. CAUTI is known to cost health care in the U.S. $400–$500 million annually (Leuck et al.,
2015).
A3. Current Practice
The growing concerns over

Cardiac Catheterization Essay
Cardiac Treatment nowadays had devolved in both way invasive and noninvasive, complicated and
risky procedger, cardiac catheterization and Cardiac surgery had play major roles of cardiac
coronary artery treatment ,cardiac catheterization can be diagnosis and treatment procedger which
in–could percutaneous transluminal coronary angioplasty, cardiac surgery of coronary artery bypass
is another obtain if cardiac catheterization is not suitable. Post–Surgery infection had significant
infect on patient and hospital , for cardiac patient it is more complicated because of vascular disease
which eliminate blood flow and nutrition to the infected tissue ,Cardiac medication can interacted
with other medication
(1) Retrospective evaluation for ... Show more content on Helpwriting.net ...
After opening wounding, the blood vessels in the wound site had spasm which caused clot to
formed, after that blood vessels then dilate to allow white blood cells to move through, enzymes and
nutrients to reach the wounded area. This leads to a rise in exudate levels so the surround It,
erythema, heat, edema, pain and functional disturbance
During proliferation, which MR Y,S is going through the wound is restored with new tissue which is
comprised of collagen and extracellular matrix and into which a new net of blood vessels develop.
Healthy granulation tissue is dependent upon blood vessels supply. Healthy granulation tissue is
granulose and uneven in texture; it does not bleed easily and is pink / red in co. The color and
condition of the granulation tissue is often an indicator of how the wound is healing. Dark
granulation tissue can be indicative of poor perfusion, or infection. Epithelial cells lastly resurface
the wound.
Maturation is the last phase and occurs once the wound has closed. This phase involves renovation
of collagen from type III to type I. Cellular activity reduces and the number of blood vessels in the
wounded area retreat and

Essay about Cardiac Catheterization
Cardiac catheterization is often referred to as coronary angiography or a coronary angiogram. It is a
radiographic procedure that is used to look at and visualize the heart and the coronary arteries.
During a cardiac catheterization it is possible for the cardiologist performing the procedure to see
how effectively blood is flowing through the coronary arteries. In addition, this procedure allows the
cardiologists to see how blood is moving through the chambers of the heart and how effective the
heart valves are functioning. A cardiac catheterization can also allow for the visualization of the
movement of the walls of the heart to see if the pumping action of the heart is normal. The primary
application of cardiac catheterization is to ... Show more content on Helpwriting.net ...
The stent will be placed where it can be expanded to hold the artery open. Some stents are designed
to simply keep the artery held open. Other stents used are drug–eluting stents. These stents are
coated with pharmacologic agents that work to prevent restenosis of the artery. Another form of PCI
is artherectomy. This is a procedure that has a cardiologist using a cutting blade that spins rapidly or
a laser beam to cut away or burn away plaque that is blocking a branch of the coronary arteries. To
perform a cardiac catheterization the patient is brought to the cardiac catheterization lab. These
procedures are performed by specially trained cardiologists, nurses and radiologic technologists.
The procedure is performed on a specialized table with fluoroscopy equipment, cardiac monitoring
equipment, and the use of computerized technology to assist in data and image collection and
analysis. To perform a cardiac catheterization the cardiologist will insert a sheath, or a short tube
usually into the femoral artery. A long very thin catheter will then be fed through the sheath and
guided through the arteries until it is in the heart and coronary arteries. The physician uses
fluoroscopy equipment to guide the catheter into the coronary arteries. To allow for clear viewing of
the coronary arteries, contrast material is injected into the catheter. As the contrast material flows
through the heart chambers and coronary arteries x–rays are taken. The

Reflection Paper Cath Lab
This Friday, September 29th, I had my second clinical observation experience in the Cardiac Cath
Lab. I was there from 7:00 a.m. till noon, viewing the flow and duties of the nursing staff on the
unit, learning about the procedures done on this specialized unit. Throughout most of the morning I
followed Sara, an RN, who had been in the unit for eight years. It was an impressive experience that
broadened my previously limited knowledge of the roles and experience of a Cath Lab nurse. The
Cardiac Catheterization Lab is a highly specialized area of work, and therefore does require some
specialized training for its nurses. Among the requirements include a background in intensive care
nursing and having Advanced Cardiac Life Support certification. Some nurses were also
Cardiovascular Nurse–Board Certified, and had X–ray training and licensure. Because it can be a
very high intensity area, the VA does not accept new graduates to the Cath Lab. With its intensity, I
inquired of several nurses what techniques they utilize to cope with traumatic events. Sara discussed
how much she relies on her fellow coworkers in emergent events to step up and be willing to jump
in and assist as needed. She also mentioned how each nurse attends a biweekly meeting with several
other staff members to discuss any major successes or errors which have occurred. Sara explained
this time as an excellent learning opportunity, as well as an outlet when each person on the team can
share their thoughts.

Criteria-Based Regulation Summary
Journal Four The next article focused on a criteria–based reminder to help decrease the duration of
catheterization and increase proper catheter care, causing a decrease in CAUTIs (Chen et al., 2013).
The criteria–based reminder was used to remind the nurse to check if the catheter could be removed
and also reminds them the catheter needed to be properly cleaned. The research method was a
randomized control trial (Chen et al., 2013). The sample of this study was from two respiratory
ICUs in a medical center in Taiwan. The study involved 231 patients who had catheters inserted in
the ICUs and 130 patients who had catheters inserted on other units (Chen et al., 2013). Data was
collected by having urine specimens taken from urinary catheter patients on the unit, they then
tested for urinary tract infections (Chen et al., 2013). Two groups of catheter patients were tested,
one with the criteria–based reminder implemented and one without (Chen et al., 2013). The study
showed that the criteria–based reminder group had a 21.8% incidence of UTIs, and the group
without the reminder had a 32.8% incidence of UTIs (Chen et al., 2013). The study also showed the
reminder method dropped CAUTI rates by ... Show more content on Helpwriting.net ...
Journal one and Journal two focus on the education and attitudes of health care workers to decrease
rates of CAUTIs (Justus et al., 2016; Saint et al., 2016). Journal four's focus is the use of a reminder
method to decrease CAUTIs (Chen et al., 2013). This method helps to increase the use of proper
catheter interventions in hospitals by reminding health care workers about them daily. Journal three
and journal five both focus on the use of certain interventions to decrease rates of UTIs in
catheterized patients (Fakih et al., 2012; Saint et al., 2013). Articles three and five evaluate if certain
interventions used in hospitals now are helpful in decreasing rates of

Prevention Of Catheter Associated Urinary Tract Infections...
Prevention of Catheter Associated Urinary Tract Infections
In the Healthcare Setting
Dayna Menard
Mount Vernon Nazarene University
Prevention of Catheter Associated Urinary Tract Infections In the Healthcare Setting
A Urinary Tract Infection (UTI) is a serious problem in the clinical setting. "UTIs are mostly
associated with catheterization" (Hooton, 2010, p. 629). The infection can be described as bacteria
invading the urinary tract. More so, the bacteria accounts for nosocomial bacteremia since the
patient obtains the infection in the hospital (Hooton et al., 2010). A Catheter Associated Urinary
Tract Infection (CAUTI) is common because nurses do not find this problem at the top of their to–
do list during their shift. It can be easy for the nurse to become accustomed to a slight deviation
from the correct method. Any break in the chain of infection has opened the opportunity for
microorganisms to reproduce in a susceptible host. Research has proven that when hospitals, long–
term care facilities, and other healthcare settings intervene with making positives changes, less of
the patients developed a UTI with catheterization. Infection control with catheterized patients can be
implemented and resolved with collaboration and education among healthcare staff.
There has been a reoccurring incidence of staff members using urinary indwelling catheters for
unnecessary reasons and convenience. More so, the nurses did not think of the issue as the most

The Pathology Of A Cardiac Catheterization Laboratory Essay
Seth Kahn's (2011), article entitled, "Putting Ethnographic Writing in Context," identifies
ethnography as the study of "relationships, rituals, values, and habits that make people understand
themselves as members of a group." Ethnographers adopt a stance of observation, as well as
participation to better understand the discourse among members within a particular group, or
discourse community (Khan, 2011). This ethnographic research will "connect what community
members know and do, with what they say and how they say it" (Devitt, Bawarshi, & Reiff, 2003).
The purpose of this study is to explore how nurses, working in a cardiac catheterization laboratory,
learn the 'local knowledge' necessary to communicate with a multidisciplinary discourse community
successfully. To protect the identity of participants in this study, the name of the laboratory included
in the study will be identified as the XYZ Cardiac Catheterization Laboratory. Cardiovascular
diseases have long been the leading cause of death in the United States (Narang et al., 2016).
Research predicts the progression of cardiovascular disease will affect forty percent of our
population by the year, 2030 (Narang et al., 2016). Furthermore, research shows that the
cardiovascular workforce is inadequate to meet the rising demands of this patient population
(Narang et al., 2016). In particular, a subset of cardiac nurses, a cardiac catheterization laboratory
nurse is a key member of this cardiovascular workforce.

Business Case For Quality And Inadequate Nursing Care
Business case for quality
Inadequate nursing care can be a result of staffing issues or under educated nurses. Errors can be
made that not only affect the patient's well–being, but can affect the financial standing of a hospital.
This paper will describe a business case for quality by discussing the current situation in need of
change, the proposed program, a market analysis, an implementation plan, a timeline for
implementation, and an evaluation plan, including relevant financial data of the proposed program.
Current Situation Summary
The current practice for post op cardiac catheterization (cath), to include percutaneous coronary
intervention (PCI) is to provide the initial recovery in the cath lab, then transfer to the floor for the
... Show more content on Helpwriting.net ...
These patients can be receiving blood transfusions or can be on cardiac drips with minimal titration.
The acuity level of the average patient is relatively high. Taking into consideration the acuity of the
patients already assigned to a nurse, if a post op cardiac cath patient is admitted, the potential for
error, or missed vitals and site checks, is elevated. In the past 90 days, there have been four post op
complications, varying from site bleeding to decreased blood pressure. All incidents required
intervention and increased the patient's length of hospital stay. According to Schuman (2014), high
risk, high volume negative patient events often occur as a result of several factors, including
workforce shortages and lack of knowledge. Vascular complications expose patients to additional
discomfort, extended hospital stay, and higher hospital costs, including additional treatment, such as
blood transfusions and vascular surgery ("Strategies to minimize", 2007). The cost of applying a
femstop device to the bleeding site on average is $74 per device (James, 2013). The average daily
hospital stay is $1450 per day (Oh, 2012). Adding these costs together, a single site post op bleeding
episode can cost upwards of $1500. This does not include the cost of blood transfusion or
medication, therefore the cost could escalate to near $2500 relatively quickly. With the new
affordable care act laws, the potential for preventable conditions not reimbursed by

Cardiac Catheterization Essay
Cardiac Treatment nowadays had devolved in both way invasive and noninvasive, complicated and
risky procedure, cardiac catheterization and Cardiac surgery had play major roles of cardiac
coronary artery treatment ,cardiac catheterization can be diagnosis and treatment procedure which
in–could percutaneous transluminal coronary angioplasty, cardiac surgery of coronary artery bypass
is another obtain if cardiac catheterization is not suitable. Post–Surgery infection had significant
infect on patient and hospital , for cardiac patient it is more complicated because of vascular disease
which eliminate blood flow and nutrition to the infected tissue ,Cardiac medication can interacted
with other medication
(1) Retrospective evaluation for MR.Y'S unhealed wound, noticing that he is self–employed as ...
Show more content on Helpwriting.net ...
(7) according to NCBI corticosteroids effect healing of the wound mediated by cytokines and
antagonism of various growth factors that intrusive with fibroblast proliferation, inflammation, ,
degradation, and collagen synthesis deposition of connective tissue ground substances,
angiogenesis, wound contraction, and re–epithelialization ,
For the chemotherapy dose not differentiate between cancer cell and healthy cell which in the end
kill the bad and good cell targets dividing cells–interferes with wound healing which pointed out to
us by Cincovidas
(8) NCBI point out, There is many chemical inside the cigarette by looking to some as Nicotine
which vasoconstriction that decrease the diameter of artery which lead to decrease blood flow to
skin causing tissue ischemia, also increased the risk of thrombotic which lead to occlude the blood
supply to the tissue which could be one of main reason of delay healing for MR

Cardiac Catheterization Report
This Friday at the Cardiac Catheterization Lab was a bit more uneventful than most of the previous
days and compared to most of the experiences I have had in the past. My mentor was not there this
week, nor will she be here this week but there was still a lot for me to do and I know many of the
other employees in the cardiology department so they put me to work which was great. Since I was
not here during spring break and the other volunteer that works in the cardiac office on Wednesdays
(or Thursdays) was not there either, so all the completed patient files had piled up in the bins and
outside of the bins. I normally only have about ten to twenty files to put away, however, I had about
forty to fifty or so patient files to file away and it

Personal Narrative: My Experience Of Cardiac Catheterization
As Friday was my first day starting my experience at the cardiac catheterization lab, I was quite
nervous and curious about the different things that I would have to do considering in all my time
volunteering at the hospital, I have been to the cath lab only one or two times. However, when I
went to the lab I was warmly welcomed by some of the staff and I later met many of the nurses and
doctors there as well. Everyone was very friendly and they were excited to have my help and to
"train me." In fact, one of the doctors I met wanted me to do some research regarding cardiac
catheterization to "get me more involved in the field," which is pretty exciting because I'm not very
familiar with anything related to cardiology but I chose this specific

Cardiac Catheterization Reflection
This past Friday at the Cardiac Catheterization Lab my mentor was not there but I still got to do
everything that I enjoy doing, like watching procedures and talking to the doctors, nurses, and staff.
When I arrived I knew my mentor would not be there so I had asked another one of the ladies in the
office if there were any surgeries that were going on for me to watch. After I was given scrubs to
change into I was able to go into where the surgeries are happening. I went into the control room
that I was told to go and the nurses and other staff were preparing the patient and setting up the
computers and everything they needed before the doctor arrived. The surgery overall was one I have
seen before and not as exciting as some of the more unique and different ones that I have seen
previously. ... Show more content on Helpwriting.net ...
One of the control rooms had people in them and I saw nurses preparing in the operating room, so I
went in and was told that there would be a case occurring soon. While waiting for the patient to
come into the operating room I was talking with one of the staff members and the guy he was
training, and funny enough, the guy in training was a biomedical engineering major too. He was
also telling me how if you go into any field in engineering you can find a career path that you are
interested in because of how broad and diverse each engineering field is. After talking for a bit the
patient came in the room and the doctor started operating, everyone had headsets so I could not hear
what they were saying but what I was watching on the screen was nothing I have seen before but it
was very interesting (and

An Evidence Based Quality Improvement Project Using A...
I am writing to obtain permission to conduct an evidence–based quality improvement project using
a pretest/posttest design in your facility with the purpose of evaluating the effectiveness of an
educational intervention regarding the importance and use of the nurse driven protocol on nurses '
knowledge and CAUTI rates.
This study will be done to fullfill requirements for completion of the Doctor of Nursing Practice
degree at Regis University, Denver, CO. The following information is an overview of the project:
Can Empowered Nurses Decrease CAUTI rates?
This project will employ a Population–Intervention–Comparative–Outcome (PICO) fromat for
development of the research question to be investigated:
Population: Nurses on the ... Show more content on Helpwriting.net ...
O A nurse–driven protocol is the recommended tool to be used by the nurse to remove catheters
without orders following set CDC guidelines and prevent CAUTI
O Nurses are best positioned to make the decision to remove catheters as they are in direct and
constant contact with the patient.
O According to Hospital Compare Cape Fear Valley Hospital is labeled as as "Worse than national
bench mark" for CAUTI rates (Medicare.Gov, 2015)
O Potential for reduction in reimbursement by 1– % if it falls with other hospitals that rank among
the lowest– performing 25 percent with regards to Hospital Acquired conditions (HAC): CAUTI
being of them.
O The hospital already has protocols in place, but the need for education regarding these protocl is
great.The need on these protocols are great Type of Study: Pretest, education, posttest quality
improvement
Participant Requirement: Full and part time nurses
Risks, Cost, and Benefits:
There no risk to the patients. Nurses may have to work longer hours to care for patients with
CAUTIs. The hospital will have to pay for the cost of re–education of staff and shoulder the
intangible cost that may

The Use Of Automatic Real Time Tracking And Augmented 3d...
The interest to detect and track the endovascular devices during X–ray guided interventional
procedures spans over a decade. The recent developments in real–time detection, tracking,
visualization over an augmented reality with multi modality fusion has transformed the surgical
environment. However, it's quite challenging to combine robustness of automatic real–time tracking
and augmented 3D visualization. In addition, various endovascular procedures use different devices
and tracking requirements (tip or whole catheter).
The important parameters that affect the detection and tracking can be classified in to 3 broad
categories; endovascular devices, projection geometry and motion. At first, the detection of various
shapes and radio–opaque devices is a challenge. Secondly, the detection is challenged by image
magnification and image geometry by various projections (Cranio–caudal tilt). Thirdly, and
importantly real–time tracking challenged by the patient motion and the deformation of the vessel.
Over the years, many of these challenges were addressed with success limited to devices. However,
the potential clinical benefits; to deploy the fenestrated stent grafts accurately without blocking
branches of abdominal Aorta (renal), to reduce contrast medium injected that might reduce the risk
of renal pathologies, to reduce the radiation exposure to the patient, personal and the environmental,
sustains the research interest. In addition, a successfully registered 3D

Letter To A Patient Hospital: A Case Study
It is with great pleasure I write this letter to give my highest recommendation to Ankur Sethi for
your structural heart disease fellowship program. I was introduced to Ankur in July, 2016 in the
capacity of the Director, Endovascular Services of Cardiac Catheterization Laboratory at the Mount
Sinai Hospital and Associate Professor of Medicine at Icahn School of Medicine when he started his
interventional cardiology fellowship. Over the years I had an opportunity to know him both
personally and professionally.
Without a doubt he is one of the brightest interventional fellows I have come across. He came to us
very well trained in diagnostic coronary and peripheral angiography and with a robust background
in clinical cardiovascular medicine.

Cardiac Catheterization
Cardiovascular disease has long been the leading cause of death in the United States and is predicted
to affect forty percent of the population by 2030 (Narang et al., 2016). Moreover, research states the
cardiovascular workforce is inadequate to meet the rising demands of our aging population (Narang
et al., 2016). Nurses caring for patients in the cardiac catheterization laboratory are key members of
the cardiovascular workforce. While there is research to support the development of nurses working
in the pre– and post–cardiac catheterization laboratory settings; current literature reveals little
information about the development of nurses working in the cardiac catheterization laboratory
(Currey, White, Rolley, Oldland, & Driscoll, 2015). ... Show more content on Helpwriting.net ...
This ethnographic study will explore how new cardiac catheterization laboratory nurses learn the
local knowledge necessary to communicate effectively in the workplace. The data collected during
this study came from face–to–face interviews with three nurses with different levels of cardiac
catheterization laboratory experience. First, Mary is a clinical manager of the cardiac catheterization
laboratory with twenty years of expertise in the department, as well as cardiovascular critical care
experience. Second, John is a staff nurse with ten years of expertise in the cardiac catheterization
laboratory, as well as experience in the ADD his other experience. Third, Susan is a staff nurse with
four months of cardiac catheterization laboratory experience, who previously worked in the
emergency department. Each interview had participants respond to predetermined open–ended
questions and dealt with medical knowledge and communication skills (See Appendix

Cardiac Catheterization Case Study
The suggested and safest course of treatment in order to fix this is Cardiac Catheterization. Other
possible solutions would be medicine but that would only reduce the symptoms of the defect.
Another option would be open–heart surgery which is done by putting the patient under anesthesia
and with an incision through the chest in order to cover up the holes in the heart. Another option that
is not preferred would be to wait it out and see if the holes would cover themselves through time.
Cardiac Catheterization would allow doctors to cover up the holes in the heart Brianna has with ease
and would erase the holes. Doctors would insert a narrow tube in a blood vessel in the groin. From
there, they would guide the tube to the heart using imaging

The Similarities And Differences Between Rcis And Rces
The Similarities and Differences of RCIS and RCES Seeking cardiovascular technician who are able
to monitoring patients and assisting doctors with performing angiograms, PCIs, Interventional
Radiology procedures, and Electrophysiology procedures. Minimum requirement: Registered
Cardiovascular Invasive Specialist (RCIS) or Registered Cardiovascular Electrophysiology
Specialist (RCES). This is an example of the many job posting for cardiovascular technician. What
do these individuals have in common that cardiac laboratory can accept either credentials? What set
them apart to have different credential title? It is easier to discuss the similarities of both RCIS and
RCES registrant since they are so similar. Similarity It is easier to discuss the similarities of both
RCIS and RCES individuals since they are so alike. The first similarities of RCIS and RCES
individuals is the amount of extensive cardiovascular education they receive through a 2 years
program which include didactic and skills labs. Both are credentials through Cardiovascular
Credentialing International (CCI) with upon passing the RCIS or RCES exam. Since the field of
invasive and electrophysiology is still expanding, new techniques and equipment are continually
being research, released and revised. As a results, RCIS and RCES individuals pursue continue
education (CEUs) in order to be informed and proficient with innovative techniques and equipment.
Furthermore, CCI required both RCES and RCIS registrants

The Microbiology Of A Cardiac Catheterization Laboratory...
Seth Kahn (2011) writes in his article entitled, "Putting Ethnographic Writing in Context," that
ethnography is the study of "relationships, rituals, values, and habits that make people understand
themselves as members of a group" (p. 176). Regarding a group's language use, Kahn (2011) adds
ethnographers will adopt a stance of observation, as well as participation to better understand the
discourse among members within a particular group, or discourse community. Furthermore,
Bawarshi (2003), explains that ethnographic research connects what community members know and
do, with the language used by the community. The purpose of this ethnographic research is to
explore how nurses, working in a cardiac catheterization laboratory learn the 'local knowledge'
necessary to communicate with a multidisciplinary discourse community successfully. To protect
the identity of participants in this study, the name of the laboratory included in the study will be
identified as the XYZ Cardiac Catheterization Laboratory. Cardiovascular diseases have long been
the leading cause of death in the United States (Narang et al., 2016). Moreover, research predicts the
progression of cardiovascular disease will impact forty percent of the nation's population by the
year, 2030 (Narang et al., 2016). The literature also shows that the cardiovascular workforce is
inadequate for meeting the rising demands of the cardiovascular patient population (Narang et al.,
2016). In particular, a subset of

Amt Task2
Valerie Johnson
AMT2 Task 2
Western Governor's University
May 1, 2014
Trinity Community Hospital conducted a focused community health needs assessment centering on
cancer, orthopedic and cardiovascular services. The information was obtained through a multitude
of sources including: epidemiological surveys, focus groups, interviews with healthcare
professionals and healthcare facilities' planning guidelines.
Risk Factors
Oncology Services The needs assessment revealed that 15% of the population will be older than age
65 within the next 5 years. 50% of men and 33% of women are expected to develop cancer during
their lifetime. New cases of cancer are expected to grow by 34% in the next 5 years.
Current physician practices that ... Show more content on Helpwriting.net ...
Angioplasties are expected to increase by 25.8%. There will be a need for additional catheterization
labs, surgical suites and expanded cardiac rehabilitation programs. There needs to be better
coordination of care to ensure timely scheduling of procedures. Education programs need to be
developed emphasizing cardiac risk factors, healthy living and lifestyle modifications.
Addressing Needs
Trinity Community Hospital currently does not have any formal oncology, orthopedic or cardiology
programs in place.
Oncology
Trinity, currently is not addressing the needs of the community in regards to oncology services.
There are no oncologists that practice at Trinity Community Hospital, but there are physicians who
have expressed interest if a program was developed. The physician groups that offer oncology
services are at their capacity. The hospital currently does have imaging services, including a MRI
scanner. Additionally, the hospital has a mobile PET scanner 2 days per week. Trinity Community
Hospital currently does not have any chemotherapy units or nurses that have experience with
chemotherapy. While, the other 2 hospitals in the area have cancer programs, there are no
coordinators in place to facilitate the scheduling of patients. The care of oncology patients is
fragmented. Currently there are no prevention programs in place. There are educational programs in
place, but they are not offered frequently.
Orthopedic Services Trinity

This Friday at the Cardiac Catheterization Lab was a very productive and eventful one. First thing in
the morning I went to watch a procedure, or "case" as they call it that the hospital since there were
not any patient files ready to be filed away. When I went to go to the control room with the surgery
happening, the patient was already on the surgery bed and the nurses and tech people (I do not know
their professional name or title) were preparing the equipment that they needed to perform the
surgery. Also, when I walked in I saw one of the traveling tech people that I met a few weeks ago
and he said hi to me and explained that he was helping the doctor with the same type of procedure
that I watched with him on the first day I met him.

Symptoms And Treatment Of Vascular Closure
Background
Vascular closure devices following cardiac catherization through the femoral artery have been
gaining significant traction since its use in the mid–1990s. Compared to the previous gold standard
of manual compression, VCDs allow for shortened time to ambulation, decreased duration of
hospitalization post procedure, and increased patient comfort. The devices have also shown safeness
comparable to manual compression. Despite the many advantages and variety of devices available,
there are still complications to take into account. More common issues include device failure,
bleeding, and hematoma. Less common but more serious complications include infection, ischemia,
limb loss, and death.
Case Report
Our patient is a 74–year–old ... Show more content on Helpwriting.net ...
Due to these findings patient was directly admitted to the hospital and placed on a heparin drip. On
physical exam patient had absent pulses below the right femoral artery. However, there was no
discoloration, change of temperature, or sensory as well as motor deficits of the right lower
extremity. Patient was taking a low–dose aspirin and red yeast rice for cholesterol management at
that time.
The following morning the patient underwent successful angioplasty of the right common femoral
artery with thrombectomy and a 6 x 20 mm balloon angioplasty, reducing a 90% stenosis to less
than 30%. A spider catheter was deployed to perform the thrombectomy, however an atrial blazer
catheter failed to retrieve the spider device as it was unable to completely collapse. As a result the
patient was taken to the OR for vascular surgery. The spider basket was retrieved through the wall of
the common femoral artery with its contents.
The specimen was sent to pathology, which noted a foreign body device surrounded by soft tissue
attached to the spider device. The foreign body was noted to be a Angio–Seal plug from the left
heart catheterization that had been presumed a thrombus.
Discussion
Promising results have shown that the Angio–seal VCD has excellent efficacy and safety after
routine catheterization and intervention. However, clear indications of use and risk of complications
need to be evaluated and monitored.
Advantages to using a closure

The Change Theory Of Nursing Model
Framework The Change Theory of Nursing Model will be used to facilitate change in the unit
because it will drive the patient in a desired direction (Nursing Theory, 2016). The model, developed
by Kurt Lewin, uses three stages of change. Before change can be implemented the agent goes
through unfreezing, experiencing the change, and refreezing (Nursing Theory, 2016). Unfreezing
This phase involves focusing on the staff's mindfulness for the necessity of change based on the
evidence collected by an infection control committee. This phase is necessary to overcome the
tensions of individual resistance and group compliance (Nursing Theory, 2016). Using three
methods is how this phase is achieved. First, redirecting the behavior away from the existing
situation. Second, reducing the restricting forces that have a negative affect on the movement.
Lastly, using a combination of the two methods mentioned above. Experiencing the Change This
stage is where the staff will be required to view the education power point on the new CAUTI
prevention tool. The staff will then take a post education competency test to demonstrate proficiency
of the risks and complications of CAUTIs as well as the prevention tool. Nurses are encouraged to
assess the need to continue the Foley each shift and offer patients an urinal, commode, or bedpan
when needed. When indications are no longer met, the RN is to call the doctor for Foley removal.
Refreezing This is where establishing the change

The Antibacterial And Antiseptic Impregnated Catheters
Methodology
Extraneous Variables
It is very important for the researcher to control the extraneous variable that could affect the study
results. The extraneous variables that would affect the results in this study include, the catheter
material, the catheter care, and the method of obtaining the urine sample. To control the catheter
material, this study will be using the antimicrobial and antiseptic–impregnated catheters instead of
the standard catheters as recommended by the Centers for Disease Control and Prevention (CDC)
2009 guidelines because they are effective in reducing the risk of CAUTIs. To control the catheter
care, the study will follow the CDC guidelines for routine catheter care by ensuring that all the
indwelling urinary catheters (IUC) maintain a sealed drainage system, and an unobstructed urine
flow. In addition, the nursing staff will be cleansing the meatal area daily with warm soapy water
instead of antiseptics, while maintaining the standard precautions including hand hygiene and
wearing of gloves while performing peri–urethral care. To control the procedure for obtaining urine
sample, the study will use the CDC recommendation for collecting the urine sample aseptically, by
aspirating the urine from the sampling port with a sterile syringe after thoroughly cleansing the port
with an antiseptic wipe (Gould et al., n.d.).
Instruments
Choosing an instrument to measure study variables is a very crucial in research. If a researcher
chose to use an existing

Pediatric Cardiac Catheterization
Indications for pediatric cardiac catheterization have undergone significant changes over the last 3
decades. In early 1980s, with emerging of none to less invasive diagnostic modalities and more
specifically with current echocardiography diagnostic ability, cardiac catheterization is no longer
considered as a mainstay diagnostic tool for most cardiac anomalies except in rare occasions or
when accurate hemodynamics measurements are needed. But with dramatic improve in the quality
and availability of instruments which can be used effectively for newborn, interventional
catheterization emerged as a preferred modality for comparing with cardiac surgery which has its
well–known higher risk of mortality and morbidity in neonates. In addition, it can be used
effectively as an alternatives or adjuncts to surgical procedures (hybrid procedures) for few other
conditions.
Thus, in the current era, It is much more common to perform interventional cardiac catheterization
rather than for ... Show more content on Helpwriting.net ...
2– Minor complications: blood loss requires transfusion, hypotension requiring IVF, deep venous
thrombosis, pulse loss requiring heparin, transient heart block, dysrhythmias requiring treatment,
metabolic acidosis requiring bicarbonate administration, and balloon

Cardiac Catheterization: A Short Story
Dr. Hughes smiled. "That is also a catheterization but this is a Cardiac catheterization. What that
involves is inserting a catheter into the vessel of the heart usually from the groin or the arm. If we
find we need to put a stent in, then we will do it at that time." "So I will be here for only one day?"
Adam asked holding Tammy's hand a little tighter. "I am hoping for one night but again that will
depend on what the test results show. Let's hope that is all he will need," Dr. Hughes said. "I'll come
by again shortly." He nodded, walked out of the room, and walked into the room across the hall.
They could hear him talk to that patient, now. "Well that is settled. I'll sleep here tonight." Adam
looked up at Tammy. She looked back with a look

Business Case For Quality And Inadequate Nursing Care
Business case for quality
Inadequate nursing care can be a result of staffing issues or under educated nurses. Errors can be
made that not only affect the patient's well–being, but can affect the financial standing of a hospital.
Creating a business case for quality, would make changes benefitting the hospital as a whole. This
paper will describe the current situation in need of change, discuss the proposed program, and
provide a market analysis, an implementation plan, a timeline for implementation, and an evaluation
plan, including relevant financial data of the proposed program.
Current Situation Summary
The current practice for post op cardiac catheterization (cath), to include percutaneous coronary
intervention (PCI) is to provide the initial recovery in the cath lab, then transfer to the floor for the
next several hours of monitoring. PCI is the placement of a stent into a narrowed cardiac artery with
administration of high dose anticoagulants to maintain patency. Initial recovery consists of the first
hour post cath, with vitals and site checks every 15 minutes ("Fort Walton Beach Hospital", 2014).
The current policy states that if the first hour post op is stable, which means minimal changes in
vitals and unchanged site checks, then the next several hours of recovery can be provided on the
progressive care unit (PCU). According to the policy, after the first hour, vitals and site checks will
be completed every 30 minutes times 4, then every hour times 4 ("Fort Walton

My First Day Of My Independent Study Mentorship At The...
An hour or so into my first day at my internship and my mentor gets a call from the Emergency
Room about an elderly patient who came in complaining of chest pain. After running some tests and
EKGs, the ER staff finds some abnormal results which slightly suggest that the patient might be
having a heart attack. The patient is rushed into the cath lab while my mentor has to leave to attend a
case at another facility so he leaves me with his partner Dr. Fernandez to watch the case. Dr.
Fernandez starts the procedure of cardiac catheterization in which he plants a stent in the patient's
heart in roughly 30 minutes. Although the patient suffered no heart attack, Dr. Fernandez found
some narrowing the patient's heart. That was my first day of my ... Show more content on
Helpwriting.net ...
Pillai. Interventional cardiology is an incredibly time consuming and challenging specialty in
medicine. I learned from my mentor what it is like to see multiple patients in the hospital and in his
office, perform procedures, study cases, all of which are followed by loads of paperwork, in the
course of just one day. After spending the past 10 weeks in this internship, I can certainly say that I
can see myself taking care of hearts in the future.
So what actually inspired me pursue an internship in cardiology, due to the fact that last semester,
during my internship in the Emergency Department in Memorial Hermann, I saw many cases
dealing with chest pain and heart disease. Due to my extensive exposure to heart patients and my
research on chest pain, I started to grow an interest for cardiology. My former mentor Dr. Kutsen
referred me to his colleague, Dr. Pillai to continue my internship in the field of cardiology. I choose
cardiac catheterization as the topic of my study in this internship because it tends to be one of the
most accurate and effective procedure performed by Interventional Cardiologists. It can aid in
earlier detection and treatment of coronary artery disease which is essentially the number one killer
in the United States. Throughout my internship, I learned what a typical Interventional Cardiologist
does on the daily basis. Dr. Pillai informed me about his educational background which seemed
overwhelming to me at first. After

The Threat of Catheter-Related Infections
Clinical problem: Catheter–related infections pose a detrimental threat to adult patients in intensive
care units with a central line. Effects of an infection include: an increase in the patients' length of
hospital stay, morbidity and mortality rates, and hospital readmission rates.
Objective: To determine if the evidence based practice interventions studied and published can help
to decrease the rate of infection occurring in central lines.
Data sources: The search engine that was used to find three randomized controlled trial articles and
support my PICOT question was PubMed. Key terms that were used to search for them included
intensive care unit infections, chlorhexidine dressings, antiseptic solutions, and prevention methods
for catheter–related infections. A clinical guideline for the prevention of intravascular catheter–
related infection was retrieved from the Agency for Healthcare Research and Quality (AHRQ).
Results: The clinical guideline from the AHRQ encouraged interventions like the chlorhexidine
impregnated sponge, antiseptic solution, and other precautious measures in order to reduce catheter–
related infections. The research completed by Atahan and colleagues (2012), Timsit and colleagues
(2012), and Timsit and colleagues (2009) concluded that the use of 2% chlorhexidine gel tegaderm
dressing, chlorhexidine impregnated sponge, and the antiseptic solution has significantly helped to
reduce infection rates in catheters.
Conclusion: After synthesizing the

The Prevention Of Catheter Associated Urinary Tract Infection
This literature review essay will demonstrate a review of four different research articles and
research related methodology The articles and review are based on the prevention of Catheter–
associated Urinary Tract Infection (UTI). The aim of this literature review is to review publications
concerning the management of Catheter–related to UTI 's including the prevention. Articles
reviewed include the various precaution and preventions concerning Catheter–associated urinary
tract infection (CAUTI) The article evidence summarized bellow was generated using a literature
search conducted for Randomised Controlled Trials, Systemic Review or quantitative and
qualitative research.
A catheter is used in an event of an individual that has either had trauma or surgery and as a result
has temporary urinary retention (Patton & Thibodeau, 2013)
General strategies for the prevention of CAUTI include measures such as hand hygiene and
adherence. Strategies used for the prevention of CAUTI include using an aseptic technique for
catheter insertion, limiting the duration of urinary catheters, and following standard infection control
precautions for catheter care. Successful achievement implementation of these measures will result
in a decrease of CAUTI 's (Bennett, 2014).
CAUTI are a big problem within the clinical settings. Up to about 80% of individuals develop a UTI
due to the presence of a urinary catheter (American Association of critical Care, 2015). Long lasting
catheterization

Ethical Dilemma In Nursing
Introduction
The choice of right versus wrong is instilled throughout childhood. However, there are some
situations where you have to choose between the two because both choices have their advantages
and disadvantages. This is an ethical dilemma. An ethical dilemma involves morals that clash
between each other, and some involve the legal aspect of the choices (Grohar– Murray). Everyone
faces some sort of ethical dilemma. There are some professions that have to battle ethical dilemmas
every day. Amongst those professions the nursing occupation and other healthcare related titles have
to keep in mind several different laws, rules, and regulations that effects these decisions. The nurse
also must remember their primary duty is to the ... Show more content on Helpwriting.net ...
What happens when the patient is legally incompetent and the patient's family agrees to the
treatment while the patient is refusing? The next section, 2.1: Primacy of the Patient's Interests,
explains what to do "when the patient's wishes are in conflict with those of other." In these situations
"the nurse's commitment remains to the identified patient" (2015). Simply put the nurse must listen
to the desires of the patient that is admitted to the hospital or care facility over the patient's family.
Background
On this particular floor, there was a patient who was legally incompetent. This patient has a history
of being noncompliant with his medicines and hypertension. He has a drug issue and a list of
medical problems. Those health problems include a left middle cerebral artery infarct with a
hemorrhagic conversion, ejection fraction of 30%, and a heart rhythm of atrial fibrillation.
Occasionally this patient's heart rhythm would switch to sinus tachycardia during the shift. Along
with the pervious complications listed this patient had other symptoms associated with strokes. The
healthcare team was not sure as to what was the cause of the sudden spikes in heart rate. The
increase happened while the patient was in the bathroom, however, the cardiologist advised his heart
rate should not drastically increase as it did from a bowel movement.
The cardiologist decided to perform a heart catheterization (Heart Cath) on this

Reflective Essay on Assessment and Management of Urinary...
REFLECTIVE ESSAY ON ASSESSMENT AND MANAGEMENT OF URINARY
INCONTINENCE
INTRODUCTION
Incontinence is one of the major problems faced by the elderly. Nurses can play a significant role in
discovering continence problems (Lea R.et.al.2007). Urinary incontinence is the unintentional
passing of urine. It is a very common problem and is thought to affect more than 50 million people
in the developed world.(NHS.UK). To identify the problem and provide necessary treatment at the
early stage, a thorough physical assessment is necessary. In my placement area I came across many
residents using incontinence pads, urinary catheters and incontinence sheaths. I understood that,
incontinence was a major problem among the elderly and it made me select ... Show more content
on Helpwriting.net ...
When I started my placement , Mrs . X who was suffering from Parkinsonism and dementia was on
Indwelling urinary catheter for the management of urinary incontinence. Adhering to the results
from the literature review I planned for initiating several steps to control incontinence in Mrs. X.
My mentor was always with me with full support and guidelines. Fluid management was the first
step started. An input output chart was kept and well maintained. Then steps wre also taken to
manage constipation. Exercises were the last method practiced and the final result was really
appreciable as she got a great reduction in the incontinence rate.
FEELINGS
After the experience I felt so glad and proud to myself as it was a great success towards its end. In
the beginning, during the time of planning I thought it may be bit difficult for a patient with
parkinsonism and dementia to make follow our instructions and continue till the end of this practice.
But when we started the programme her response was so nice that she found very cooperative and

This Friday was a very eventful and exciting day at the Cardiac Catheterization Lab. When I first
arrived at the office I asked my mentor, Maria, if there were any procedures that I could watch.
After two phone calls, there was one surgery that had just begun that I could sit in and watch. When
I went to the control room, I had looked through the glass and I had noticed that there were at least
six or seven people in the surgery room. After about five minutes watching the surgery and the
screen that projected the heart, the tech guy that I met a few weeks ago comes into the control room,
says hi, and tells me that this is a good case for me to watch because it is a different surgery than the
ones I have previously seen. In this case, the patient

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