Question

You are a nurse preparing to receive a new patient, fresh from surgery, to your unit. The patient is a 71-year-old man who underwent a surgical repair of a fractured femur. As you receive a report from the postanesthesia recovery unit, you learn that his medical history includes hypertension, 40 pack-years of smoking, and COPD. His surgical repair was successful but complicated by excessive bleeding, and he is receiving IV fluids to compensate. He is widowed, and his three children are scattered throughout the United States. He lives alone, receives Meals on Wheels, and pays a cleaning service to keep his home clean.

What general outcomes would you expect to establish from this information?

List potential plan of care revisions available to nurses.

To effect performance improvement in nursing, what steps are necessary in the process?

Health care facilities and organizations implement programs to promote excellence in nursing that are called quality-assurance programs. How do these programs work?

Answer 1

#. The general outcomes that is expected to establish from this information is that the elderly patient is all alone . He has no one to take care of him . He has a history of hypertension , smoking and COPD. He had severe bleeding during the surgery and for that he is receiving IV fluids.

#. Plan of care include :-

- Prevention of infection

- Prevention of injury ,fall

- Restoration of body fluids

- Proper nutrition supply

- Provision of psychological and emotional support

- Prevention of complications associated with surgery

#. For performance improvement in nursing, the steps necessary in the process are :-

Assessment

Diagnosis

Planning

Implementation

Evaluation

#. Quality Assurance (QA) Program

Ongoing systematic process designed to evaluate and promote excellence in the heath care provided to patients. Requires evaluation of structure, process, and outcome.

Structure Evaluation

Focus on the setting in which the care is given. It answers questions such as: What effect does the setting have on the quality of care?

Process Evaluation

* Focuses on how the care was given.

*Examples of process criteria: Performs and records chest assessment, including auscultation, once per shift. Checks patient's identification band prior to giving medication.

* It answers such questions as: Is the care relevant to the patient's needs? Is the care appropriate, complete and timely?

Outcome Evaluation

*Focuses on measurable changes in the health status of the patient as a result of nursing care. Written in terms of client responses or health states

*For example... How many patients undergoing hip repairs develop pneumonia? How many patients who have colostomy experience infection that delay discharge?