Question

Case Study A 43 year old Male patient is brought to the OR for a total hip arthroplasty. His chart shows that he HIV+; he is in the early stages of Aids. He has kaposi's sarcoma skin lesions, painfully swollen lymph nodes in the groin and axilla, and is underweight.

                           Question
1. what important principles should you consider while positioning the patient to protect him from pain and injury?

2. what are some special considerations concerning an AIDS patient when placing the ESU grounding pad?

3. what complications could be encountered during the case that the CST should be prepared to assist the OR team in resolving?

4. Discuss the concept of standard precautions. Do you treat this patient any differently because he is HIV+?

Answer 1

1. The important principles are;

• check the general condition of the patient
• explain the procedure to the patient
• arrange the comfort devices near the bed side
• identify the rationale before positioning
• using a right techniques at right time.
• provide comfort to the patient
• provide the position which will improve the circulation
• provide the position which helps to prevent pressure sores
• maintain good body alignment of the patient
• support the body parts in good alignmnet by using supportive devices to promote comfort and prevent muscle strain
• avoid prolonged flexion of any one body segment by changing the position at least every two hour.
• reduce the pressure caused by bodyweight of his or her body or object by changing the position and using protective devices.

2. grounding pads are used to protect the person from the hamful effect of the electricity while doing surgery. An Electrosurgical Unit consists of a generator and a handpiece with one or more electrodes.

The special considerations are;

• The caregiver should wear the gloves while giveing care to the patient.
• barrier nursing should be practiced while providing the care to the patient.
• sterile and disposable equipments should be used to the procedure.
• universal precautions must be taken.
• check the CD4 count of the patient
• as a care giver the nurse must monitor the progress of the every patient regularly
• the nurse should use the precautions like wear the gloves, use a face shield, wear mask, goggles, shoe cover etc
• perform hand washing
• handile the body fluids very carefully.
• after the procedure disinfect the room.

3. The complications what we can mainly saw in this caes are;

• fracture of medial tibial condyle
• fractures of intracondylar eminences
• rupture of medial collateral ligament etc.

the main role of a nurse are;

• in the operation room the nurse will act as a scrub nurse.
• a circulating nurse manages the overall nursing care of the OT.
• she should maintain safe and comfortable environment.

4. the standard precautions are;

• All health-care workers should use appropriate barrier precautions
• Hands and other skin surfaces should be washed immediately and thoroughly
• All health-care workers should take precautions to prevent injuries caused by needles, scalpels etc.
• gloves- gloves to be worn when there is potential for hand or skin contact with blood or other body secretions.
• wear face protection - during procedures that are likely to generate droplets of blood or body fluids to prevent exposure to mucous membranes of the mouth nose etc.
• wear protective body clothing - when there is a potential for splashing of blood or body fluids.
• never try to pipette by mouth.
• aviod accidental injuries.
• correct disposal of used needles and other sharp objects.
• as a nurse we have to treat the HIV patient with all the universal precaution as mentioned above.