NRNP 6560: Advanced Care of Adults in Acute Settings III/ Week 1 Week 1: Pre-Operative Assessment, Post-Operative Care, and Hospital Admission With over 50 million inpatient surgical procedures performed annually (CDC, 2014), advanced practice nurses must be prepared to practice in perioperative environments. While the scope of practice may differ based on state laws and institutional regulations, all advanced practice nurses are an integral part of the multidisciplinary care team. From pre- to post-operation, they must coordinate patient care and communicate with patients, physicians, and family members. This week, you practice risk stratification for patients undergoing invasive procedures and reflect on the impact of risk stratification on patient education and informed consent. Discussion: Risk Stratification Risk stratification is an important technique that allows patients to be classified according to their health risk status, taking into consideration many factors, such as diagnosis, age, BMI, comorbidities, labs and other assessment scores, health behaviors and health literacy, and social and caregiver support needs, to name a few. Utilizing such a framework or model can be used not only to identify patient-specific risks to refine treatment plants, but can also be applied to improve workflows, better manage population health, and effectively use resources. For this Discussion, you will consider risk stratification in the preoperative environment. To prepare: • Review the risk stratification video in this week’s Learning Resources. • You will receive a set of patient scenarios from your Instructor. Review each of the three patient scenarios provided. Identify each patient as high, intermediate, or low risk. • Consider patient education needs and strategies for each patient, as well as what the informed consent for each procedure would be. By Day 3 of Week 1 Post your assessment of which level of risk each patient in the case scenarios corresponds with (high, intermediate, or low). Explain the rationale for your decision-making. Scenarios: 1. A 60-year-old female with no previous cardiac history, except for preoperative for stratification for a new murmur, is sent to you. An echocardiogram is performed demonstrating an ejection fraction of 60%, and severe aortic stenosis. Her proposed surgery is a total knee replacement. 2. A 25-year-old male is sent to you for preoperative risk stratification. His proposed surgery is an emergency cholecystectomy. He is active and has no exertional symptoms playing basketball for over an hour 3 times weekly. He has no previous cardiac, medical, or surgical history. 3. A 75-year-old female with history of coronary artery disease with previous CABG and PCI, hypertension, and hyperlipidemia is sent to you for preoperative risk stratification. Her proposed surgery is hip replacement. You are unable to assess her functional status due to hip pain, which renders her mobility challenged. Her previous echocardiogram demonstrates an ejection fraction of 55–60% with no wall motion abnormality. She has no active anginal or exertional symptoms.
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