Clinical Objectives Of The Operating Room Nursing Essay

Clinical Objectives Of The Operating Room Nursing Essay The Pre-operative nurse has many duties to perform for their patients prior to surgery. Patients usually go through the Assessment Clinic prior to being transported to the Outpatient facilities. However, if patients do not go through the Assessment Clinic, it is the pre-operative nurses duty to gather this information. The information to be gathered prior to surgery is as follows; past medical history, last flu/pneumonia vaccination, prior surgeries, assessment of various pre-existing disorders/diseases processes (such as hypertension, migraines, diabetes, heart trouble, etc.), current medications (dosage, frequency, last dose taken), name and phone number of a family member, pain assessment, NPO status, assessment of any metal in or on the patients body (can it be removed), alcohol/tobacco/drug use, if the patient has any dentures, glasses, or contacts that need to be removed prior to surgery, and what procedure is being done and the location of the body the procedure is to be done on. When all of the Administration Assessment is complete, the nurse then starts to prep the patient for surgery according to her duties. The pre-operative nurses have many duties. The nurse is to start by checking the physicians orders against the chart for the specific procedure being done. The nurse must also ensure any lab work ordered is with in normal limits for that patient. If there is previous history of heart conditions, the patient must be cleared through radiology prior to surgery; the nurse is responsible for making sure all appropriate forms from radiology are present and signed accordingly. Prior to being administered any medications or having any invasive procedures (IV), the nurse explains the procedure to the patient and makes sure they have no questions. The nurse then ensures that all surgery consent forms are present and signed by the patient. For any female patients that are not post-menopausal or has not had a hysterectomy, the nurse must get a urinalysis to rule o ut possible pregnancy prior to surgery. The nurse applies Sequential Compression Devices (SCDs) to the patients calves to help prevent blood clots during surgery. The patients respiratory status is confirmed through obtaining RR, HR and BP. The pre-operative nurse does not typically obtain these vitals as the OR aids are responsible for this; however, the nurse is responsible for making sure the vitals are within normal ranges for that patient and that the patients vitals are charted. The nurse then starts the patients IV. Prior to injecting the Jelco, the nurse administers 0.1 ml of lidocaine, intro-dermally to numb the area. This helps calm the patients anxieties due to the thought of the smaller needle delivering a numbing agent before the big needle is inserted. If the physician has ordered a catheter prior to surgery, the nurse is responsible for carrying out these orders. This is a sterile procedure and can be performed by the pre-operative nurse. After all of these duties have been performed, the nurse does another pain assessment on the patient. If it is deemed necessary for pain medication administration, the nurse will notify the physician by phone and the nurse takes a telephone medication order. It is the nurses responsibility to make sure the physician comes back and signs the telephone medication order that was given over the phone as well as to carry out the orders as soon as she can so the patient is not in any pain. Antibiotics are almost always ordered prior to any surgery. If antibiotics are ordered, the nurse will administer through IV already established. All duties performed must be charted prior to patient being transferred to the operating room. The nurse will continue to check in on the patient periodically until the patient is taken back into surgery. Duties of the Intra-operative Nurse Once the patient is ready for surgery, they are transferred to the intra-operative nurse. The intra-operative nurse does a pre-op interview asking the patient of any allergies, any metals in or on the body, and if these metals can be removed. If the metal can be removed, it is the intra-operative nurses responsibility to remove it and secure it to either a family member or where ever determined appropriate by said nurse. The intra-operative nurse is responsible for the patient during surgery and until they are transferred to the Post-Anesthesia Care Unit (PACU). The intra-operative nurse must maintain a log of times for entering the OR, intubation, anesthesia administration, Foley catheter insertion, when surgery starts, and when surgery stops. The intra-operative nurse is the only personnel in the operating room that is not sterile and therefore can leave the operating room during surgery to obtain any supplies needed such as extra sutures, emergency supplies in case a patient codes , etc. For this reason the intra-operative nurse is called the Circulator. The intra-operative nurse assists the anesthesiologist with placements of the intubation tube and the naso-gastric tube. Blood pressure cuff, EKG (3 Lead), and Pulse Ox are all attached to the patient by the intra-operative nurse. The nurse applies a sticky Bovie pad to the patients outside, upper thigh. The Bovie sends probes of electricity through the patients body during surgery which cauterizes the patients veins and helps minimize bleeding. This is the reason for removing any metal prior to surgery. Once the patient is under anesthesia, the nurse is responsible for correctly positioning the patient on the operating table according to the procedure being performed and maintaining the patients safety during surgery. Once positioning is correct, the nurse begins to prep the patient for surgery. This includes cleaning the surgical area, as well as, any areas nearby that could contaminate the surgical procedure or compromise the sterile field. The prep solution of choice for this facility is Betadine. The nurse cleans the surgical site and surrounding areas three times with the prep solution, using a fresh prep sponge each time and patted the area with sterile drape cloths in between each cleansing. The intra-operative nurse also hooks up the suction canisters and preps a bag of normal saline used for irrigation. The intra-operative nurse is also responsible for counting all instruments and sponges before surgery, before suturing, and after suturing. All of these duties are performed before the attending physician enters the operating room. Once the surgeon enters the room, the intra-operative nurse assists him/her with donning sterile gloves, gown, and mask and a Time Out is performed. The Time out procedure consists of specific verbal reports between the intra-operative nurse, the anesthesiologist, and the surgeon. Patient ID is established through chart, arm band, and stating aloud by the intra-operative nurse. The procedure is read aloud from the informed consent. Any imaging required prior to surgery is confirmed labeled and stated to be present. Pre-procedure antibiotics, dosage, and route are stated aloud by the intra-operative nurse. Any safety precautions such as history of drug allergies, medication uses, etc. are stated aloud by the intra-operative nurse. Once all of this information has been stated aloud, the intra-operative nurse says, Does everyone agree? at which time all personnel must say aloud, Agreed. Once surgery has begun, the nurse calls a friend or family member to inform them surgery has begun. The nurse is to call the family every hour that the patient is in the operating room. During surgery, the nurse is responsible for answering the phone, turning lights off and on, adjusting the heating or air conditioning, positioning any unsterile equipment, removing and reapplying any sterile garments, keeping track and charting what supplies were used for that patients procedure, and any extra equipment needed by surgical personnel during surgery for billing purposes. Also during surgery, the intra-operative nurse is to chart all times logged, any specimens (body parts) removed, sutures used, anyone present in the operating room, amount of any fluids collected through suctioning, and who performed what procedures. If any specimens were removed, the intra-operative nurse is responsible for labeling and delivering to the lab. Once all supplies are accounted for and the patient is released from the operating room, the patient is transferred to the PACU. duties of the PACU nurse I was not able to observe a nurse performing duties in the PACU, however, one of the nurses was kind enough to sit with me and explain some of their duties. Once a patient is transferred to the PACU, the PACU nurse applies a face mask delivering oxygen and vitals are obtained every ten minutes. The vitals obtained include blood pressure, pulse ox and EKG readings. The PACU nurse must monitor the patients temperature, as well as patients hemodynamics for any rhythm changes according to the patients medical history. Patients are set up with a Patient controlled analgesic unit (PCA unit) to deliver pain medication PRN as deemed by the patient at the push of a button. The PCA unit is designed to only deliver a specific amount of pain medication regardless of how often the patient pushes the button therefore the patient is not at risk of overdosing and doesnt have to wait on the nurse to administer pain medication. If a Foley catheter hasnt been inserted yet, the PACU nurse will perform this duty as the patient will not have bathroom privileges until they are Post-op. PACU nurses cannot intubate, however, they can ex-tubate. The PACU nurse is also responsible for discontinuing arterial lines, inserting nerve blocks for pain management, and filling out all proper forms and charting. PACU nurses can only care for a maximum of two patients at a time. However, if the patient is less than eight years of age or an Intensive Care Unit patient, then that will be the PACU nurses only patient until they are transferred to post-op. Once the patient is awake and determined to be stable, they are transferred back to Outpatient where they were prepped Pre-op. DUTIES OF THE PRE-OPERATIVE NURSE Once patients are transferred back to Outpatient area, a Pre-operative nurse assumes responsibility for the patient until discharge, but performs post-op duties. Vitals are obtained every thirty minutes by the outpatient aids, but are charted and monitored by the post-operative nurse. The nurse assesses the surgical site for bleeding or excess swelling if the site is visible. The patients pain is assessed and the PCA button is placed well within reach for the patient. The post-operative nurse checks physicians orders for discharge pain medications and calls the order into the patients personal pharmacy of choice. The nurse discontinues the patients IV, catheter, and SCDs. The family or whoever is providing transportation home for the patient is notified and allowed to return to the Outpatient prep area until patient is discharged. The post-operative nurse also gathers any discharge instructions as ordered by the physician and sets the post-op follow-up appointment prior to discharge. The physician will specify the criteria in which the patient must fulfill before the patient is discharged. For example, if kidney stones were zapped, the patient must void freely at least once before discharge. The post -operative nurse is responsible for ensuring that all required information in regards to forms being signed and paperwork required in medical record is present, and all charting required is complete for that patient. ONE ASPECT OF PATIENT TEACHING One aspect of patient teaching that I identified was during post-op and prior to discharge. The example I observed was when the post-operative nurse specified to the patient what she should expect in the days to come, specifically how to wipe after going to the bathroom, as well as specific warning signs of complications that would need immediate attention. WHAT WERE MY STRENGTHS WEAKNESSES I believe my strengths were first and foremost my previous, in-class instruction. I felt very informed and knew what supplies were needed and how to start an IV. Secondly, I believe my willingness to learn whatever the staff wanted to teach me without reserve is another one of my strengths. My weakness was my not understanding the jargon used by everyone. I had to repeatedly ask what all of the acronyms used stood for. It seemed that they had an acronym for everything. I believe the more clinical hours I am able to participate in, the more jargon I will learn. I also believe that taking a medical terminology class would be a tremendous asset to my education investment.

Hip Hop Essay

Music has been around since the beginning of civilization. Music was used to tell myths, religious stories, and warrior tales. Since the beginning of civilization music has greatly progressed. Music still tells a story, we know just have many genres to satisfy the cultural and social tastes of our modern society. Hip Hop is a genre of music that has significantly grown the last couple of decades. It’s increased popularity has brought it to the forefront of globalization. Technological advances has made it easy for Hip Hop to spread out globally. This occurrence of globalization is a key example that as our cultural borders are broken down by technology, our own cultural and social practices become fluid. Although there are many positive and negative comments about the globalization of Hip Hop, it is a reflection of the growing phenomenon occurring all over the world. Hip hop originated in the South Bronx of New York City in the 1970s. The term rap is often used synonymously with hip hop, but hip hop can also be described as an entire subculture (â€Å"Hip Hop†, 2004). The term Hip Hop is said to have come from a joke between Keith Cowboy, rapper with Grandmaster Flash and the Furious Five, and their friends (â€Å"Hip Hop†, 2004). Although Hip Hop was created on American soil, it’s influences are global. It can be said that Hip Hop might be a result of ethnic globalization. Hip Hop has roots in African, Caribbean, and Latino culture (â€Å"Hip Hop Globalization and Youth Culture†, 2005). Spoken word, which is still popular today is also an influence in Hip Hop music and culture. Spoken word is a style of poetry spoken in a rhythmic fashion. Hip Hop ranges from rap music, to B-boy dance. It was a platform to empower ethnic youth without violence. Hip Hop in the beginning was essentially still an underground subculture. It was popular with many ethnic communities but it was not popular in the mainstream music industry. This all changed with the band Blondie and their song â€Å"Rapture†. â€Å"Rapture† is one of the first rap song’s to reach the top of the charts in mainstream pop music. Although Blondie is a punk/rock band, they were the proper catalyst to give Hip Hop the mainstream attention it deserved. Hip Hop has changed since it’s birth in the 1970’s. Hip Hop is now apart of the mainstream music scene. It is not uncommon to see artist from different genres collaborating with Hip Hop artists. It is also not uncommon to see Hip Hop music and culture in movies, television shows, and commercials. In the past you would only see people from ethnic communities wearing Hip Hop clothing, now all races including Asian, Caucasian, etc have accepted the Hip Hop style. The subject matter has also changed. In the past Hip Hop lyrics focused on political and societal frustrations, now Hip Hop lyrics steer more toward provocative content. Hip Hop subject matter consists mostly of the aspirations of wealth, sex, drug use, and criminal activity. During the beginning years the age of the Hip Hop listener was wide spread. It ranged from teens to even adults in their 50’s. Although Hip Hop still has an adult audience, it is now more geared toward younger audiences. Younger listeners are more likely to purchase Hip Hop music and paraphernalia, than the older audience. As Blondie helped Hip Hop garner increased exposure in the United States, The internet and other advancements in technology helped Hip Hop gain global exposure. Technological changes in the late twentieth century and early twenty-first have enabled access to the social spaces previously bounded by time and geographic borders; a process identified by John Thompson as mediazation—a flow of images across time and space (â€Å"Hip Hop Globalization and Youth Culture†, 2005). The internet has created a world without barriers and borders. The internet helps connect people from Hong Kong, to people in Bellevue, Washington. Without the internet we would not have social networking. Social networking sites such as Facebook, Twitter, and MySpace, exposes us to different ideas, cultures, and music. MySpace is the leading social networking site when it comes to music. MySpace allows musicians from all over the globe to share their music with a diverse audience. User can find international music that they would not have been exposed to if MySpace was not created. Because of these connections to international music outlets Hip Hop has been able to spread to many countries. Many Countries have acquired Hip Hop into their own music scene. Many of these countries have mixed Hip Hop with their own popular music to form a new kind of Hip Hop. As more music driven social networking sites are created blending of different music cultures will be the norm. Japan has been one of the top countries for globalization of music. You can find reggae, dance hall, death metal, or Hip Hop blaring from clubs. Hip Hop has been the most popular type of music to globalize into the Japanese music market. Japan was introduced to hip hop in the fall of 1983 in the movie Wild Style (â€Å"Japanese Hip Hop, 2010). This movie created an underground buzz. Soon Hip Hop in Japan began to be embraced by the Japanese youth. They ere inspired by the popular B-boy style of the western Hip Hop Culture. In the 21st Hip Hop’s popularity has become mainstream. Young Japanese listeners have also adopt the dress culture as well, wearing baggy clothes, and backward caps. Because Hip Hop in America focuses on the hard life living in the ghetto, some think that Japanese Hip Hop is not authentic. With a lack of ghettos, Japanese youth consider hip hop to be more about fashion–baggy jeans, medallions, dread locks. Actual Japanese rap lyrics have a tendency to refer to mundane subjects such as food, cell phones, and shopping (â€Å"Japanese Hip Hop†, 2010). The Japanese subculture of â€Å"blackfacers† may also challenge Japanese Hip Hop authenticity. The Japanese pop group, the Gosperats, has been known to wear black face makeup during performances (â€Å"Japanese Hip Hop, 2010). This example of imitation will most likely not be embraced by western â€Å"Hip Hop Heads† (Avid Hip Hop Listeners). Many would think that instead of taking Hip Hop into their own hands and constructing something different and new for the genre, they just ride on the backs of western Hip Hop creativity. Brazil is another country that has adopted Hip Hop culture into their own culture. Brazilian Hip Hop was born in the barrios (ghettos) of Brazil. The Brazilian youth were drawn to the western Hip Hop culture. Hip Hop gave them a platform to voice the political and economic turmoil of living in the barrio. To escape their impoverished lives, break dancers, DJs, graffiti artists, and rappers would meet at the Largo de Sao Bento and in the center of Sao Paulo on weekends, where Brazilian rap’s distinctive sound (often incorporating roots, samba, and reggae) and lyrics began to be developed (â€Å"Popular Music†, 2005). This integration of Hip Hop and Brazilian based music birthed Baile Funk. Baile Funk can be described as Hip Hop as it might sound in the post-apocalyptic wasteland of Mad Max (Edlund, 2005). This wild sound of Baile Funk screams the pain of the Brazilian slums. Brazilian Hip Hop has garnered much respect world wide. It’s authentic sound, and unapologetic, infectious beats have inspired artist everywhere. Because the Brazilian youth choose to hybridize the Brazilian and hip hop sound, they are respected for their originality. Latin Hip Hop is significant because of the close proximity that Latino countries such as Mexico and Cuba are to America. Latino Hip Hop developed within the youth community. The Latino youth could relate to the hard life Hip Hop artist had in the ghetto. Many Latino Hip Hop acts were created by youth frustration in substandard living conditions. Because of the border between Mexico and the United States, Mexican Hip Hop was greatly influenced by western Hip Hop. The mixture of Spanish lyrics with American ones created a â€Å"Spanglish† sound. Control Machete, founded in 1995, is most accurately classified as hip-hop, blended with the distinctive sounds of traditional Mexican guitar harmonies and the rhythms of danzon (â€Å"Popular Music†, 2005). This mix was used to target the Mexican youth to seek change of political and social problems amongst the Mexican community. These Mexican Hip Hop bands have also garnered a substantial following in the United States; because of the close proximity to the U. S. music flowing in both directions increase the influence of the Mexican music scene (â€Å"Popular Music†, 2005). Cuba is another Latin country affected by Hip Hop music. Even though trade and travel between the United States and Cuba is restricted ,Hip Hop has still been able to influence their music. Cuban citizens were suppressed in many ways including free speech in journalism. Music was the only outlet to air political, economic, and social grievances. Songs about prostitution, street life, poverty, domestic violence, obsession with money, class differences, and the lack of spiritual and ethical values abound, and their biting, poetic criticism is a refreshing antidote to the island’s lifeless press (â€Å"Cuban Hip Hop†, 2008). Lastly, Europe has not been able to dodge the influence of Hip Hop culture. The British Hip Hop scene is still forming an audience in the United States, while it has wide spread popularity in it’s native U. K. British grime is the fusion of cockney slang with hard beats, and Hip Hop flavor. The style grew out of London’s mostly black projects, called council estates, sometime around 2002, and spread via pirate radio, which functions in Britain essentially as mix tapes do here (Edlund, 2005). French Hip Hop is also alive in Europe. This is an incredible feat because French culture is usually very resistant to American influences. Although French Hip Hop is mainstream in Europe, it has not garnered much success in the states. Throughout the past twenty years, the French hip-hop community has cultivated its own style and sensibilities while staying closely connected to American artists via music videos, concerts, radio, and other media (Hip Hop Music and Culture, 2005). There are many questions about the true authenticity of these forms of Hip Hop. With the exception of the Japanese Hip Hop Movement, it can be said with confidence that authenticity has been achieved. While the Japanese Hip Hop movement stays true to the old school rap values and mentality, it does not go further than that. It does not seek to mix cultural influences with it’s music like the other countries. The European, Latino, and Brazilian Hip Hop movement have all mixed their culture, old and new to build something that is truly their own. By adding each countries unique social, economic, and political turmoil, each international Hip Hop genre speaks a song of oppression, pain, and hope for the future that their own culture can relate to and value. Besides the Japanese Hip Hop community all other Hip Hop communities chose to hybridize their cultures with Hip Hop. The Japanese Hip Hop culture sought to homogenize itself. They seem to be more focus on imitating American Hip Hop life instead of building their own experiences. The adaptation of Hip Hop internationally is not really different in each country. Although there problems may be different, they have the common denominator of being powered by the youth. Each Culture’s youth has grabbed hold of the Western Hip Hop ideals to create their own individuality in their own country. Also, Hip Hop seems to flourish is poor societies. These artist have more heart felt words to speak and genuine creativity because when you are brought up in such poor societal conditions that is sometimes all you have to hold on to. Hip Hop proves to be the voice of the people that may not be able to speak for themselves in conventional ways. Globalization has allowed many people who would not have the means to speak up, to be able to take center stage. Many believe that globalization will be the end of individuality and creativity. This has been a theory that seems to fail when put up against Hip Hop globalization. Hip Hop Globalization has proven to hybridize communities and music,that in the end forms something that has never been seen before. Globalization may prove that instead of making the world â€Å"flat†, it will create new mountains and craters of creativity that were never imagined.

Everyday Use by Alice Walker Essay

A loving mother The unconditional love of Mama towards Dee and Maggie is shown. For example, ‘I will wait for her (Dee) in the yard that Maggie and I made so clean†¦Ã¢â‚¬â„¢ Mama takes good care of the house in order to create a comfortable living environment for them. Also, mama saves money to send Dee to study in Augusta as to receive a better education although she is poor. Mama gives the best to her daughter. Tough and strong There is a long description portraying the masculine side of Mama. ‘In real life I am a big-boned woman with rough, man-working hands†¦I can kill and clean a hog as mercilessly as a man.’ shows Mama belongs to the labor class. Readers may guess that Mama is a single mother as her husband is mentioned once. Mama seems to bring teo daughters up by herself. Poor and uneducated The narrator directly divulges the education level of Mama: ‘I never had an education myself†¦sometimes Maggie reads to me.’ She can’t break through this poor life. Patient When mama asked what happen to ‘Dee’, Dee replied, ‘She’s dead’ which shows her inconsideration towards identity. Instead of blaming Dee, Mama accepts the big chances of Dee. Mama asks her about her new and complicated name: ‘How do you pronounce this name?’ I asked. ‘You don’t have to call me by it if you don’t want to.’ said Wangero ‘Why shouldn’t I?’ I asked. The one who understand the meaning of quilts /mature Mama explains the family tree and who is Dee’s named after in details. At las, she gives the quilts to Maggie because she knows Maggie also understand its importance and will treasure the quilts. -> However, the dream/thought of Dee and Mama is to be brought together on a TV program reveals the distant relationship between the two and also how Mama remains a practical woman with few illusions and dream of how things are. Voice (whether she can be trusted) of the narrator The voice of the narrator is trustful as she is honest to divulge everything to readers. Mama doesn’t feel ashamed about her education level and outlook. As a narrator, Mama reveals her background information directly: ‘I never had an education myself’; ‘In real life I am a big-boned woman with rough, man-working hands’. She also has no hesitation on talking about she has a daughter who walks like a lame animal.

Hawthorne’s Use of Allegory - 1212 Words

Hawthorne’s Use of Allegory The Ministers Black Veil by Nathaniel Hawthorne is a short story that was first published in the 1836 edition of the Token and Atlantic Souvenir and reappeared over time in Twice-Told Tales, a collection of short stories by Nathaniel Hawthorne. The short story narrates the events following Reverend Mr. Hoopers decision to begin wearing a black veil that obscures his full face, except for his mouth and chin. Mr. Hooper simply arrives one day at the meeting house wearing the semi-transparent black veil and refuses from then on to take it of, leading to the loss of his fiancà ©e and isolation form the world. He is even buried in the black veil. Yet, what is important to note are Mr. Hoopers last words to those†¦show more content†¦The themes of the story serve to further explicate the universal nature of all human beings. These themes include for example shame, guilt, the nature of sinning and morality. With regard to shame, whilst it is true that the veil covers Mr. Hoopers f ace, it does at the same time expose the nature of sin as one embedded deep inside humans. In other words, the veil exposes the sin existent in the world which makes the townspeople grow more and more uncomfortable. These feelings of discomfort are thus the result of being faced with the shame within. The more one has learned to ignore the sense of shame at the sins committed and the darkness surrounded by, the more he or she is incapable of facing Mr. Hooper. This leads the discussion to the second theme in the short story: guilts hidden nature. Indeed, most townspeople are faced with guilt suppressed upon looking at Mr. Hooper as they have never had to face a physical form of their guilt. However, Mr. Hoopers didactic usage of the veil serves as a constant reminder of that which is rather forgotten: sins committed. It is for this reason that many townspeople would rather ignore Mr. Hooper. However, the Reverend convinces the townspeople that everyone shares sins no matter what the y attempt to do to hide it or avoid facing it. Human nature is simply sinful and there is no avoiding this universal fact that binds all beings. It isShow MoreRelatedHawthorne’s Use of Allegory1545 Words   |  7 Pagesdeclaration underlines the meanings of the veil in the story as symbolic of sin, darkness, and the duality within human nature. Thus, The Ministers Black Veil by Nathaniel Hawthorne is a literary work of art that demonstrates the authors use of allegory to highlight the psychological angle of the story and characters using agents of symbols, setting, characters, and actions in a coherent way to represent non-literal and metaphorical meanings about the human character (Abrams 7). 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