Personal Theory

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Discussion Prompt

Choose a clinical situation in your specialty and create a theory from your observations. Report the theory to the class. Use a form that clearly identifies your concepts and proposition such as; “psychosocial development (Concept A) progresses through (Proposition) stages (Concept B)”. Identify and define the concepts involved and the proposition between them. For example, a surgical unit nurse may have observed that elevating the head of the bed for an abdominal surgery patient (Concept A) reduces (Proposition) complaints of pain (Concept B). The concepts are the head of the bed and pain. The proposition is that changing one will decrease the other. Raising the head of the bed decreases pain. Use current literature to define your concepts. Each concept should have at least two supporting references.

 

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THE TASK

  • MAKE A PEER RESPONSE OR REVIEW OF THE ESSAY BELOW
  • Length: A minimum of 150 words per post, not including references
  • Citations: At least one high-level scholarly reference in APA per post from within the last 5 year

Personal Theory

 

In my practice as RN Circulator in an ortho-heavy OR I apply and work extremity tourniquets daily. My observations working in other practice areas and observations from my coworkers in recovery show frequent occurrences of post-operative tourniquet pain with or without skin issues related to intra-operative tourniquet use. Our surgeons use standardized tourniquet pressures which are 250mm/Hg for upper, and 300 – 350mm/Hg for lower extremities with only a few exceptions. We use timers to alert about tourniquet times which are set at 60 minutes for upper and 120 minutes for lower extremities. My observations also show fluctuations in the occurrence of tourniquet concerns with different pressure levels, so here is my theory: Patients receiving orthopedic procedure under use of a tourniquet (Concept A) will experience less post-operative adverse effects (Concept B) if lower tourniquet pressures are being used (Proposition).

Tourniquets are mostly being used in orthopedic procedures, as they provide the surgeon with a cleaner surgical area free of bleeding which enables them to work faster, promotes less intra-procedural blood loss and better adaptation of cement and implants in arthroplasties (Kim, et al. 2019).  High standardized tourniquet pressures are still used by most orthopedic surgeons (Kukreja, et al. 2018). Adverse events associated with tourniquet use include ischemia to the thigh muscle, wound complications, neurovascular injury, swelling and bruising and DVTs (Liu, et al. 2014).

Certain safeguards should be incorporated to minimize adverse events associated with the use of tourniquets. Perioperative personnel should evaluate the patient’s health record for possible contra-indications for tourniquet use and select the most appropriate tourniquet size and shape to fit the patient’s limb. After application of the tourniquet observe for too snug or too loose fit, as this might also foster tourniquet related issues. The risk for pressure related injuries decreases with lower tourniquet pressures, ideally under the use of the individual patient’s limb occlusion pressure while applying tourniquet pressure for the shortest amount of time possible (McEwen, 2018).

References:

Kim, T., Bamne, A., Sim, J., Park, J. and Na, G. (2019). Is lower tourniquet pressure during total knee arthroplasty effective? A prospective randomized controlled trial. BMC Musculoskelet Disord 20, 275 (2019). https://doi.org/10.1186/s12891-019-2636-7

Kukreja, P., Lehtonen, E., Pinto, M., Patel, H., McKissack, H. and Shah, A. (2018). Postoperative tourniquet pain in patients undergoing foot and ankle surgery. Online article. Retrieved from: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7053790/

Liu, D., Graham, D., Gillies, K. and Gillies, R. (2014). Effects of Tourniquet Use on Quadriceps Function and Pain in Total Knee Arthroplasty. Online article. Retrieved from: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4258487/

McEwen, J. (2018). 10 best tourniquet practices for surgical tourniquets in 2018. Online publication on Tourniquets.org website. Retrieved from: https://tourniquets.org/10_best_practices_for_surgical_tourniquets/