Biomedical subjects

R A Marley

Publications and source records attributed to R A Marley.

10 recordsLinked to original sources

PubMed2001

Patient care after discharge from the ambulatory surgical center.

UNLABELLED: An important and often forgotten aspect of postoperative care occurs after the patient is discharged from the ambulatory surgical center. With more than 60% of all surgeries and procedures occurring on an ambulatory basis, what happens after the patient is no longer in continuous professional care is of concern to the ambulatory nurse. Numerous physical postoperative complaints are common and expected sequelae of anesthesia and surgery in the ambulatory patient. In this article, important postdischarge complications are reviewed and contemporary management options discussed. The information contained in this review article is valuable to the provider in educating patients regarding their anticipated course of postoperative recovery. OBJECTIVES: -Based on the content of this article, the reader should be able to (1) identify important postdischarge complications to provide patients with comprehensive discharge instructions regarding their continued recovery at home; (2) discuss contemporary management options available to treat postdischarge complications; (3) realize the incidence of specific postdischarge complications and how that relates to patient satisfaction with the surgical experience; (4) recognize signs and symptoms of postdischarge complications; and (5) identify risk factors of patients for developing specific complications in the postoperative phase.

Aftercare↗

PubMed1998

Postoperative oxygen therapy.

Much has been published in the medical literature concerning adverse events relating to the surgical patient. Among the notable disorders requiring the expertise of the postanesthesia care unit nurse are the diagnosis and management of respiratory dysfunction acutely attributable to the effects of surgery and anesthesia. Inhalational and/or intravenous anesthetic agents contribute to pathophysiological alterations that lend to the development of hypoxemia in the postoperative period. When patients present with preexisting respiratory disease, their care is frequently more complex and challenging. This review session will address the oxygenation component of respiration and the perioperative influences that alter it as well as treatment considerations for normalizing oxygenation.

Humans↗

PubMed1998

Postextubation laryngeal edema: a review with consideration for home discharge.

Respiratory complications occurring in the immediate postoperative period are well known to the seasoned postanesthesia care unit nurse. The most common adverse respiratory events originating in this setting are airway obstruction, hypoventilation, hypoxemia, and pulmonary aspiration of gastric contents. The focus of this article details airway compromise secondary to edema of the larynx and adjacent structures as a consequence of translaryngeal intubation. Postextubation laryngeal edema is a relatively rare problem; however, severe episodes may have life-threatening ramifications. A review of pertinent airway anatomy and airflow dynamics as they relate to this compromised airway condition is presented. Risk factors for the development of postextubation laryngeal edema plus contemporary patient treatment strategies will be reinforced. Patient management issues are addressed, with emphasis placed on the ambulatory patient in which discharge to a remote location is anticipated.

Humans↗

PubMed1997

Midazolam as a pediatric premedicant in the ambulatory setting.

In the preoperative setting, the nurse is responsible for the comprehensive evaluation and preparation of the patient. Among these activities, the administration of various premedications to achieve a physiological (eg, raise gastric fluid pH) or psychological (eg, reduce apprehension) effect is commonplace. Midazolam, a benzodiazepine, is one of the more popular medications used preoperatively for its anxiolytic properties. Several studies have evaluated the variety of routes by which midazolam can effectively be administered to the pediatric patient. A review of midazolam as a premedication specific to the pediatric population in the ambulatory setting is presented.

Ambulatory Surgical Procedures↗

PubMed1996

Patient discharge from the ambulatory setting.

Ambulatory surgical care is an integral part of the health care spectrum. The advantages of such care are well documented. One benefit of outpatient care is the potential for cost savings for the patient, medical facility, and third party payers by dismissing the patient to a remote recovery location following surgery and intermediate anesthetic recovery. To realize this goal an essential component of patient management must be the safe and expedient postoperative care of the patient until they are discharged from the ambulatory facility. This article will review considerations for discharging the surgical patient from the ambulatory setting.

Ambulatory Surgical Procedures↗

PubMed1996

Postoperative nausea and vomiting: the outpatient enigma.

Postoperative nausea and vomiting is an all too common side effect of surgery and anesthesia. The usual occurrence of vomiting within the first 24 hours following surgery involves one quarter to one third of all patients. Although nausea and vomiting is typically self-limiting, lasting less than 24 hours, the consequences must be considered. Patient dissatisfaction, adverse physiological sequelae, delays in discharge from the ambulatory facility, unanticipated hospital admission, and added cost are problems associated with postoperative vomiting. This article will review the multiple factors contributing to postoperative nausea and vomiting and discuss contemporary strategies for the management of these factors.

Ambulatory Surgical Procedures↗

PubMed1996

Preoperative assessment of the ambulatory patient.

Whenever the human body is subjected to anesthesia and an invasive surgical procedure, the potential for complications exists. A goal of perioperative care is to minimize that risk while providing the safest care available for the patient. Initial steps toward accomplishing this goal include (1) conducting a thorough preoperative assessment of the patient's medical, surgical, and anesthetic history; (2) performing a physical examination; and (3) procuring and interpreting the results of necessary diagnostic procedures and laboratory evaluations. The increased use of ambulatory surgical services, coupled with changes in health care economics, dictates reform in patient evaluation before surgery. The evaluative process must be cost-effective and efficient without compromising reliability. This article familiarizes and updates the perianesthesia nurse on management issues for the surgical patient.

Ambulatory Surgical Procedures↗

PubMed1995

AANA journal course: update for nurse anesthetists--perioperative therapeutic aerosol administration.

The inhalation route is an important approach to contemporary drug delivery. Mastery of this technique, through proper instruction and reevaluation, is essential to provide optimal drug therapy. Aerosol therapy is primarily employed in the perioperative setting to topically anesthetize the upper and lower airways, relieve vascular congestion, treat upper airway inflammation, promote bronchodilation, augment humidity therapy, and foster bronchial secretion mobilization. This AANA Journal course describes: 1. Factors which influence aerosol particle deposition. 2. Selection and use of aerosol generating devices and delivery systems. 3. Techniques of aerosol administration for the upper and lower airways.

Administration, Inhalation↗

PubMed1994

Postoperative administration of aerosolized medications: Part II--The techniques.

Based on the content of this article, the reader should be able to: (1) verbalize the standard steps for proper aerosol administration for both small-volume jet nebulizers and metered dose inhalers in the nonintubated patient; (2) describe what type and volume of diluent to add to medication used in small-volume jet nebulization; (3) discuss considerations for using a particular carrier gas for small-volume jet nebulization; (4) describe proper techniques for administration of aerosolized medications to intubated patients; and (5) establish criteria pertinent to the evaluation of treatment efficacy.

Aerosols↗

PubMed1994

Postoperative administration of aerosolized medications: Part I--The basics.

Based on the content of this article, the reader should be able to (1) describe the advantages and disadvantages of instituting drug delivery using the inhalation route; (2) verbalize factors that impact on aerosol deposition within the lung; (3) list the various types of aerosol-generating devices; (4) describe the benefits of incorporating a spacer device with the metered dose inhaler; and (5) identify and be familiar with the major categories of aerosolizable agents.

Aerosols↗