Running head: EBP PROJECT PAPER
EBP Project Paper
Casey L. Stevens
University of South Florida
EBP PROJECT PAPER
EBP Project Paper
An abdominal aortic aneurysm (AAA) is an enlarged area in the lower part of the
2 aorta, the major blood vessel that supplies blood to the body (Osborn, Wraa, & Watson,
2010). Once the aneurysm is initiated it will grow larger as the tension on the vessel wall increases. If a growing aneurysm is left untreated, it may rupture due to the increased tension (Osborn et.al.,2010). Abdominal aortic aneurysms often grow slowly and usually without symptoms making them hard to detect. Risk factors to be aware of are being a male between the ages of 65-75, if you have a family history of abdominal aortic aneurysms, tobacco use, and atherosclerosis. Diagnostic testing performed for aortic aneurysms include abdominal ultrasound, computerized tomography (CT) scan, magnetic resonance imaging (MRI), and abdominal angiography. Options for treating AAA are open surgical repair and endovascular repair (Osborn et.al., 2010). The surgical approach is dependent on the location of the aneurysm, but the traditional approach is a midline or transverse incision with retroperitoneal dissection of the aneurysm (Osborn et.al.,2010).
There are many complications that go along with an AAA including: rupture, thrombosis, and embolization (Osborn et.al.,2010)
Background/ Clinical Relevance/ Medical and Nursing Interventions in Hospital
A 67 year-old male presented to Tampa General Hospital for a scheduled open abdominal surgery to repair his abdominal aortic aneurysm. The patient’s aneurysm was
2 inches in size and was detected one week prior to the surgery date with a computerized tomography (CT) scan. The patient has an extensive history including hypertension, obesity, diabetes, atherosclerosis, and previous smoking habits. The patient is five feet,
EBP PROJECT PAPER eleven inches tall with a weight of 230 pounds. His body mass index is 32.1 putting him
3 in the obese category.
Once the patient was out of surgery he was placed on the vascular intensive care unit (VICU) for close monitoring. The patient was intubated, sedated with propofol, and on a ventilator setting, assist control, to help his breathing. The patient had many nursing interventions ordered to help the patient postoperatively. One of the main concerns for this patient was to get him off the ventilator as quickly as possible to prevent any complications that could arise. A way to do that was to take the patient off his sedation and see if he could follow any commands. This nursing intervention is called a sedation vacation. While caring for the patient a question came up as to why propofol was the chosen sedation compared to any of the others that could have been used. The physician stated that the decision was reached because propofol has a short half-life and the patient could be woken up from the sedation quickly for neurovascular checks and to see if the patient was ready to be weaned off the vent.
Comparison of Interventions/Medical and Nursing Interventions from Current
Sedation is defined as an induced state of quiet, calm, or sleep by means of medication and is used often in the critically ill patient. The intensive care unit (ICU) patient requires sedation to ease discomfort with invasive procedures, reduce anxiety, improve tolerance of mechanical ventilation, promote patient rest and healing, and facilitate nursing care (Joseph-Belfort, & Alison, 2009). For this patient propofol was the medication chosen for the patient’s conscious sedation use. Propofol produces less postoperative sedation, drowsiness, confusion, clumsiness, and nausea and a more rapid
EBP PROJECT PAPER recovery of psychomotor performance than IV midazolam (Bone, 2013). Some experts
4 state that midazolam or diazepam should be used for rapid sedation in acutely agitated patients, while propofol is the preferred sedative when rapid awakening (e.g., for neurologic assessment or extubation) is important (Bone, 2013).
For this patient the correct nursing and medical interventions were applied in his health care. Having propofol as his medication for sedation allowed the patient to wake up easily for his sedation holidays and neurovascular tests. Because it only took 10 minutes for the patient to wake up and able to follow commands the physician was able to write an order for the patient to be extubated. The propofol allowed this to happen ultimately bettering the chances of the patient to be transferred to a general medical floor allowing him to be discharged.
EBP PROJECT PAPER
Belmont, J., & Alison,. (2009). Sedation vacation in a surgical intensive care unit.
Dimensions of Critical Care Nursing, 28(2), 81-82.
Bone, J., (2013). Propofol. Retrieved from: http://web.ebscohost.com.ezproxy.hsc.usf.edu/dynamed/detail?vid=3&sid
Grey, M., (2013) 5-Minute Clinical Consult. Retrieved from mobile device
Irwin, M. G., Thompson, N. and Kenny, G. N. C. (1997), Patient-maintained propofol sedation. Anaesthesia, 52: 525–530. doi: 10.1111/j.1365-2222.1997.123-az0117.
Osborne, K.S., Wraa, C.E. &Watson, A.B. (2010). Medical –Surgical Nursing:
Preparation for Practice. Upper Saddle River, NJ: Pearson.