Musculoskeletal Limitations

The Patient with Musculoskeletal Limitations Complicated by a Medical Illness
Question one
Surgical care improvement project (SCIP) is an initiative aimed at providing
healthcare for patients who have just undergone surgical procedures. It is estimated that more
than 40% of operative procedures normally end up in post-operative complications. However,
the introduction of the improvement project serves to significantly reduce the resulting
complications. The SCIP is based on several core measures to assist in the reduction of post-
operative complications. The ten core measures are based on prophylactic antibiotic treatment
in pre and post-operative procedures. Also, antibiotics are given to the patient during the
treatment process(‘SCIP core measures’, 2011). Another measure is the use of urinary catheter
and hair removal strategies for patients. Other measures involve temperature management
and the elimination of blood clots that would cause thrombosis in the veins also referred to as
venous thromboembolism. The major aspect that has assisted in the reduction of surgical site
infection has been the use of antibiotics. It is widely known that knee procedures such as
knee arthroscopy involve the exposure of the knee tissues to the environment(‘SCIP core
measures’, 2011). The environment contains numerous microbes that are opportunistic and
take advantage of any opening on the skin surface. However, the presence of antibiotics
serves to eliminate the microbes that ultimately serve to be the major causes of disease
infection after operation procedures. Certain precautions have to be taken before the
administration of the antibiotics(Drake, 2011). The drugs used should not have side effect to
the patients. Neither are the antibiotics supposed to evoke the immune the case
of the 60 year old woman, she had associated allergies with penicillin. The woman had taken
certain drugs associated with the treatment of osteoarthritis which was also being examined

by the medical procedure. Lisiprinol, lebrax and Celebrex were the drugs used by the old lady
in the treatment of her conditions. Lisiprinol lowers blood pressure since the patient has
hypertension. The drugs are administered after six hours when their effect is non-interfered
by the other drugs. Additionally, the drug used is a cephalosporin and has no effect or similar
effect as penicillin since it would not evoke an allergic reaction. The use of antibiotics in the
surgical care processes has significantly reduced surgical site infections(‘SCIP core
measures’, 2011). Ancef is an antibiotic of cephalosporin activity. Similarly other drugs have
been used to reduce chances of infection after the surgical procedures(Drake, 2011). Nurses
have to administer the drugs at specific times for the drugs to be able to function effectively.
Question two
The surgical care improvement method outlines measures involved in the removal of
hair. Use of shaving or clippers to remove hairs would result in skin abrasions which would
ultimately result in infections of the skin. Such infections would result in complications after
surgical procedures. In the case of the sixty old woman, less hair is found around the knee
region and since the knee is one of the common areas where skin abrasions can result in
infection sites for microbes (Anderson, 2010).
In case there was excessive hair in the knee region it would be clipped off. However,
the removal of the hair in this case shall not be by the use of a razor blade or other abrasive
methods to the skin which end up affecting the skin by leaving infection sites that can easily
be accessible to microbes. However electric clippers can be used in the removal of hair
around the knee region since they are non-abrasive(Drake, 2011). If there were previous hair
removal, the data abstractors supposed to look at the alternative methods. Also if the patient
had in any way clipped hair from their skin, the data abstractor should seek methods that
would not complicate the current status. The data abstractor can obtain the information about

the patient from previous records especially the nurse’s report and mark at the appropriate
hair removal method that had been initially used. This would assist the surgeons in knowing
the appropriate method of hair removal that they can rely on the removal of hair especially at
the knee(Anderson, 2010).
Question three
Venous thromboembolism is one of the common surgical complications after
operative surgeries. Exposure of the skin directly activates clotting factors forming clots .This
mechanism is used by the body to prevent entry of foreign microbes and over bleeding that
would result in high pressure and loose of oxygen in the body. However, after forming clots,
it is necessary that the initial clots formed in the blood would be dissolved by plasmin via
plasminogen activating factors. However, sometimes the rate of clot formation during certain
surgical procedures becomes greater compared to the rate of clot dissolution. The end result
in this case would be blocking of the veins by clot or thrombus. The ultimate result of this is
blockage of the blood supply by the thrombus ultimately resulting in what is commonly
referred to venous thromboembolism commonly abbreviated as VTE. A major common form
of VTE is DVT which in full means deep venous thromboembolism( Mont et al., 2014).
Surgical care improvement project involves the use of lovenox an anticoagulant. The
anticoagulant has the ability to break down all the clots that have been formed in the body
making blood to flow properly through the body. As a result, major complication issues such
as venous thromboembolism are all avoided. However, in the administration of lovenox
timing of the drug plays a very important role. Very late delay in the administration of the
drug after surgical processes would directly be of no use since the process of clot formation
would have already taken place and the administration of the drug would not be effective as
anticipated before. Therefore it is necessary that the nurse ensures that the patient in this case

the sixty old woman takes the drug at the required time to avoid formation of clots. In this
case the drug was administered earlier the day after the surgical operation. The use of the leg
attached to the hose pipe in the upright direction also assist the floor of blood from the
surgical site and therefore the drug would efficiently remove the clots (Drake, 2011).
In conclusion the use of surgical care improvement projects has over the years
reduced the associated surgical difficulties and complications that are normally as a result of
surgical processes. The use of antibiotics has significantly reduced infection via sites while
the application of certain drugs which are anticoagulants have effectively removed the
thrombus that are as a result of clots formed during the surgical processes. Generally use of
the SCIP has reduced the number of post complications and deaths that would be as a result
of procedures. Although the process is being implemented, proper care and timing is
important in meeting the set objectives relating to better health for patients (Kinnier, Barnard
& Bilimoria, 2014).



ANDERSON, J. (2010). Individual SCIP Measures Don’t Cut Infection. Hospitalist News,
3(7), 8.
Drake, K. (2011). SCIP core measures. Nursing Management (Springhouse), 42(5), 24-30.
Kinnier, C., Barnard, C., & Bilimoria, K. (2014). The Need to Revisit VTE Quality
Measures. JAMA, 312(3), 286.
Mont, M., Hozack, W., Callaghan, J., Krebs, V., Parvizi, J., & Mason, J. (2014). Venous
Thromboemboli Following Total Joint Arthroplasty: SCIP Measures Move Us Closer
to an Agreement. The Journal of Arthroplasty, 29(4), 651-652.
SCIP core measures. (2011). Nursing Management (Springhouse), 42(5), 30-31.

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