Case Report: Priapism Following an Anterior Lumbar Interbody Fusion.

Priapism is a disorder where the penis without sexual stimulation maintains a prolonged rigid erection lasting 4 or more hours. There are two classifications of priapism, ischemic (low flow) or nonischemic high flow, and each have specific etiologies, diagnostic criteria, and management. This presented case study involved a 58-year-old male who experienced an ischemic priapism more than 24 hours after an anterior lumbar interbody fusion (ALIF). A flaccid penis was achieved after the patient received two 400 µg of phenylephrine HCL into the corpora cavernosum. Review of the literature suggests anesthetic medications given during the surgical procedure may have caused the priapism. Lessons that can be learned from this case study highlight that even though the nurse may not expect to see a priapism after an ALIF, the nurse must always be diligent and not become complacent with unexpected findings or assessments that may cause irreparable harm to the patient.

The Efficacy of Regional Anesthesia Techniques to Control Postoperative Pain After Total Knee Arthroplasty.

BACKGROUND: Choosing the most effective type of anesthesia for controlling postoperative pain is paramount for improving patient outcomes and patient satisfaction. Most often, the type of anesthesia selected is dependent on the duration and type of surgical procedure and anesthesiologist/surgeon preference. Using a combination of regional anesthesia techniques, however, remains the cornerstone of multimodal analgesia for postoperative pain management after total knee arthroplasty. PURPOSE: The purpose of this study was to determine what regional anesthesia techniques and/or combinations of regional anesthesia techniques provided the best postoperative pain control in patients who had undergone a total knee arthroplasty. METHODS: Retrospective chart review. RESULTS: Patients who received a single-shot regional anesthetic reported significantly more postoperative opiate consumption and requested pain medication significantly sooner than patients who received multimodal techniques of regional analgesia. CONCLUSION: This study found support for the use of multimodal analgesia techniques for optimum postoperative pain management after total knee arthroplasty.

Mulitmodal analgesia for postoperative total knee arthroplasty.

BACKGROUND: Postoperative pain after a total knee arthroplasty (TKA) is a major concern for the patient and nurse. Pain after a TKA can be severe and, when inadequately controlled, can impair or prevent functional rehabilitation with physiologic, psychologic, and economic consequences (). With multiple pain management regimens, healthcare providers need data on approaches that provide optimal postoperative pain relief with minimal side effects. PURPOSE: This retrospective study examined whether there were differences between regional anesthetics used for TKAs in their ability to control postoperative pain with fewer side effects. METHODS: Retrospective chart review of two hundred fifty seven charts. RESULTS: Patients who received all 3 anesthetic modalities (intrathecal morphine sulfate, single-shot femoral nerve block, and wound catheter) had better pain control postoperative TKA and requested less opioids.

Nursing experience and the care of dying patients.

PURPOSE/OBJECTIVES: To examine relationships among demographic variables and nurses attitudes toward death and caring for dying patients. DESIGN: Descriptive and correlational. SETTING: Two metropolitan hospitals in Detroit, MI. SAMPLE: 58 RNs practicing in oncology and medical/surgical nursing. The majority was female and white, with a mean age of 41 years. METHODS: Completed survey of three measurement tools: a demographic survey, Frommelt Attitudes Toward Care of the Dying (FATCOD) Scale, and Death Attitude Profile Revised (DAP-R) Scale. Of 60 surveys distributed, 58 were completed and returned. MAIN RESEARCH VARIABLES: Past experiences (level of education and death training), personal experiences (age, race, religion, and attitudes toward death), professional experiences (months or years of nursing experience and the percentage of time spent in contact with terminally ill or dying patients), and attitudes toward caring for dying patients. FINDINGS: Most respondents demonstrated a positive attitude about caring for dying patients. Nurses who reported spending a higher percentage of time in contact with terminally ill or dying patients reported more positive attitudes. No significant relationship was found between nurses attitudes toward death and nurses attitudes about caring for dying patients. Statistically significant relationships were found among certain demographic variables, DAP-R subscales, and FATCOD Scale. CONCLUSIONS: Regardless of how the nurses felt about death, providing professional and quality care to dying patients and their families was salient. IMPLICATIONS FOR NURSING: Developing continuing education programs that teach effective coping strategies to prevent death anxiety and identifying barriers that can make caring for dying patients difficult may make the journey from novice to expert nurse a gratifying and rewarding experience.