A patient with a history of COPD and seizures is admitted to the hospital for COPD exacerbation. His home medications were ordered as well as initiation of oral steroids and inhaled bronchodilators for the COPD exacerbation

QUESTION

A patient with a history of COPD and seizures is admitted to the hospital for COPD exacerbation. His home medications were ordered as well as initiation of oral steroids and inhaled bronchodilators for the COPD exacerbation.

After three days in the hospital the patient complains of pain in his left leg. Ultrasound confirmed a DVT.

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Standard of practice indicates prophylaxis for DVT would have been appropriate in this setting.

Discuss the role of the nurse that might have prevented this complication.

While receiving treatment for the DVT, the patient experiences a seizure.

One of the seizure medications had not been given because it was not on the unit at the usual medication time. This was noted in the MAR.

Discuss system issues or failures that contributed to the patient experiencing a seizure.

Identify appropriate education that might improve patient outcomes in the future.

ANSWER

Preventing Complications in a Hospitalized Patient with COPD and Seizures: Role of the Nurse and System Improvements

Introduction

In the case of a patient with a history of COPD and seizures admitted to the hospital for a COPD exacerbation, it is crucial to provide appropriate care to prevent complications. This essay will discuss the role of the nurse in preventing deep vein thrombosis (DVT) and seizure-related complications, as well as system issues or failures that contributed to the patient experiencing a seizure. Furthermore, it will propose appropriate education to improve patient outcomes in the future.

Role of the Nurse in Preventing DVT

Deep vein thrombosis is a common complication in hospitalized patients, particularly those with limited mobility or chronic illnesses such as COPD (Cayley, 2007). Nurses play a vital role in preventing DVT through the implementation of prophylactic measures. In this case, the nurse could have taken several actions to reduce the risk of DVT:

Assessment: The nurse should have assessed the patient’s risk factors for DVT, including immobility, advanced age, history of DVT, and COPD exacerbation. This assessment would have prompted appropriate preventive measures.

Early ambulation: Encouraging and facilitating early ambulation, within the patient’s limitations, helps prevent stasis and promotes blood circulation, reducing the risk of DVT.

Compression stockings: Applying compression stockings can aid in preventing DVT by improving venous return and reducing venous stasis in the lower extremities. The nurse should have assessed the patient’s eligibility for compression stockings and ensured their proper use.

Pharmacological prophylaxis: The nurse should have collaborated with the healthcare team to assess the patient’s eligibility for pharmacological prophylaxis, such as low molecular weight heparin or intermittent pneumatic compression devices. These measures can effectively prevent DVT in high-risk patients.

System Issues or Failures Leading to Seizure

While the patient was receiving treatment for DVT, a seizure occurred due to the omission of a seizure medication (Rodziewicz, 2023). Several system issues or failures contributed to this complication:

Medication availability: The absence of a seizure medication on the unit at the usual medication time indicates a breakdown in the medication supply chain or inventory management system. It is crucial for healthcare facilities to ensure that necessary medications are readily available to prevent delays in treatment.

Communication and documentation: The fact that the medication omission was noted in the Medication Administration Record (MAR) suggests that there might have been a breakdown in communication or documentation. Nurses rely on accurate and timely information exchange to provide safe and effective care. Ensuring effective communication channels and meticulous documentation can help prevent medication errors.

Medication reconciliation: Prior to the patient’s admission, a thorough medication reconciliation should have been conducted to ensure that all necessary medications, including seizure medications, were appropriately prescribed and available. This process helps identify discrepancies and prevent medication-related complications.

Appropriate Education for Improved Patient Outcomes

To improve patient outcomes in the future, it is crucial to implement appropriate education strategies (Paterick et al., 2017). Some key educational interventions may include:

Nurse training and awareness: Conduct regular training sessions to educate nurses about the importance of preventive measures for DVT, medication administration protocols, and the significance of accurate documentation. This education should focus on enhancing their skills in risk assessment, early intervention, and communication.

Interprofessional collaboration: Promote interdisciplinary collaboration among healthcare providers, including nurses, physicians, pharmacists, and administrators. Encourage open communication, feedback, and teamwork to address system issues and identify potential improvements.

Quality improvement initiatives: Implement quality improvement initiatives, such as regular audits and medication reconciliation processes, to identify and address system failures. These initiatives can help identify gaps, streamline processes, and ensure the availability of essential medications to reduce the risk of complications.

Conclusion

In the case of a hospitalized patient with COPD and seizures, the nurse plays a vital role in preventing complications such as DVT and seizure-related events. By conducting appropriate risk assessments, implementing preventive measures, ensuring medication availability, and promoting effective communication, nurses can significantly enhance patient safety and outcomes. Furthermore, addressing system issues and failures through education, interprofessional collaboration, and quality improvement initiatives can further optimize patient care and prevent future complications.

References

Cayley, W. E. (2007). Preventing deep vein thrombosis in hospital inpatients. BMJ, 335(7611), 147–151. https://doi.org/10.1136/bmj.39247.542477.ae 

Paterick, T. E., Patel, N., Tajik, A. J., & Chandrasekaran, K. (2017). Improving Health Outcomes Through Patient Education and Partnerships with Patients. Baylor University Medical Center Proceedings, 30(1), 112–113. https://doi.org/10.1080/08998280.2017.11929552 

Rodziewicz, T. L. (2023, May 2). Medical Error Reduction and Prevention. StatPearls – NCBI Bookshelf. https://www.ncbi.nlm.nih.gov/books/NBK499956/ 

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