Leadership
- Brief Biography (2 pages)
a. The person�s background and how it influenced/contributed to their leadership style.
b. Information their rise to their leadership position (how/why they became leaders). - Organizational Profile (2 pages)
a. Description of the organization or movement at the time of their leadership. (This will vary based on the
type of organization).
b. Identification of the relevant global and cultural contexts (ASL: Chapter 2), and explanation of how they
are relevant. - Characteristics of Leadership (1 page)
a. Thorough description of multiple, specific traits that contributed to this person�s success or failure as
a leader. - Use of Power (1 page)
a. Thorough description of the person�s use of power as a leader
b. Description of how they did or did not foster the growth of other leaders within their organization or
movement. - Leadership Style (1 page)
a. Description of the person�s leadership style
Q. 1 In relation to your chosen patient, discuss the pathophysiology of their condition and
using evidence based practice explore current treatment options for your patient’s
condition, include any pharmacological and non-pharmacological considerations.
This is a common operation procedure performed in the U.S. Though practiced for along
period of time, the procedure faces numerous controversies especially on post-surgery
complications. Tonsillectomy refers to the surgical removal of palatine tonsils. It is among the
most common surgical procedures performed (McCance Et al., 2014)
Pathophysiology of the disease; tonsils are 3 tissue masses namely the lingual tonsil,
pharyngeal tonsil and the palatine tonsil. These tonsils ate lymphoid tissues which are covered by
cryptic invagination respiratory epithelium. Tonsils play an important role in immunity process.
They produce lymphocytes and synthesize immune-globins. However, diseased tonsils are
usually less effective because they are associated with reduced transportation of antigen, reduced
production of the antibody and recurrent bacterial infection. This normally causes the tonsils to
enlarge resulting to systems complication such as Difficulty in breathing, difficulty swallowing
and disrupted breathing especially when the patient is sleeping. In some cases, there could be
cancerous tissue on one or all tonsils. This could lead to recurrent bleeding from the blood
vessels neighboring the tonsils surface (Tollefson, 2012).
Tonsillectomy is normally recommended especially if there are frequent episodes of
tonsillitis such as more than seven episodes per year, or more than three episodes per year. It is
also recommended if the bacterial infection does not improve with antibiotic therapy. However
the process is not usually smooth sailing but also associated with risks and complications like
other surgeries. For instance, some patients may react to anesthetics. Anesthesia is used to make
the patient relax during the surgery, but some studies have reported minor complications such as
headache, nausea and soreness of the muscle. Swelling of the tongue and the soft palate could
cause breathing difficulty. Bleeding may occur during the process and may also occur during
healing processes. This implies that further treatment is required and the patient longer hospital
stays (McCance Et al., 2014).
For patients presenting airway obstruction or hemolytic anemia, they are treated using
corticosteroids. This pharmacological therapy has been indicated to be effective in reducing
fever, pharyngitis and mononucleosis (MN) which could be infectious. Antibiotic treatments are
normally used for secondary bacterial infection. Ampicillin and related compounds should be
avoided where MN is suspected because it causes generalized popular rash. Cephalexin reacts
similarly. The evidence based recommended antibiotic is the antistreptococcal antibiotics e.g.
erythromycin. Antibiotics should only be administered is there is an indication of bacterial
etiology. The etiology is presented by presence of tonsillar exudates, fever, leukocytosis and
GABHS. The bacterial infections are indistinguishable and may require culturing of the bacteria.
Administering of penicillin for 10 days is recommended (Martini, Nath & Bartholomew, 2014).
The non-pharmacological therapy entails patient education; patient is requested to
complete medications even where the symptoms have been relieved. It is also important for the
patient to take a lot of fluids, particularly water and ice pops. Patient is advised to take foods
which are easy to swallow. The patient should avoid crunchy and over spiced food. The patient is
also required to take ample rest. They should avoid strenuous activity until one is able to resumes
normal diet and pain is relieved (Jarvis, Forbes & Watt, 2012).
Q. 2 Critically discuss four (4) components of the PACU discharge criteria outlined
in the Aldrete Scale. Utilize the scale provided on LEO as a resource in your case
study.
The main goal for postoperative care is to mitigate complications and to promote rapid
healing for surgical incision. The care involves assessment, diagnosis of the post-surgery events,
intervention and evaluation of the patient’s outcome. The extent of PACU is highly influenced
by the type of surgery and the patients’ health status at that time. Where post anesthesia
complications are identified, patients must be retained in the hospital until their conditions
stabilizes (Smedley, 2012). After tonsillectomy and any other type of surgery, the patient is
transferred to PACU where anesthesia reversal and other processes are conducted. The amount
spend in this care unit depends on the length of surgery, status of the regional anesthesia and the
status of the patients consciousness. In PACU, the nurse reports on the patient’s condition when
performing an assessment for post-surgery complications (Tamura Et al., 2012).
The patient is only discharged from PACU after she meets the standard discaharge
criteria as indicated by Aldrete Scale. This is scales provides scores on patients vital components.
Muscle activity must be scored. This includes the ability for the patient to move jaws and muscle
extremities with ease either on command or spontaneously. Where all muscle in question move,
the item is scored as one, where none muscle extremities moves, then it is scored as 0. It is
important to evaluate because nerves and blood vessels could be accidently injured during the
process. The earlier the condition is identified the better. The second component is the
respiration efficiency (Estes, 2013). In this case study, the patient was assessed if they could
breathe deeply with ease, where a score of 2 is given. If the respiratory system is limited or cases
of dyspnea are observed, then it is scored as 1, the 0 score is given if there is no spontaneous
respiratory activity observed. Postoperative patients are characterized with poor ventilation. The
aim is to identify airway obstruction and changes in oxygenation in order to correct it as fast as
possible.
The third component is the circulation system. This entails checking the systolic and
diastolic systems. This is monitored through the anesthetic state. If the systolic and diastolic
pressure seems to be +/- 20% is normal, then a score of 2 is given. BP of +/- 20 % to 50%, the
scoring is 1; and if there is alteration of the pressure is more than 50%, the score is zero. Some
patients may experience hypoxemia and may require supplementary oxygen. This situation may
alter the blood pressure which could result to stroke and ischemic heart attack. Lastly,
Consciousness is the most important component of Aldrete assessment (Lopez Et al., 2013;
Wilding Et al., 2010). The patient full alertness is indicated by their ability to answer give
questions vividly and attentively. Where the patient is considered to be awake, then a score of
two is given, if the patient are aroused only their names are called, then they get a score of 1,
and score of zero where the auditory stimulation elicit reduced response. This is important to
identify conscious complicated and uncomplicated conditions due to reactions to anesthesia
medication which could change the patients’ blood pressure, respirations and heart rates (Atlas
Et al., 2014).
Q. 3 Discharge plan
Amy is 20 year old female. She was admitted on October 23 rd , 2014. She was suffering
from difficulty in breathing and swallowing, fever and insomnia which was diagnosed as
tonsillitis. Tonsillectomy was recommended, which she undertook three days ago. Depending
with the patient’s condition and the type of surgery, the patient is discharged from PACU to in
for an extended stay or to day surgery before a person is discharged to home. According to
evidence based practice discharge depends on the patient’s recovery from anesthesia. Before the
discharge, the patient must be conscious and mental state is fully returned. The patient should
manifest stable vital symptoms including respiratory, cardiovascular system, excessive bleeding
have stopped and the muscular systems. The pain should remain under control, the baseline
temperature at normal level. Patient could stay longer at the PACU if there is nausea and
vomiting. Additionally the patient must score nine out of possible ten PAS. If patients PAS score
is below the standardized care, the chief anestheologists can be consulted. Before discharge, the
RN must obtain verbal or written order from the physician; the orders must be recorded (Atlas Et
al., 2014).
Preparation for discharge is an ongoing process even throughout the surgical processes.
At the time of discharge, the nurse should ensure that the care providers know how to care for
would sites and dressing systems including recommendations for vital daily activities during
bathing. The reaction to the medication provides should be avoided and alternative drugs
described or enhanced (Lewis Et al., 2013). The patient is prohibited to take physical activities
such as returning to work, driving and exercises. Other important restrictions and modification
should be supported. The instructions should be written instructions. Increasingly people are
discharged from the ospital with many care demands, the care provider who receives the nurse
should take care to protect the wounds drains, the wound dressing and other necessary traction
apparatus (Tamura et al, 2011).
Social workers contact the family to inform them on discharge plan, Provides
transportation to home and arranges medical supplies. Nurses ensure that patients care givers are
informed on date of discharge. Provides the care giver and patient discharge list which contain
treatment instructions, nutrition plan, physical activity recommended and scheduled
appointment. Nurse should ask the patient care giver to verbalize the information to evaluate if
they understand the instructions (Davis Et al., 2011). Documentation of the transfer is done and
the patient is discharged from PACU. Sign and date the discharge form and discharge summary
is documented. Pharmacist provides drug regime and the dosage. Family care giver advised on
dietary modification. Family must make arrangement for care services at home. Family must
ensure that the transition is smooth and peaceful. There is need to understand that the patient
health is still undergoing recovery and thus need massive support (Atlas Et al., 2014).
References
Atlas, S., Matthews, J. R., Fritsvold, E., & Vinall, P. E. (2014). Social implications of chronic
illness & disability. San Diego, CA: Bridgepoint Education, Inc.
Estes, M.E.Z. (2013). Health assessment & physical examination (5th ed.). Clifton Park, NY:
Delmar.
Davis, G., Cox, E., Wolfe, R., & Becker, C. (2011). Cutaneous Capnography in the PACU:
Immediate Assessment of Respiratory Status Emerging From Anesthesia. Journal Of
Vascular Nursing, 29(2), 93.
Jarvis, C., Forbes, H., & Watt, E. (2012). Jarvis’s Physical Examination & Health Assessment
(Australian and New Zealand ed.).St. Louis, Missouri: Elsevier Saunders.
Lewis, E., Craig, M., & Johnson, L. (2013). Use of the Pain Assessment Behavioral Scale
(PABS) in PACU. Journal Of Perianesthesia Nursing, 28(3), e47-e48.
doi:10.1016/j.jopan.2013.04.137
Lopez, M., Bellarmino, G., & Viellette, E. (2014). Early Assessment and Prevention of Skin
Breakdown in the Post Anesthesia Care Unit (PACU). Journal Of Perianesthesia Nursing,
29(5), e34.
Martini, F. H., Nath, J. L., & Bartholomew, E. F. (2014). Fundamentals or Anatomy &
Physiology (9th ed.). California: Pearson.
McCance, K., Heuther, S., Brashers, V., & Rote, N. (Eds.). (2014). Pathophysiology: The
biologic basis for disease in adults and children (7th ed.). St. Louis: Mosby Elsevier
Smedley, P. (2012). Patient Risk Assessment in the PACU: An Essential Element in Clinical
Decision Making and Planning Care. British Journal Of Anaesthetic And Recovery Nursing,
13(1-2), 21-29.
Tollefson, J. (2012). Clinical psychomotor skills: Assessment tools for nursing students (5th ed.).
South Melbourne: Cengage Learning.
