Surgical Procedures and Complications

This assignment delves into various surgical procedures and associated complications across different specialties like cardiothoracic, orthopedic surgery, and endodontics. It analyzes the causes of these complications, including hemorrhage, venous thromboembolism, urinary tract infections, postoperative pain, and neurological deficits. The document further explores preventative measures and management strategies employed to minimize these risks and ensure patient well-being.

Running head: NURSING CARE
Nursing Care for Client with Acute Health Problems
Name of the Student
Name of the University
Author Note

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Table of Contents
Assignment Task No. 1..............................................................................................................4
1. Answer...............................................................................................................................5
1. a) Answer:......................................................................................................................5
1 b) Answer........................................................................................................................5
1 c) Answer........................................................................................................................5
1 d) Answer........................................................................................................................5
1 e) Answer........................................................................................................................6
2. Answer...............................................................................................................................6
2 a) Answer........................................................................................................................6
2 b) Answer........................................................................................................................6
3) Answer...............................................................................................................................7
4) Answer...............................................................................................................................7
5) Answer...............................................................................................................................8
6) Answer...............................................................................................................................8
Answer 7:...............................................................................................................................9
Answer 8:...............................................................................................................................9
Assignment Task No. 2............................................................................................................11
Answer 1..............................................................................................................................12
Answer 2..............................................................................................................................12
Answer 3..............................................................................................................................12

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Answer 4..............................................................................................................................13
Answer 5..............................................................................................................................13
Answer 6..............................................................................................................................14
Answer 7..............................................................................................................................14
Answer 8..............................................................................................................................15
Answer 9..............................................................................................................................15
Answer 10............................................................................................................................15
Answer 11............................................................................................................................16
Answer 12............................................................................................................................16
Answer 13............................................................................................................................16
Answer 14............................................................................................................................17
Answer 15............................................................................................................................17
Answer 16............................................................................................................................17
Answer 17............................................................................................................................18
Answer 18............................................................................................................................18
Answer 19............................................................................................................................18
Answer 20............................................................................................................................18
Answer 21............................................................................................................................18
Answer 22............................................................................................................................19
Answer 23............................................................................................................................19
Answer 24............................................................................................................................19

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Answer 25............................................................................................................................19
Answer 26............................................................................................................................19
Answer 27............................................................................................................................20
References................................................................................................................................21

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Assignment Task No. 1

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1.Answer
1. a) Answer:
Nurses face a continuous problem in maintaining confidentiality of patients. It is the
duty of the nurse to maintain the privacy of the patients. The confidentiality applies in
protecting the patient’s information like the personal identity, past medical history, present
health condition, future health plan, financial plan availed for the medical check-ups (Code of
ethics for nurses in Australia, 2008). The principles of confidentiality includes
 Nurses must be aware of the legislation policy of the confidentiality
 Nurses must ensure that the patients and their carers are completely aware of their
rights of privacy and have given written consent on the written document to co-
operate with the medical professionals with their medical health information.
 Nurses must share the health information to the patient and must ensure that this
information must only be shared with the concerned doctors
 Nurses must respect the client’s right to access their own information
 Nurses must only access the personal and medical information of the student only
when it is required for quality care of the patient
1 b) Answer
Nurses have an obligation to deliver safe and ethical aligned care to the patients. In
such obligation, nurses are not allowed to cite their personal judgement on the lifestyle and
behaviour of the client and thereby refusing to deliver quality care to that particular patient
(Code of ethics for nurses in Australia, 2008). Nurses must respect the dignity, culture,
ethnicity, values and believes of the patients who are receiving the treatment. They must also

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provide impartial, honest and accurate information of the patient in relation to the quality
nursing care. It is the legal duty of care of the nurses that they must practise the medical
profession in a competent and safe manner. Nurses must also practise in accordance with the
laws, which are relevant in the domain of nursing and medical care. At the end, it is the legal
duty of nurse that they must preserve the trust of the patient and act accordingly.
1 c) Answer
In the domain of nursing practice, advocacy refers to the nurse advocates who are the
liaison between patients and the doctors. They assist patient in understanding the process of
disease diagnosis and also guide them to make the best possible decision, which is beneficial
for their health(Code of ethics for nurses in Australia, 2008).
1 d) Answer
Public liability in the sector of nursing domain refers to nurse public liability. It is a kind of
insurance policy that protects the claims of the nurses in accordance to the legal liability like
personal injury or property damage (Code of ethics for nurses in Australia, 2008).
1 e) Answer
As per the Nurses Code of Ethics (NMBA), the nurses and the midwifes in order to
practice as a registered nurses and mid-wives, need to get enrolled under the Nursing and
Midwifery Board of Australia (NMBA). NMBA recommends the nurse to abide by the
nursing standard practice in Australia. The nursing standards deal with the practise and the
behaviour of the nurse and the midwives (Code of ethics for nurses in Australia, 2008)..
The NMBA code also includes:
 Code of conduct
 Code of ethics

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 Professional boundary guide
 Practice standards (Code of ethics for nurses in Australia, 2008).
2. Answer
2 a) Answer
 Establishment of the severity of the burn injury
 Rapid initial assessment of the cardiovascular and respiratory status
 Rapid healing of the portion with minor burn via using cool sterile saline
 Overing partial thickness wounds with ointment (Lewis, Dirksen, Heitkemper&
Bucher, 2014)
2 b) Answer
The primary treatment for haemorrhage and Shock is to control the source of
bleeding. After stopping the source of the bleeding, patient must be given proper body fluid
support (blood transfusion) in order to normalize the blood corpuscles and other micro-
nutrient parameters(Bouglé, Harrois, &Duranteau, 2013).
3) Answer
The principal goal of the pre-operative assessment is to reduce the risk of morbidity and
mortality arising out of the after the surgery. Such assessment tries to revert the patient back to the
normal physiological condition after the surgery. Anaesthesia which is done before any surgery has
adverse metabolic and hemodynamic effect giving rise to stress during pre-operative condition. The
pre-operative assessment aims in reducing this pre-operative stress and trauma and thereby improving
the surgical outcome and lowering the tenure of the hospital stay(Oresanya , Lyons, & Finlayson,
2014).
The goals of the pre-operative assessment are:

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 Documentation of the condition
 Assessment of the patient’s health
 Uncovering hidden conditions that may cause problem after surgery
 Per-operative risk determination
 Optimization of the present condition of the patient
 Development of the appropriate per-operative care plan
 Educating patient about the surgery and anaesthesia
 Reduction of the cost and hospital stay and increase in the level of the patient
satisfaction (Lewis, Dirksen, Heitkemper, & Bucher, 2014)
4) Answer
Anaesthetic drug: Such drug must only be administered on the basis of the
magnitude of the injury, the time or the duration of the operation time, the amount of blood
loss during operation and the severity of the post-operative pain. There are different types of
anaesthesia like local anaesthesia, regional anaesthesia (spinal anaesthesia and epidural
anaesthesia) and general anaesthesia. The commonly used anaesthetic drugs are Barbiturates,
Amobarbital and Benzodiazepines(Bullock, & Manias, 2011).
Drugs used for the reduction of the anxiety, Selective Serotonine Reuptake Inhibitor
(SSRIs). SSRIs is said to increase the extracellular level of the neurotransmitter, serotonine
via limiting the re-absorption of serotonine into the presynaptic cells (Bullock, & Manias,
2011).
5) Answer
The post-operative care begins immediately after the surgery and last till the tenure
patient stays in the hospital and even last after the patient is discharged(Ahmad & Khan,
2017). The post-operative care plans following an acute event include:

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Patient should only be discharged to the general ward with orders for vital signs, pain control,
urine output, type of intravenous fluid and laboratory investigation. The patient progress
should be monitored via detail nursing observation. The aftercare prevention plan also
include
 Adequate nutrition supply
 Encouragement for early mobilization(Lewis, Dirksen, Heitkemper, & Bucher,
2014)
6) Answer
Antibiotic:It is used to fight against any pre-existing infection or at times used to prevent the
development of any additional infection. Antibiotics such as penicillin, amoxicillin and
clindamycin are commonly prescribed(Bullock, & Manias, 2011).
Anti-inflammatory:Such medication helps to reduce swelling and mild pain. Generally
Ibuprofen is prescribed in the majority of the cases(Bullock, & Manias, 2011).
Pain killer: In case of acute event the use of pain killers becomes one of the most important
medications in the post –operative care. Such medicines help to reduce the trauma of the post
surgical pain. The pain medications which are commonly used are opiods, local anaesthetics,
non-steroidal anti-inflammatory drugs (NSAIDs) and other psychoactive drugs(Bullock, &
Manias, 2011).
Answer 7:
The discharge planning for a person with multiple traumas like fractured limbs, acute
brain injury and left pneumothorax and facial fractures must include development and
implementation of a person centred plan before leaving the hospital. Since the patient has
acute brain injury therefore

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 After discharge patient must not be left alone
 Patient must be on alight diet
 Strict restriction under the consumption of alcoholic beverages
 No intake of sedatives
 Restriction in driving and operation of machinery(Lewis, Dirksen, Heitkemper, &
Bucher, 2014)
Answer 8:
The potential complications that are arising out of the blood transfusion are:
Allergic reactions:some people experience allergic reaction after blood transfusion
even after being injected compatible blood group. The symptoms include hives and itching.
The condition is usually treated via the use of anti-histamine drugs.
Fever: Fever after blood transfusion is common but not serious. Fever is the outcome
of the body’s response upon receiving the white blood cells. However, if the patient is also
experiencing chest pain along with nausea then fever can be an alarming sign.
Acute ImmunoHemolytic Reaction: This condition is extremely serious in which
the patients’ antibody attacks the blood corpuscles of the transfused blood(Frisch, Wessell,
Charters, Yu, Jeffries & Silverton, 2014).

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Assignment Task No. 2

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Answer 1
1. Name of the patient: Mrs. Bennett
2. Age: 76 years
3. Sex: Female
4. Address: XXX
5. Contact Number
6. Contact Number of the Family Member
7. Attending Doctor Name
8. Blood Group
Answer 2
Respiration: Respiratory rate and Blood pressure
Pulse: Pulse rate, heart beat(Lewis, Dirksen, Heitkemper, & Bucher, 2014)
Neurological Status:
 Cerebral Function: General behaviour, level of consciousness and emotional status
 Cranial Nerves: Facial senses
 Motor: Muscle tone, muscle size and involuntary movements
 Mental status examinationfor proper access of the cognitive functions (memory,
orientation and language)(Vaccaro et al., 2013)
Answer 3
 The hospital staffs may slip and fall down while running in a hurry in the OT due to
presence of non-porous floor
 The staff may encounter electrical shock while operating the monitoring machine

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 Blood borne disease may occur due to transfusion of contaminated blood at the time
of operation(Javed, Hafeez, Zubair, Anwar, Tayyab&Husnain, 2017)
 Contamination can occur to the open wounds from the bed sheets.
Answer 4
Antiseptic Mechanism
of action
Antimicrobial
activity
Onset of
action
Duration of
coverage
Application Examples
Aqueous
iodophore
Free-iodine
damage the
microbial
DNA
Gram
positive and
Gram
negative
Intermediat
e
2 hours Local Betadine
70%
alcohol
Dehydrates
the protein
of DNA
Both Gram
positive and
gram
negative
Rapid 48 hours Local over
hairless
surface
Dura-Prep
solution
(Bullock, &
Manias,
2011)
Answer 5
1. Time taken to recover from anaesthesia
2. Medicine used for recovery from anaesthesia
3. Medicines used to control pain and infection
4. Whether blood transfusion have occurred in the PACU
5. Whether pain pump has been used
6. How well they can move their leg (in case of Mrs.Benette, epidural or spinal
anaesthesia might occur and hence this parameter is crucial)
7. Whether they have reached a pain level that is bearable (Crisp & Taylor, 2012)

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8. The amount of Fluid intake during the stay at PACU
9. The amount of urine discharge during their stay at PACU
10. Any exiting infection (mild)
Answer 6
Estimation of the vital signs upon 15 mins of arrival and then in 30 minutes and after
every 1 hr. x 4, then after every 4 hr. x 24 hr and then as per orders from the doctor (Crisp &
Taylor, 2012)
Answer 7
1. Periodic checkup of hemoglobin: Due to excessive blood loss.
2. Checkup of the sensitivity of the CNS as morphine may affect CNS (Wang et al.,
2012)
3. The rate of healing at the wounded site (surgical site infection) as infection may
spread from the wounded site
4. The condition of the drainage site healing. The drainage site healing is used for fast
healing
5. The amount of liquid intake as this will reflect her nutrient level
6. Whether she is encountering venous thromboembolism (VTE) which is common in hip
and femur surgery(Lapidus, Ponzer , Pettersson& de Bri, 2013)
7. Since the patient is forced to undergo a sedentary life with Charnley pillow insitu, pressure
ulcers will be common and hence needs to be monitored. The major area include:
things and hips.
8. Cardiovascular events which is common in this kind of surgery as it involves whole
lot of blood drainage.
9. Urinary tract infections (UTI) as she will be on catheter urine collection(Meddings,
Rogers, Krein, Fakih, Olmsted &Saint, 2013)

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10. Conditions for pneumonia as it is common post-surgery outcomes among the elderly
patient
Answer 8
1. Late recovery: If the pain is untreated, the patient will found difficult to move and
hence late recovery
2. Mental irritation: Continuous exposure to unbearable pain may make the patient
mentally distressed, tired and exhausted. Chronic pain may actually affect a person’s
brain and even change the wiring of the nervous system
3. Insomnia: Sleeping becomes difficult if the pain is untreated. The portion of the brain
that sense pain also regulates the sleep cycle. This portion of the brain becomes more
indulge in regulating and sensing pain and hence leading to sleep deprivation.
4. Downward spiral of chronic pain symptoms: Common in untreated pain(Pasqualini et
al., 2012)
Answer 9
 Increased level of confusion
 Low temperament
 Increased level of aggression
 High note of irritability
 Agitation(Gélinas, Puntillo, Joffe, & Barr, 2013)
Answer 10
1. Request doctor to prescribe her painkiller to treat her unbearable pain
2. Provide her mild sleeping pills. She is sleep deprived and thus may be getting
hyperactive and irritated

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3. Apply restrain so that she might not step out of her bed because taking her
postoperative condition, drastic physical movements may be detrimental
4. Perform counseling so that she might feel compose(Lewis, Dirksen, Heitkemper&
Bucher, 2014)
Answer 11
1. Changing the dressing at the wound site: It will prevent the blood flow
2. Wrapping petroleum based gauzed around the drainage tube and securing it with an
adhesive tape: secure the drainage site and prevent blood flow
3. Wound may ooze out due to haemolysis of the subcutaneous blood in that case it
would be better to consult the doctor.
4. Use blood coagulant to stop bleeding(Lewis, Dirksen, Heitkemper& Bucher, 2014)
Answer 12
After sudden blood loss, fall in blood pressure, respiratory rate and oxygen saturation
is common. The loss of blood leads to the loss of hemoglobin. Hemoglobin is the red pigment
present in the blood, which is the carrier of oxygen inside the body. Excessive blood loss
leads to the loss of the red blood cells. It is the red blood cells where the hemoglobin is
present. So decreased in the amount of amount of hemoglobin is reflected in the lack of
oxygen deposition in the body. Due the lack of oxygen, the oxygen saturation rate is
decreasing as the blood concentration rate of oxygen is decreasing. Decrease in oxygen
saturation rate means lack of proper supply of oxygen in different organs and decreased in the
rate of respiration. Due to lack of adequate oxygen supply, the brain is getting less oxygen
and hence getting drowsy (Lewis, Dirksen, Heitkemper& Bucher, 2014).
Answer 13
1. Oxygen therapy: Use of mechanical device that supplies oxygen inside the lungs.

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2. Liquid oxygen therapy
3. Raising the head of the patient to promote effective breathing along with
diaphragmatic descent.This maximizesinhalation.
4. Use of bronchodialators that smoothens the smooth muscles surrounding the lungs
and eradicates labored breathing.
5. Proper monitoring of the vital statistics via pulse oximeters
6. Immediately call the doctor if the condition does not improves(Lewis, Dirksen,
Heitkemper& Bucher, 2014)
Answer 14
The right chest on inspiration and shortness of breath as experienced by Mrs Bennett
may be due to high rate of blood loss during surgery and decrease in the haemoglobin count.
It may also be due to the infection in chest giving indications for pneumonia(Lewis, Dirksen,
Heitkemper& Bucher, 2014).
Answer 15
1. Check the vital signs and the symptoms of Mrs. Bennett in order to record her pulse
rate, heart rate and respiratory rate
2. Record the blood pressure of Mrs. Bennett
3. Record the level of oxygen saturation
4. Perform chest X-ray
5. Check her blood haemoglobin level(Lewis, Dirksen, Heitkemper& Bucher, 2014)
Answer 16
1. Continuous supply of oxygen from the external supply
2. Prevention of blood loss
3. Proper screening for septicaemiain order to prevent the chest infection

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4. Proper screening of blood haemoglobin level(Lewis, Dirksen, Heitkemper& Bucher,
2014)
Answer 17
1. Attention to the airway
2. Attention to the blood circulation
3. Checking the respiratory rate, heart rate and oxygen saturation
4. Increasing the external supply of oxygen(Lewis, Dirksen, Heitkemper& Bucher,
2014)
Answer 18
Pulse oximeter and vital signs monitoring machine (Lewis, Dirksen, Heitkemper& Bucher,
2014)
Answer 19
Dopamine and epinephrine (Bullock & Manias, 2011)
Answer 20
Name of Drug Route of Administration Mode of Action
Dopamine Intravenous It improves the pumping
strength of the heart
Epinephrine Intravenous It works by relaxing the
muscles of the airways and
tightening of the blood
vessels(Bullock, & Manias,
2011)

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Answer 21
The odor is usually caused by the by the breakdown of the tissue. This break down of tissue
is due to the fact that when a part of the skin is injured, anaerobic bacteria which do not
utilizes oxygen for respiration colonizes at the wound site. The proliferation of the bacteria
degrades the tissues. The cells of the degraded tissue release chemicals like putrescine and
cadaverine as byproducts. These excreted byproducts emit foul smell.
Answer 22
1. Culture of the tissue sat the wound site. If the microbial media shows growth of
anaerobic bacteria then the diagnosis if confirmed
2. If the patient experience pain at the drain site then it may be a possible indication for
difficulty in wound healing
3. Associated skin infection at the surrounding surface(Lewis, Dirksen, Heitkemper&
Bucher, 2014)
Answer 23
1. Slight odour at the close proximity when the dressing is removed
2. Moderate odour at the close proximity when the dressing is intact
3. Strong odour on entering the room when dressing is removed
4. Very strong odour when the dressing is intact
Answer 24
Infection in the blood or blood poisoning is known as septicemia(Görlinger et al., 2013)
Answer 25
If septicemia is left untreated then it may result into sepsis. During sepsis the inflammation is
spread throughout the body. Inflammation causes blood clots and blocks oxygen
transport(Görlinger et al., 2013).

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Answer 26
1. Blood clots can from in the veins of the leg
2. Infection at the site of incision
3. Mental depression for sedentary life(Crisp & Taylor, 2012)
4. Pain during voluntary movement of the leg
Answer 27
1. Hematologist to treat blood infection and blood clot
2. A physiotherapist to reduce pain when the wound heals via providing proper message
to the muscle which will promote the blood circulation
3. A physiologist to treat mental depression via the help of several intrapersonnnal and
interactive techniques (Tollefson, Bishop, Jelly, Watson, Tambree, K. 2012).
4. A nurse to provide assistance while movement (Crisp & Taylor, 2012)

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References
Ahmad, A. N., & Khan, F. (2017).Post-operative Care.In Introduction to Surgery for
Students pp. 121-131.Springer, Cham.
Australian Nursing & Midwifery Council (2008). Code of professional conduct for nurses in
Australia.www.anmc.org.au
Australian Nursing & Midwifery Council, Royal College of Nursing, Australia, Australian
Nursing Federation. (2008). Code of ethics for nurses in Australia.www.anmc.org.au
Australian Nursing & Midwifery Council.(2002). National competency standards for the
enrolled nurse. www.anmc.org.au
Bouglé, A., Harrois, A., &Duranteau, J. (2013).Resuscitative strategies in traumatic
hemorrhagic shock. Annals of intensive care, vol. 3(1), pp.
1.https://doi.org/10.1186/2110-5820-3-1
Bullock, S., & Manias, E. (2011) Fundamentals of Pharmacology (6th Ed.) Sydney: Pearson
Publications o Lewis,S., Dirksen, S., Heitkemper,M,. & Bucher, L. (2014) Medical
surgical nursing: Assessment and management of clinical problem (9th Ed.).
Australia: Elsevier Health Sciences
Chang, T. M. (2012). From artificial red blood cells, oxygen carriers, and oxygen
therapeutics to artificial cells, nanomedicine, and beyond. Artificial Cells, Blood
Substitutes, and Biotechnology, vol. 40(3), pp. 197-
199.http://dx.doi.org/10.3109/10731199.2012.662408
Crisp, J. & Taylor, C. (2012).Potter & Perry’s fundamentals of nursing (4th Australian Ed.).
Chatswood, NSW: Mosby Elsevier.

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Frisch, N. B., Wessell, N. M., Charters, M. A., Yu, S., Jeffries, J. J., & Silverton, C. D.
(2014).Predictors and complications of blood transfusion in total hip and knee
arthroplasty. The Journal of arthroplasty, vol. 29(9), pp. 189-
192.https://doi.org/10.1016/j.arth.2014.03.048
Gélinas, C., Puntillo, K. A., Joffe, A. M., & Barr, J. (2013, April). A validated approach to
evaluating psychometric properties of pain assessment tools for use in nonverbal
critically ill adults. In Seminars in respiratory and critical care medicine (Vol. 34,
No. 02, pp. 153-168). Thieme Medical Publishers.
Görlinger, K., Shore-Lesserson, L., Dirkmann, D., Hanke, A. A., Rahe-Meyer, N., & Tanaka,
K. A. (2013).Management of hemorrhage in cardiothoracic surgery. Journal of
cardiothoracic and vascular anesthesia, vol. 27(4), S20-
S34.https://doi.org/10.1016/j.joen.2011.09.017
Javed, J., Hafeez, R. H., Zubair, M. Z., Anwar, M. A., Tayyab, M. T., &Husnain, S. H.
(2017).Microbiological surveillance of operation theatres and ICUs of a tertiary care
hospital, Lahore. Biomedica, vol. 24(2), pp. 99-102.
Lapidus, L. J., Ponzer, S., Pettersson, H., & de Bri, E. (2013).Symptomatic venous
thromboembolism and mortality in orthopaedic surgery–an observational study of 45
968 consecutive procedures. BMC musculoskeletal disorders, vol. 14(1), pp.
177.https://doi.org/10.1186/1471-2474-14-177
Meddings, J., Rogers, M. A., Krein, S. L., Fakih, M. G., Olmsted, R. N., & Saint, S. (2013).
Reducing unnecessary urinary catheter use and other strategies to prevent catheter-
associated urinary tract infection: an integrative review. BMJ Qual Saf, bmjqs-2012.

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NURSING CARE
Oresanya, L. B., Lyons, W. L., & Finlayson, E. (2014). Preoperative assessment of the older
patient: a narrative review. Jama, vol. 311(20), pp. 2110-2120
doi:10.1001/jama.2014.4573.
Pasqualini, D., Mollo, L., Scotti, N., Cantatore, G., Castellucci, A., Migliaretti, G., &Berutti,
E. (2012). Postoperative pain after manual and mechanical glide path: a randomized
clinical trial. Journal of endodontics, vol. 38(1), pp. 32-36.
Tollefson, J., Bishop, T., Jelly, E., Watson, G., Tambree., K. (2012). Clinical psychomotor
skills: assessment tools for nursing students (4th Ed.). South Melbourne: Cengage
Learning Australia.
Vaccaro, A. R., Oner, C., Kepler, C. K., Dvorak, M., Schnake, K., Bellabarba,
C., ...&Shanmuganathan, R. (2013). AOSpine thoracolumbar spine injury
classification system: fracture description, neurological status, and key
modifiers. Spine, vol. 38(23), pp. 2028-2037.0.1097/BRS.0b013e3182a8a381
Wang, X., Loram, L. C., Ramos, K., de Jesus, A. J., Thomas, J., Cheng, K., ...& Yin, H.
(2012). Morphine activates neuroinflammation in a manner parallel to
endotoxin. Proceedings of the National Academy of Sciences, 109(16), 6325-
6330.10.1073/pnas.1200130109