Due 9/30/2020 Annotated Bibliography on research for immobile post-surgical clients
1. Construct an Annotated Bibliography with at least 6 sources, based on the attached research topic and paper. The sources in the attached paper should also be used in the Annotated Bibliography.
2. Be sure to use the attached Annotated Bibliography template and grading rubric.
3. All source must be credible and scholarly.
4. The documents attached are a template for an annotated bibliography in APA format and MUST USE AS THE ATTACHED TEMPLATE.
5. Two articles must be quantitative and two qualitative articles.
5
Problem Statement
Student’s Name
Affiliation
Course
Professor
Date
PICOT Problem Statement
One of the health risks for immobile post-surgical patients is the development of deep vein thrombosis (DVT). DVT refers to the blood clot which forms inside a vein that is deep beneath the skin of the patient’s leg or pelvis. In the United States, approximately 1 in 10 people die due to DVT complications (Manici, Alemanno, & Nuzzaco, 2018). The risk of developing DVT increases in people with predisposing factors such as sedentary lifestyle, obesity, liver complications, immobilization, advanced age, and cancer. However, immobile post-surgical patients are at higher risk of DVT due to medications for cholecystectomy, staying in one position for long periods, and contraindications of cholecystectomy. Over the years, the established methods of DVT prophylaxis are mechanical devices such as sequential compression device (SCD) and leg exercises to improve blood circulation. Manici, Alemanno, & Nuzzaco (2018) states that novel leg exercises and the SCDs are effective methods of DVT prophylaxis since they facilitate active ankle movement. The general problem is the impact of immobility on the effectiveness of both leg exercises and SCDs in post-surgical clients. According to Dhakal et al. (2019), SCDs have a negligible effect in reducing the prevalence of DVT in hospitalized postoperative patients in the short-term due to the long periods of bed rest and less physical activity. Due to the limited physical activity for post-operative patients, SCDs may ineffective in reducing preventing DVT in immobile post-surgical patients.
The specific problem is that, post-operative patients are reluctant to engage in physical activities due to the health risks associated with the surgery, hence recommending leg exercises for patients recovering from cholecystectomy remains questionable as they are immobile and careful to avoid post-surgery injuries. Manici, Alemanno, & Nuzzaco (2018) found that single motion leg exercise improved post-exercise venous flow volumes in lower extremities among post-operative patients. Snyder et al. (2017) stated that SCD and leg exercises are appropriate methods of DVT prophylaxis, but it is crucial to assess the physiological effects of the interventions. Optimum protection for patients is the primary consideration in determining the appropriate DVT prophylaxis to realize positive outcomes and better quality of care. Snyder et al. (2017) affirmed the disadvantages of mechanical DVT prophylaxis methods such as active leg movement in post-operative patients emanate from the patient’s immobility and bedridden conditions. SCDs are popularly used because patients report better outcomes, especially aged, hospitalized, and post-operative patients. Tanaka et al. (2016) stated that post-operative patients experience difficulties with leg movements due to pain, weakness, fatigue, and bedridden conditions. As such, it is important to factor in the wellbeing of the patients and provides unbiased information about the effectiveness of methods of mechanical DVT prophylaxis to clear doubts about any misinformation. Similarly, Tanaka et al. (2016) claimed that leg exercises are ineffective in the prevention of DVT since post-operative patients experience extended periods of bedtime during hospitalization. Post-operative patients are less likely to make individual efforts to practice leg exercises compared to healthy patients with DVT due to body weaknesses and poor physical health.
This study will investigate the effectiveness of both SCDs and leg exercise, and compare the most effective mechanical methods of DVT prophylaxis. It is crucial to establish the most effective treatment plan for bedridden and post-operative patients because they are a higher risk of DVT or Pulmonary Embolism (PE). The evaluation considers the difficulties that face immobile post-surgical patients as a result of the surgery and the risks associated with immobility regarding the prevention of DVT. Examining the effectiveness of SCDs and leg exercises as interventions of reducing the prevalence of DVT in immobile post-surgical patients could have a significant influence on the recommendations for an evidence-based treatment plan for post-operative patients.
PICOT question
For an immobile post-surgical client who is at an increased risk for deep venous thrombosis (P) how effective is the application of sequential compression devices (SCDs) (I) in comparison to leg exercises (C) in reducing the prevalence of deep vein thrombosis (O) within one month time (T)?
References
Carvalho, B., Zheng, L. L., & Butwick, A. (2017). Comparative Effectiveness of Lower Leg Compression Devices Versus Sequential Compression Devices to Prevent Postspinal Hypotension During Cesarean Delivery. Anesthesia & Analgesia, 124(2), 696–697. https://doi.org/10.1213/ane.0000000000001750
Dhakal, P., Wang, L., Gardiner, J., Shrotriya, S., Sharma, M., & Rayamajhi, S. (2019). Effectiveness of Sequential Compression Devices in Prevention of Venous Thromboembolism in Medically Ill Hospitalized Patients: A Retrospective Cohort Study. Turkish Journal of Hematology. https://doi.org/10.4274/tjh.galenos.2019.2018.0413
Kozier, B., & Berman, A. (2012). Kozier & Erb’s fundamentals of nursing: concepts, process, and practice. Pearson.
Manici, M., Alemanno, G., & Nuzzaco, M. I. (2018). Venous Thromboembolism Prevention and Prophylaxis. In Nursing in Critical Care Setting (pp. 317-333). Springer, Cham. https://doi.org/10.1007/978-3-319-50559-620
Snyder, M. A., Sympson, A. N., Scheuerman, C. M., Gregg, J. L., & Hussain, L. R. (2017). Efficacy in deep vein thrombosis prevention with extended mechanical compression device therapy and prophylactic aspirin following total knee arthroplasty: a randomized control trial. The Journal of arthroplasty, 32(5), 1478-1482. https://doi.org/10.1016/j.arth.2016.12.027
Tanaka, K., Kamada, H., Shimizu, Y., Aikawa, S., Nishino, T., Ochiai, N., … & Yamazaki, M. (2016). The use of a novel in-bed active Leg Exercise Apparatus (LEX) for increasing venous blood flow. Journal of Rural Medicine, 11(1), 11-16. https://doi.org/10.2185/jrm.2906
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