bluuebunny/crossref_metadata_2025 huggingface dataset:
Effect of the 30 degree lateral recumbent position on pulmonary artery and pulmonary artery wedge pressures in critically ill adult cardiac surgery patients
Authors: Bridges EJ , Woods SL , Brengelmann GL , Mitchell P , Laurent-Bopp D
Published: November 2019

BACKGROUND: Despite demonstrated benefits of lateral positioning, critically ill patients may require prolonged supine positioning to obtain reproducible hemodynamic measurements. OBJECTIVES: TO determine the effect of 30 degree right and left lateral positions on pulmonary artery and pulmonary artery wedge pressures after cardiac surgery in critically ill adult patients. METHODS: An experimental repeated-measures design was used to study 35 patients with stable hemodynamics after cardiac surgery. Subjects were randomly assigned to 1 of 2 position sequences. Pulmonary artery and pulmonary artery wedge pressures were measured in each position. RESULTS: Measurements obtained from patients in the 30 degree left lateral position differed significantly (all Ps < .05) from measurements obtained from patients in the supine position for pulmonary artery systolic, end-diastolic, and mean pressures. Pulmonary artery wedge pressures did not differ significantly; however, data were available from only 17 subjects. The largest mean difference in pressures between the 2 positions was 2.0 +/- 2.1 mm Hg for pulmonary artery systolic pressures, whereas maximum differences for end-diastolic and pulmonary artery wedge pressures were 1.4 +/- 2.7 mm Hg and 1.6 +/- 2.4 mm Hg, respectively. Clinically significant position-related changes in pressure occurred in 12 (2.1%) of 581 pressure pairs. Clinically significant changes occurred in end-diastolic pressure in 2 subjects and in pulmonary artery wedge pressure in 1 subject. CONCLUSiONS: In patients with stable hemodynamics during the first 12 to 24 hours after cardiac surgery, measurements of pulmonary artery and pulmonary artery wedge pressures obtained in the 30 degree lateral and supine positions are clinically interchangeable.
Effects of pectin on diarrhea in critically ill tube-fed patients receiving antibiotics
Authors: Schultz AA , Ashby-Hughes B , Taylor R , Gillis DE , Wilkins M
Published: November 2019

BACKGROUND: Anaerobic colonic flora are necessary for the fermentation of fiber into short-chain fatty acids and constitute the bulk of fecal mass. Lack of dietary fiber in most enteral feedings, compounded by antibiotic therapy, suppresses normal colonic metabolism, resulting in diarrhea. Pectin, a water-soluble fiber, stimulates epithelial growth in the colon and thus reduces diarrhea. METHODS: Forty-four critically ill patients receiving enteral nutrition and antibiotic therapy were randomized to receive fiber-containing or fiber-free tube feedings and pectin or placebo. Data on frequency, consistency, and volume of fecal output; energy (caloric) intake; and administration of specific medications were collected for 9 days. Diarrhea was defined as 2 or more days with scores of 12 or higher on the Hart and Dobb diarrhea scale. RESULTS: Subjects in the 4 groups did not differ significantly in age, sex, severity of illness, or energy intake. Twelve subjects (27.3%) experienced diarrhea. Significantly fewer subjects in the fiber-free/placebo and fiber/pectin groups experienced diarrhea than did subjects in the fiber/placebo group (P = .02). On the basis of repeated-measures analysis of variance of daily mean scores, the severity of diarrhea did not differ significantly among the study groups over time (P = .16). CONCLUSIONS: The reduced rate of diarrhea found in this study may be related to the stringent definition of diarrhea used. The therapeutic dose of pectin for reducing diarrhea needs further exploration. The trend was toward less diarrhea in the fiber/pectin group, but the study needs to be replicated with a larger sample.
Rejection after organ transplantation: a historical review
Authors: De Vito Dabbs A , Dauber JH , Hoffman LA
Published: November 2019

Progress toward understanding the biochemical basis of human individuality spans centuries, but tissue rejection remains the primary clinical challenge of organ transplantation. This article highlights the chronology of scientific discoveries made in the quest to overcome the rejection associated with transplantation. The purposes of this review are to raise clinicians' awareness of the advances in surgery, genetics, immunology, and immunosuppression that have contributed to the current knowledge of tissue rejection and to indicate potential new directions in this challenging field.
More than a pump: the endocrine functions of the heart
Authors: Collins AS
Published: November 2019

The endocrine functions of all tissues, including the heart, are being delineated in more detail as our understanding of cellular biology unfolds. Natriuretic peptides form an important counterregulatory system to balance the effects of sympathetic neurohormones. As we learn to intervene with therapeutic manipulations of this system, critical care practitioners will be involved in the assessment, monitoring, and evaluation of new cardiovascular therapies.
Pain experiences of traumatically injured patients in a critical care setting
Authors: Stanik-Hutt JA , Soeken KL , Belcher AE , Fontaine DK , Gift AG
Published: November 2019

BACKGROUND: Little is known about the acute pain experiences of traumatically injured critically ill patients. OBJECTIVES: To describe pain experiences of traumatically injured adults during the first 72 hours of hospitalization. METHODS: Thirty multiply injured adults at a level I trauma center participated in the study. Pain was measured by using the McGill Pain Questionnaire and a visual analog scale. Subjects completed pain measures while at rest in a supine recumbent position and after a turn onto the side. RESULTS: The typical subject was 37 years old, had 4 major blunt trauma injuries, and had received the equivalent of 55.9 mg of morphine during the 24 hours before data collection. Mean at-rest scores were 26.5 on the pain-rating index, 2 on the present pain intensity index, and 34.6 on the visual analog scale. Immediately after the turn, mean scores on the visual analog scale increased from 25 to 48.1 (P = .002). Other pain scores after the turn did not differ significantly from at-rest values. Subjects who turned had lower scores on the visual analog scale at rest (P = .02) and less anxiety (P = .02) than did those who refused to turn. Ninety-six percent reported pain in the injured areas, and 36% reported pain related to biomedical devices. No relationship was found among reported pain and demographic, treatment, or clinical variables. CONCLUSIONS: Additional research is needed on pain at rest and during commonly performed procedures and on improved methods for pain relief in traumatically injured critically ill patients.
Early Socialization of New Critical Care Nurses
Authors: Reising Deanna L.
Published: November 2019

• Background Critical care nurses provide care to acutely ill patients, yet little is known about the early socialization processes of new nurses to critical care units from the nurses’ perspectives.

• Objectives To explore the early socialization processes of critical care nurses.

• Methods A grounded theory design was used to generate a local theory of how critical care nurses experience socialization. Interviews and journals of participants (N = 10) during the first 4 to 5 months of the socialization experiences were collected. Preceptors were interviewed to triangulate data. Orientation materials and field notes were examined.

• Results A process of 5 phases was uncovered: the prodrome, welcome to the unit, disengagement/testing, on my own, and reconciliation. Participants experienced difficulty while being evaluated by preceptors early in the orientation process because of changing expectations. Participants also expressed disappointment in their level of comfort at the end of the orientation. The theory termed “navigating the challenge” explains the nature of the changing expectations that new critical care nurses face during their socialization process.

• Conclusions This exploratory study defines the phases that new critical care nurses experience during the early socialization process. Phase-specific recommendations are made on the basis of the results of the study.
Nurses’ Accuracy in Estimating Backrest Elevation
Authors: Dillon Amy , Munro Cindy L. , Grap Mary Jo
Published: November 2019

• Background Positioning patients is a key component of nursing care and can affect their morbidity and mortality. The Centers for Disease Control and Prevention recommend that patients receiving mechanical ventilation have the head of the bed elevated 30°to 45°to prevent nosocomial pneumonia. However, use of higher backrest positions for critically ill patients is not common nursing practice. Backrest elevation may be affected by the accuracy of nurses’ estimates of patients’ positions.

• Objectives To determine the difference between nurses’ estimates of bed angles and measured bed angles and to describe the relationship between nurses’ characteristics and the accuracy of their estimates.

• Methods A convenience sample of 67 nurses attending the 1999 American Association of Critical-Care Nurses National Teaching Institute and Critical Care Exposition in New Orleans, La. Each subject provided demographic information and estimated 3 bed angles. The angles were preselected by using a random number table. Summary statistics were used and were categorized according to the demographic information provided by participants. Estimated angles were correlated with measured angles, and accuracies in estimating angles were correlated with demographic characteristics.

• Results Nurses were accurate in estimating bed angles (correlation, 0.8488). Demographic information, including sex, age, years of practice, years of critical care practice, basic education, highest educational level, and present position had no relationship to accuracy.

• Conclusions Nurses are able to estimate backrest elevation accurately. Other explanations are needed to understand why recommendations for backrest elevation are not used in practice.
Effectiveness of Mechanical Compression Devices in Attaining Hemostasis After Femoral Sheath Removal
Authors: Jones Tina , McCutcheon Helen
Published: November 2019

• Background Cardiac interventions are widely accepted as a practical treatment option for coronary artery disease. However, few changes have occurred in the techniques used for percutaneous arterial cannulation and for attaining hemostasis after cardiac interventions. To date, researchers have focused on techniques to achieve optimal hemostasis at the time of removal of the arterial catheter and to minimize the impact and complications of arterial puncture.

• Objective To summarize the best available evidence on the effectiveness of mechanical compression devices used to obtain hemostasis following femoral sheath removal after cardiac interventional procedures.

• Method An attempt was made to detect both published and unpublished reports of research evaluations of mechanical compression techniques used to attain hemostasis after femoral sheath removal. Methodological quality was assessed by using predesigned criteria. Data were extracted from information on randomized controlled trials and were statistically combined in meta-analysis where possible. Evidence was also synthesized by using narrative summaries.

• Results Twelve studies met the inclusion criteria; however, only 3 were included in the meta-analysis. The results of meta-analysis indicated that the mechanical compression technique was the most effective for preventing formation of hematomas. The prevalence of bleeding did not differ significantly for different methods of compression.

• Conclusion A gap exists in the literature on quality randomized controlled trials of various devices used to attain hemostasis after femoral sheath removal.
Women’s Perceptions of Personal Cardiovascular Risk and Their Risk-Reducing Behaviors
Authors: Oliver-McNeil Sandra , Artinian Nancy T.
Published: November 2019

• Background Coronary heart disease is the leading cause of death in women. Risk factors include smoking, hypertension, dyslipidemia, diabetes mellitus, and obesity. Without an understanding of these risk factors, women are poorly prepared to carry out preventive self-care actions to reduce their risk.

• Objectives To describe perceptions of cardiovascular risk factors and risk-reducing behaviors among women with newly diagnosed coronary heart disease.

• Methods A descriptive study was done in a large midwestern suburban hospital. A nonprobability sample of 33 women with coronary heart disease completed a mail questionnaire. Data were collected by using the Coronary Heart Disease Knowledge Test, the Health-Promoting Lifestyle Profile II, and questions developed for the study.

• Results Thirty-three women responded. Mean age was 65.64 years (range, 36–85 years; SD, 11.32 years); mean educational level was 12.67 years (range, 8–18 years; SD, 1.79 years). Most of the respondents could not identify personal cardiovascular risk factors; the risks identified were considerably fewer and differed from those documented in the women’s medical records. Women reported moderate levels of most risk-reducing behaviors and low levels of physical activity.

• Conclusions Women with coronary heart disease may not know what risk factors they have. Women must have their risk factors assessed and should be counseled about those risks.
Celebrating the 100th Birthday of the Electrocardiogram: Lessons Learned From ECG Monitoring Research
Authors: Drew Barbara J.
Published: November 2019

In 1902, a Dutch physiologist, Willem Einthoven, invented the first ECG machine and recorded limb leads I, II, and III in a human, for which he was awarded the Nobel Prize in Medicine. In the ensuing 100 years, an explosion of knowledge in the field of electrocardiography has sparked technological advances, including pacemakers, defibrillation, invasive cardiac electrophysiology testing, implantable cardioverter defibrillators, radio-frequency ablation, trans-telephonic transmission of ECG signals, and much more.
Effects of an Augmented Postoperative Fluid Protocol on Wound Healing in Cardiac Surgery Patients
Authors: Heiner Stacy , Whitney JoAnne D. , Wood Connie , Mygrant Brenda I.
Published: November 2019

• Background Cardiac surgery patients are vulnerable to hypoperfusion postoperatively and often have subcutaneous tissue oxygen tension less than 50 mm Hg. Hypovolemia most likely contributes to this hypoperfusion and may lead to impaired wound healing.

• Objective To determine if a modified postoperative fluid replacement protocol would result in improved tissue oxygen tension, blood flow, and healing in cardiothoracic surgery patients.

• Methods A total of 166 cardiac surgery patients, 18 to 90 years old, participated in a randomized, 2-group, repeated-measures study. The experimental group received fluid augmentation during the first 36 hours after surgery; the control group received standard postoperative replacement fluids. Subcutaneous tissue oxygen tension and temperature were measured 8, 18, and 36 hours after surgery. Tissue cellularity and accumulation of hydroxyproline were evaluated in tissue obtained from subcutaneous expanded polytetrafluoroethylene tubes. Wound complications were evaluated by using the ASEPSIS Wound Scoring System.

• Results Tissue oxygen levels, tissue cellularity, and accumulation of hydroxyproline were similar in the 2 groups. A negative correlation (P = .01) existed between higher tissue oxygen values and lower (better) ASEPSIS leg wound scores. More than 80% of the patients had tissue oxygen levels of 50 mm Hg or less at each time of measure. Many values were 30 to 40 mm Hg less than the ideal for control of bacteria and healing.

• Conclusions The frequency of low oxygen levels is consistent with data from earlier studies. Determination of other interventions to improve subcutaneous tissue perfusion in cardiac surgery patients is needed.
Effectiveness of 0.12% Chlorhexidine Gluconate Oral Rinse in Reducing Prevalence of Nosocomial Pneumonia in Patients Undergoing Heart Surgery
Authors: Houston Susan , Hougland Paul , Anderson Jacqueline J. , LaRocco Mark , Kennedy Virginia , Gentry Layne O.
Published: November 2019

• Background Decreasing the levels of bacteria in the oropharynx should reduce the prevalence of nosocomial pneumonia.

• Objectives To test the effectiveness of 0.12% chlorhexidine gluconate oral rinse in decreasing microbial colonization of the respiratory tract and nosocomial pneumonia in patients undergoing open heart surgery.

• Methods A prospective, randomized, case-controlled clinical trial design was used. Peridex (0.12% chlorhexidine gluconate) was the experimental drug, and Listerine (phenolic mixture) was the control drug. A total of 561 patients undergoing aortocoronary bypass or valve surgery requiring cardiopulmonary bypass were randomized to an experimental (n = 270) or a control (n = 291) group. Nosocomial pneumonia was diagnosed by using the criteria established by the Centers for Disease Control and Prevention.

• Results The overall rate of nosocomial pneumonia was reduced by 52% (4/270 vs 9/291; P = .21) in the Peridex-treated patients. Among patients intubated for more than 24 hours who had cultures that showed microbial growth (all pneumonias occurred in this group), the pneumonia rate was reduced by 58% (4/19 vs 9/18; P = .06) in patients treated with Peridex. In patients at highest risk for pneumonia (intubated >24 hours, with cultures showing the most growth), the rate was 71% lower in the Peridex group than in the Listerine group (2/10 vs 7/10; P = .02).

• Conclusions Although rates of nosocomial pneumonia were lower in patients treated with Peridex than in patients treated with Listerine, the difference was significant only in those patients intubated more than 24 hours who had the highest degree of bacterial colonization.
Weaning the long-term ventilator-dependent patient: common problems and management
Authors: Norton LC , Neureuter A
Published: November 2019

Weaning methods are an important ingredient in successful extubation. All too frequently, however, patient problems that thwart weaning are not identified or controlled. The pre-weaning assessment form in Table 2 should be used as an evaluation tool after the patient is intubated. Any "no" answers will indicate a common problem impeding weaning. Following problem identification, a plan of care can be developed using management strategies described in Table 3. Thus, a critical void in practice, impediments to weaning, is addressed. This article has addressed the need for the prevention or early identification of problems in mechanically ventilated patients. With this knowledge to guide our practice, we should be able to wean almost any patient.
Elective resection of the liver: nursing care
Authors: Beckermann S , Galloway S
Published: November 2019

Until recently, surgical resection of the liver was done mainly for benign or traumatic conditions. Liver resections are now an accepted treatment for primary and some metastatic cancers of the liver. Nurses play an important role in the management of all liver resection patients and need to have an understanding of the anatomy and physiology of the liver, the tests performed during the preoperative period, the surgery performed, and the physiologic and psychologic responses of the patients during the postoperative period.
Furosemide: update on a commonly used drug
Authors: DePew CL , Smith ME , Hodge NS , Grow GW
Published: November 2019

Because of its efficacy, IV furosemide has become a common medication administered to the critically ill adult. It is capable of causing serious complications if given without caution, without prior assessment of the patient's clinical status, or without careful monitoring of response to therapy. Furosemide has the potential to cause problems that are more than fluid and electrolyte imbalances. The nurse must be aware of toxic effects and how to minimize them when giving higher doses and, in renal failure. It is imperative for a patient's progress that his or her nurses have a knowledgeable and respectful attitude toward the drugs they administer.
Complications of acute pancreatitis
Authors: Jeffres C
Published: November 2019

In 1925, Sir Berkeley Moynihan stated that "acute pancreatitis is the most terrible of all the calamities that occur in connection with the abdominal viscera." The case of M.H. clearly reflects the accuracy of that statement. It should be pointed out that through the exceptional, dedicated care provided by all members of the health care team, a young woman whose predicted mortality approached 100 percent was restored to her previous state of good health, and has since delivered a healthy baby girl by cesarean section. This illustrates that the nurse who possesses a sound understanding of the complications of acute pancreatitis and the pathophysiologic processes responsible, can integrate this knowledge into the management of the patient and improve the quality of care.
Lactic acidosis: a nursing challenge
Authors: Lorenz A
Published: November 2019

Despite current management, lactic acidosis continues to carry a high mortality because of the severity of the precipitating illness and the complications of lactic acidosis itself. Continuous nursing assessment of hemodynamic function, oxygenation and ventilation, and awareness of specific metabolic indicators (anion-gap, acid-base status) is mandatory. Early recognition of clinical situations likely to precede abnormal lactate accumulation can do much to improve the effectiveness of treatment.
Planning at the unit level
Authors: Bray KA
Published: November 2019

In recent years, management responsibilities at the unit level have expanded considerably. In this evolution of the nurse-manager role, the importance of the planning process in the overall productivity and success of the unit has gained widespread acceptance. To meet the challenges of today's health care climate, the nurse manager and the unit staff must have a clear understanding of what our business is, what it should be, and finally, depending on the plans developed, what it will be.
Nutritional support and head trauma
Authors: Varella LD
Published: November 2019

Nutritional therapy in the head-injured patient is designed to prevent catabolism of lean body cell mass; minimize specific and potential complications; and assist the patient to return to normal nutritional status. Prompt nutritional support accompanied by physical therapy can enhance long term rehabilitation. The critical care nurse plays a major role in this process by providing nutrition along with hemodynamic and neurologic stabilization.
Living wills: the ethical dilemmas
Authors: Ney CA
Published: November 2019

Advanced technology has created various means to prolong life, along with the supposed obligation to use those technologies. Often costly, these technologies may have little or no impact on the outcomes of illness. When and how that technology should be used may result in conflict. By writing a living will, some persons have said "Thanks, but no thanks" to the use of these technologies. Many healthcare professionals, however, are reluctant, because of misinformation or fear of litigation, to respect consumers' rejection of the offer of prolonged life at all costs. An examination of the legal, ethical and emotional aspects of NDAs and living wills may provide some guidelines for dealing with the conflicts encountered in practice. In addition, an awareness of personal feelings may clarify some of the gray areas involved in living wills and assist healthcare professionals to make decisions about Natural Death Acts.
Captopril in the treatment of chronic CHF
Authors: Kennedy GT
Published: November 2019

Captopril is an effective oral drug that helps break the cycle of CHF. Improvements in symptomatology, functional capacity and exercise tolerance are seen with long-term therapy. Captopril is an important addition to the present drug therapy of CHF.
Nurses and ionizing radiation: a study of two institutions
Authors: Miracle VA , Wigginton MA
Published: November 2019

The results of this study revealed that the nurses studied were exposed to ionizing radiation at levels defined as safe. However, since the actual exposure level that increases health risks is unknown, it is recommended that critical care nurses take as many precautions as possible to minimize exposure that, over the long run, could have deleterious effects.
Laser angioplasty in peripheral vascular disease
Authors: Paul MC , Halfman-Franey M
Published: November 2019

The use of laser energy to recanalize peripheral arterial vessels is a new and challenging alternative to more extensive surgical intervention. This exciting technique allows the critical care nurse to respond creatively to changing protocols and patient situations, establishing standards of nursing care for this patient population.
Brain graft surgery: a new treatment for Parkinson's disease
Authors: Bradbury KM , Bauer M
Published: November 2019

Brain graft surgery remains controversial, and the beneficial effects, though promising, are mixed. For those patients who are eligible, it offers new hope for an alternative to early disability and family hardship. Outlined here are the etiology, pathophysiology, and manifestations of Parkinson's disease, plus the surgical procedure and postoperative nursing care.
The HEMOPUMP cardiac assist system: nursing care of the patient
Authors: Rountree WD , Rutan PM , McClure A
Published: November 2019

This article uses a case study to demonstrate the support provided by the HEMOPUMP temporary cardiac assist system. The Nursing Plan of Care addresses the actual and potential problems encountered by the critical care nurse.
Critical care concepts in baccalaureate nursing education
Authors: Reynolds A , Wood SG , Gamero ML
Published: November 2019

The high response rate of 65.1 percent to this survey suggests nurse educators across the country are interested and involved with the incorporation of critical care concepts in baccalaureate nursing education. Nurse educators are conscientiously working to provide an educational basis for graduate nurses to adequately address the complex healthcare needs of our society. Cooperative efforts between nurse educators and practicing critical care nurses can make a difference in the future delivery of healthcare.
Emergency oxygen administration and airway management [continuing education credit]
Authors: Somerson SJ , Sicilia MR
Published: November 2019

Airway-directed vigilance is a priority for all critical care providers. Methodical respiratory assessment, proficient skill in basic airway support, and thorough preparation for advanced airway control modalities, uniquely enable the nurse to initiate timely airway intervention. Ultimately, this can contribute significantly to reduction and prevention of patient morbidity and mortality.
Pulmonary critical care. Airway pressure measurement as an aid to identify end-expiration in hemodynamic waveform analysis
Authors: Ahrens T
Published: November 2019

The value of airway pressure monitoring is the improved clarity in identifying end-expiration. Short of monitoring intrapleural pressures, airway pressure monitoring has the potential to give the most accurate method for identifying the correct respiratory point to read hemodynamic values. Airway pressure monitoring can improve the reliability of hemodynamic waveform analysis between nurses and reduce some of the subjectivity associated with hemodynamic waveform analysis.
Preparing for and understanding transesophageal echocardiography
Authors: Apple S , Thurkauf GE
Published: November 2019

The transesophageal approach to cardiac echocardiography has expanded the ability of this (almost) noninvasive method of evaluating and diagnosing certain types of cardiovascular pathology. Its use can be expected to increase as echocardiographers become skilled in endoscopy and new applications are discovered.
Acute respiratory failure and ECMO
Authors: Dirkes S , Dickinson S , Valentine J
Published: November 2019

In recent years, we have experienced advances in treatments for severe ARDS. One that holds promise for these critically ill adult patients is ECMO, which can provide gas exchange and lung rest for the patient in severe reversible respiratory failure. Advances in ECMO techniques, appropriate patient selection and the development of heparinized tubing will all improve the potential for survival in patients who are placed on ECMO therapy in the future.
Changing perspectives in the assessment of oxygenation
Authors: Ahrens T
Published: November 2019

Changing the perspective of clinical assessment to cellular oxygenation assessment will be a trend in the 1990s, particularly with the development of new technologies. New technologies such as MRI and PET scanning will increase clinicians' ability to assess cellular dysfunction and oxygenation disturbances. Because of improved technology, the focus in assessing oxygenation of the critically ill also will change. Critical care clinicians must accurately identify whether arterial or cellular oxygenation is being assessed. Arterial oxygenation problems are usually a reflection of a loss of hemoglobin or deteriorating lung function (through increased intrapulmonary shunting). Cellular oxygenation problems are more related to the relationship between oxygen delivery and cellular utilization of oxygen. In most critical care situations, cellular oxygenation is the aspect of oxygenation that is of most interest. The more familiar the clinician is with the role oxygen plays in cellular metabolism, the more meaningful the oxygenation assessment becomes. Common nursing techniques for the assessment of oxygenation (eg, physical assessment, blood gases and pulse oximetry) still have a place, but their limited accuracy must be kept in perspective when assessing cellular oxygenation.
Transesophageal echocardiography: a new window on the heart and great vessels
Authors: Thompson EJ
Published: November 2019

TEE adds an exciting new dimension to the field of echocardiography. It has expanded the physician's ability to clearly examine cardiac structures and bloodflow; in many instances it has been the means by which rapid and lifesaving diagnoses have been made. The nurse collaborates with the physician during TEE by ensuring adequate preparation, remaining at the patient's bedside to assist with and monitor the effects of probe insertion and ensuring close observation and postprocedural follow up. The complication rate for TEE is negligible. Possibilities include routine pediatric use, biplane imaging and incorporation with exercise stress testing.
Limitations of liability insurance
Authors: McHugh M , Haas SS
Published: November 2019

In the unfortunate event that you are sued for malpractice, the following suggestions could maximize the benefits of your professional liability insurance policy: Do not contact the claimant, because any statements you make can be used against you in a suit. Provide the insurer with as much information as possible. Monitor the case regularly by contacting the insurance adjuster assigned to the case and request copies of all documents generated. Communicate your feelings with the company about defending or settling the case. If you completely violated a standard of care such as giving an IV push medication to the wrong patient because of failure to check the patient's name bracelet, try to settle this case out of court. A jury would not likely be sympathetic to a nurse who injured a patient in this manner. Review the entire medical record and discuss your analysis with your attorney. Remember, as a policyholder, you have the right to demand that your claim be handled by a competent, professional lawyer. Unlike other professionals, attorneys are not required to have national certification. Defendants have the right to ask assigned attorneys about their malpractice experience. Does the attorney have a working knowledge of the procedures and technical jargon concerning the case? How many similar cases has the attorney handled? You have a right to these answers.
The gastroepiploic arteries as alternative coronary artery bypass conduits
Authors: Earp JK
Published: November 2019

The indications for GEA grafting may expand due to increased coronary bypass demand and superior patency. The utilization of the right GEA as an alternative conduit may become a future trend for complex CABG patient populations. Nurses must document more cases and conduct more research to guide future nursing actions.
Patient perception of preoperative cardiac surgical teaching done pre- and postadmission
Authors: Recker D
Published: November 2019

Preoperative cardiac surgical teaching done on a preadmission vs postadmission basis did not affect subjects' perception of importance of preoperative information or preparation. Hospital teaching methods must be examined so that patient learning is individualized and available when the patient is ready to learn. Preoperative teaching on a preadmission basis may also facilitate admission of the cardiac surgical patient the day of surgery, which could shorten the length of stay.
Management of an open abdominal wound with a synthetic covering
Authors: Bolton PJ , Von Rotz NP
Published: November 2019

The insertion of Silastic sheeting provides an opportunity for improved survival of patients with severe abdominal trauma. This new treatment modality represents a challenge to nurses to expand their knowledge base.
Trauma case review: survival following impalement
Authors: Paul S , Lee CL
Published: November 2019

Prehospital care of patients with penetrating wounds must begin within minutes of the injury; definitive treatments should be initiated within an hour. Due to the advanced skills of the paramedics, nurses, doctors, and ancillary personnel, this patient arrived in the operating room within an hour of his accident. Fortunately, the impaled reinforcement rods missed the vital structures within the patient's thoracic and pleural cavities and spared his lower abdominal organs, vascular structures, and skeletal structures in his groin. This case study illustrates the importance of coordinated efforts in caring for this patient from the prehospital setting through the emergency department and operating room.
Alcohol and trauma: the critical link
Authors: Sommers MS
Published: November 2019

The link between traumatic injury and alcohol consumption is strong. Although statistics vary, from one half to one third of trauma victims admitted to critical care units have an alcohol-related injury. The initial role of the critical care nurse is to identify the presence of alcohol by monitoring the patient's BAC. Once the presence of alcohol is confirmed, its effects impact directly on the plan of care that evolves during the critical illness. Nursing interventions focus on four specific areas affected by alcohol: the ability of alcohol to mask injury, the effects of alcohol on medications, alcohol withdrawal, and rehabilitation from alcoholism. By incorporating these four areas into the plan of care, the critical care nurse assists the patient not only to recover from a traumatic injury but also to deal with a problem drinking pattern.
Diagnosis and management of arrhythmias associated with Wolff-Parkinson-White syndrome
Authors: Conover MB
Published: November 2019

Because of the emergency nature of the arrhythmias associated with WPW syndrome, nurses are often called upon for diagnosis and intervention in critical settings. In such cases the nurse's understanding of mechanisms, ECG recognition, and emergency treatment guarantees the patient the best possible outcome, not only in the critical setting, but in the long term as well. The most common arrhythmias of WPW syndrome are PSVT and atrial fibrillation. In PSVT a differential diagnosis is made on the ECG between (1) CMT using the AV node anterogradely and an accessory pathway retrogradely and (2) AV nodal reentry tachycardia. Helpful clues are location of the P' wave, presence of QRS alternans, the initiating P'R interval, and presence of aberrancy. Atrial fibrillation with an accessory pathway has the morphology of VT but is differentiated because the rhythm is irregular and the rate is more than 200 beats per minute. Emergency treatment consists of blocking the accessory pathway with procainamide. Emergency treatment for both types of PSVT consists of breaking the reentry circuit at the AV node (eg, vagal maneuver, adenosine, or verapamil). Procainamide can also be used to block the retrograde fast pathway in the AV node and to terminate CMT by blocking the accessory pathway. Symptomatic patients with accessory pathways are referred for evaluation and possible radio-frequency ablation.
Stimulation programs for coma patients
Authors: Helwick LD
Published: November 2019

The coma stimulation techniques mentioned here are not the only methods that can be used; coma stimulation programs should be individualized. Families should be encouraged to participate even while the patient is in the ICU. Recovery from coma is often long and tedious, but with use of a coma stimulation program, there is hope for recovery from coma. Because the process of coma recovery is unclear, research is still needed. Critical care nurses have an opportunity to participate in coma recovery by incorporating these stimulation techniques into their practice.
Evaluating quantitative research designs: Part 1
Authors: Haughey BP
Published: November 2019

This article has provided an overview of the three major types of quantitative designs commonly used in nursing research, as well as some criteria for evaluating the designs of published research. The next column will include additional criteria for critiquing quantitative research designs.
Use of ventricular stroke work index and ventricular function curves in assessing myocardial contractility
Authors: Ramsey JD , Tisdale LA
Published: November 2019

Cardiac output and cardiac index values are traditionally used by critical care nurses as indicators of myocardial contractility. Due to the incidence of compensatory tachycardia in many critically ill patients, however, the value of LVSWI as an indicator of myocardial contractility is enhanced, because the formula for its calculation does not emphasize the variable of heart rate. The advantages of using LVSWI are the following: It is easily calculated at the bedside by using an integrated hemodynamic software package or by using the formula provided. It is readily available to the nurse and indicates sensitive changes in myocardial function. When used in LV function curves in the nursing assessment of myocardial contractility of critically ill adults, its use can direct changes in fluid and pharmacologic interventions. Factors that affect ventricular end-diastolic pressure such as altered myocardial compliance or increased transmural pressure alters PCWP. Although LVSWI is not completely independent of these factors and may be less precise with altered PCWP, the LVSWI does enhance the data base used to manage patients with altered ventricular function. Ideal LVSWI values may not be achievable in patients with poor myocardial contractility; however, tracking the LVSWI provides sensitive and immediate feedback on the efficacy of pharmacologic intervention. Critical care nurses should use the LVSWI for any hemodynamically unstable patient whose myocardial contractility might be compromised. This information allows the nurse to optimize the patient's hemodynamic performance with a more accurate assessment of heart function.
Coronary-subclavian steal after CABG surgery
Authors: Cosgrove LE
Published: November 2019

Patients who have undergone CABG surgery using the IMA are at risk for the development of coronary-subclavian steal. Therefore, recurrence of angina or ECG signs suggestive of myocardial ischemia after CABG with the IMA must be evaluated immediately. Recognition of the signs and symptoms with appropriate intervention is necessary to prevent the life-threatening consequences of reversed bloodflow from the myocardium. Routine assessment of bilateral blood pressure measurements may provide a critical clue in identifying this syndrome.
Treatment options for hypoplastic left heart syndrome: a mother's perspective
Authors: Swanson LT
Published: November 2019

The congenital heart defect of HLHS is nearly uniformly fatal without intervention. As surgeons gain experience with the techniques the success rates are improving; more infants with HLHS are being offered hope for survival and quality of life. The critical nature of this diagnosis, the relatively new treatment options, and uncertainty of the surgical outcome impose tremendous stress on the parents. Choice of treatment is difficult and should be made in collaboration with the attending physician. Although the first year of my son's life was difficult, the past 5 years have been wonderful. He continues to thrive and enjoy most of the activities other 6-year-olds enjoy. In retrospect, palliative surgery was a good option for him. As both his mother and a cardiac nurse, I recognize that he may once again require surgical intervention, but I am encouraged that medical and surgical advances are being made for children with HLHS.
Caring for the pneumonectomy patient: challenges and changes
Authors: Brenner ZR , Addona C
Published: November 2019

Caring for pneumonectomy patients presents the nurse with challenges such as early detection of potentially fatal complications, promoting postoperative recovery, and preparing the patient for a life with one lung. Changes in healthcare practice and treatment modalities contribute to the challenge of providing quality nursing care for all patients.
Multiple organ failure: the final complication of critical illness
Authors: McMahon K
Published: November 2019

The exact mechanisms responsible for the development and perpetuation of MOF are just beginning to be unraveled. Nurses must have an understanding of the progression of MOF and the physiologic and psychologic responses of the patient. Although caring for patients with MOF is not an easy task, the critical care nurse is in a pivotal role to make a difference in the outcome of these patients.
Meleney's synergistic gangrene: a case study
Authors: Howse EA
Published: November 2019

Meleney's synergistic gangrene is caused by S aureus and streptococcus organisms. One of the identifying symptoms is the presence of extremely painful lesions, which usually form in the second week after surgery or minor trauma. The ulcers that form at the center of the lesion are usually covered by a black eschar and encircled by a gangrenous margin. With knowledge of the pathophysiology and characteristics of this process, nurses can aid in the recognition of this unexpected complication. Nursing interventions can be planned around the needs of these patients. The key to recovery is early identification of the infection and prompt treatment.
Continuous fentanyl infusion in children following open-heart surgery
Authors: Jensen C , Cabeza S
Published: November 2019

Fentanyl can be an effective drug for managing sedation and blunting the stress responses in children who have pulmonary hypertension after undergoing open-heart surgery. However, expert nursing care is required to anticipate and assess complications associated with fentanyl infusion. The critical care nurse must be prepared to identify symptoms of narcotic withdrawal and intervene appropriately. In an effort to minimize the complications associated with fentanyl infusion, a care plan was developed that emphasizes the nursing diagnosis related to the care of an anesthetized infant or child in the intensive care unit (Table 2). This care plan is a guide to help critical care nurses care for an infant or child receiving a continuous fentanyl infusion.
A collaborative program for advanced practice in trauma/critical care nursing
Authors: Keough V , Jennrich J , Holm K , Marshall W
Published: November 2019

The students and faculty enrolled in the first TNP class have set a standard for future TNPs: a rigorous course of education with advanced practice and scholarship within an advanced practice collaborative model. Because of the increasingly number of trauma victims and the highly specialized care they require, nurses must come forward and provide quality care. The TNPs and their faculty must promote further recognition of the TNP role, become leaders in the field of acute care, and continue to develop and maintain collaborative relationship with physicians in support of advanced practice nursing in many areas of tertiary care. The first three graduates of the trauma/critical care practitioner class are now employed in advanced practice roles and are applying their education within trauma/critical care settings. Two of the students are trauma nurse practitioners in a community hospital, and one is a critical care nurse practitioner in a university hospital. Currently, there is an acute care nurse practitioner certification examination that is appropriate for nurses in the field of trauma/critical care. Co-sponsored by the AACN Certification Corporation and the American Nurses Credentialing Center, this examination is offered twice a year, in June and October. AACN is active in supporting and promoting the TNP role and, in conjunction with the American Nurses Association, has developed new standards of care and scope of practice to include this expanded role for the advanced practice nurse. The future for this exciting and demanding role looks bright for the advanced practice nurse interested in the care of the acutely ill patient. The time is right for this collaboration between nurses and physicians.
Thoracoscopic surgery: a new approach to pulmonary disease
Authors: Shawgo T
Published: November 2019

VATS offers numerous advantages for patients with pulmonary disease. Diagnosis and management of numerous pulmonary and other thoracic conditions can now be treated with a less invasive approach. Because of this advance in technology, the ICU patient population is changing. With this advance, there will be fewer thoracotomies performed, resulting in fewer ICU admissions. Thoracoscopy offers hope for those critically ill patients who cannot withstand a diagnosis or interventional surgical procedure to treat their illness.
Pulmonary edema associated with the treatment of preterm labor: what critical care nurses need to know
Authors: Dabbs AD , Kraemer KL , Hoops S
Published: November 2019

Knowledge of the physiologic changes, conditions, and therapies of pregnancy that increase the risk of pulmonary edema enables nurses to influence the outcome of their patients who develop medical complications while undergoing tocolytic therapy. Cooperation between perinatal and critical care nurses ensures optimal care of both the mother and the fetus.
Management of four arterial blood gas problems in adult mechanical ventilation: decision-making algorithms and rationale for their use
Authors: Anderson JM
Published: November 2019

Use of these algorithms does not eliminate the need to think. One must always evaluate each patient to determine if the algorithms are applicable. The algorithms provide a learning framework for any practitioner who is responsible for managing patients receiving mechanical ventilation. The effectiveness of any reference tool depends, to an extent, on the context in which it is applied. The use of these algorithms without an adequate understanding of the principles of gas exchange, acid-base balance, and the function of mechanical ventilators will probably not benefit the patient or the practitioner. The portable nature of these algorithms allows them to be used in the clinical setting. The ultimate goal, of course, is to replace the algorithms with the ability to make and justify mechanical ventilation decisions. Experience with these algorithms will also assist users in applying this approach with unfamiliar problems to find viable solutions.