bluuebunny/crossref_metadata_2025 huggingface dataset:
Critical care nurses' perceptions of obstacles and helpful behaviors in providing end-of-life care to dying patients
Authors: Kirchhoff KT , Beckstrand RL
Published: November 2019

BACKGROUND: Little is known about nurses' perceptions of obstacles or helpful behaviors ("helps") in providing end-of-life care in the intensive care setting. OBJECTIVE: To determine the importance of various obstacles and helps in providing end-of-life care as perceived by critical care nurses. METHODS: A questionnaire was mailed to 300 members of the American Association of Critical-Care Nurses. Nurses were asked to rate obstacles and helps in giving end-of-life care, and additional obstacles and/or helps, and answer demographic questions. RESULTS: Six of the top 10 obstacles were related to issues with patients' families that make care at the end of life more difficult, such as the family's not fully understanding the meaning of life support, not accepting the patient's poor prognosis, requesting more technical treatment than the patient wished, and being angry. Added obstacles related mostly to problems with physicians' behavior. Most helps were ways to make dying easier for patients and patients' families, such as agreement among physicians about care, dying with dignity, and families' acceptance of the prognosis. Added helps included allowing music, pets, and so forth into the patient's room. CONCLUSIONS: Nurses have difficulties with patients' families and physicians concerning end-of-life issues, especially when the behaviors remove the nurses from caring for a patient or cause the patient pain or prolong suffering. Nurses do not acknowledge having difficulty providing care to dying patients aside from conflicts that arise because of patients' families and physicians.
Variables influencing patients' outcomes after elective aortic reconstruction surgery
Authors: Aragon D , Clancy R , Sole ML , Zhang Y
Published: November 2019

BACKGROUND: Aortic reconstruction surgery for aneurysmal and occlusive disease is associated with significant morbidity and mortality. OBJECTIVES: To determine what variables influence patients' outcomes after elective aortic reconstruction surgery so that an evidence-based best-practice initiative can be developed for these patients. METHODS: A descriptive, comparative study of all patients undergoing elective aortic reconstruction from October 1997 through December 1998 was used. Retrospective chart review was used to collect demographic and clinical data on the first 48 subjects, who had been discharged from the hospital. Data on the other 63 subjects were collected prospectively. RESULTS: The typical subject was a 65-year-old man with a history of cardiovascular disease, hypertension, and smoking. Subjects were grouped by type of surgery and by outcome (survived without complications vs died or survived with major complications). Outcomes were not significantly different in patients undergoing different types of surgery. Variables associated with poor outcomes included history of cardiovascular disease, elevated preoperative levels of serum urea nitrogen and creatinine, high volumes of salvaged autologous blood administered intraoperatively, and early postoperative hypotension that required treatment. Pulmonary complications were the most common; next most common were cardiac complications. History of cardiovascular disease and hypotension were significant predictors of outcome. CONCLUSION: The variables associated with poor outcomes can be used to design a best-practice initiative for patients undergoing elective aortic reconstruction.
End-of-life issues in intensive care units: a national random survey of nurses' knowledge and beliefs
Authors: Puntillo KA , Benner P , Drought T , Drew B , Stotts N , Stannard D , Rushton C , Scanlon C , White C
Published: November 2019

OBJECTIVE: To investigate the knowledge, beliefs, and ethical concerns of nurses caring for patients dying in intensive care units. METHODS: A survey was mailed to 3000 members of the American Association of Critical-Care Nurses. The survey contained various scenarios depicting end-of-life actions for patients: pain management, withholding or withdrawing life support, assisted suicide, and voluntary and nonvoluntary euthanasia. RESULTS: Most of the respondents (N = 906) correctly identified the distinctions among the end-of-life actions depicted in the scenarios. Almost all (99%-100%) agreed with the actions of pain management and withholding or withdrawing life support. A total of 83% disagreed with assisted suicide, 95% disagreed with voluntary euthanasia, and 89% to 98% disagreed with nonvoluntary euthanasia. Most (78%) thought that dying patients frequently (31%) or sometimes (47%) received inadequate pain medicine, and almost all agreed with the double-effect principle. Communication between nurses and physicians was generally effective, but unit-level conferences that focused on grief counseling and debriefing staff rarely (38%) or never (49%) occurred. Among the respondents, 37% had been asked to assist in hastening a patient's death. Although 59% reported that they seldom acted against their consciences in caring for dying patients, 34% indicated that they sometimes had acted against their conscience, and 6% had done so to a great extent. CONCLUSIONS: Intensive care unit nurses strongly support good pain management for dying patients and withholding or withdrawing life-sustaining therapies to allow unavoidable death. The vast majority oppose assisted suicide and euthanasia. Wider professional and public dialogue on end-of-life care in intensive care units is warranted.
Comparison of the lower inflection point on the static total respiratory compliance curve with outcomes in postoperative cardiothoracic patients
Authors: Boyle M , Way P , Pinfold M , Lawrence J
Published: November 2019

BACKGROUND: Routine use of positive end-expiratory pressure (based on the pressure at the lower inflection point on the static total respiratory compliance curve) along with a maneuver to recruit atelectatic lung has been advocated after cardiothoracic surgery. OBJECTIVES: To determine if the lower inflection point is related to outcomes in patients after sternotomy and cardiopulmonary bypass. METHOD: A prospective observational study involving estimation of the lower inflection point on the inflation pressure-volume plot obtained with a low-flow technique. Duration of intubation, length of stay, respiratory complications, and results of spirometry were compared between patients with a "high " inflection point (> or =10 cm H2O) and patients with a "low" inflection point (< or =5 cm H2O). RESULTS: Ninety-five patients were enrolled. After exclusion for incomplete data, 65 patients (49 men, 16 women; mean age, 66.1 years; SD, 9.5 years) were included. The mean lower inflection point was 6.33 cm H2O (SD, 3.4 cm H2O). A second lower inflection point was observed on 5 plots (mean, 21 cm H2O; SD, 1.4 cm H2O). Nine patients had high inflection points (mean, 13.1 cm H2O; SD, 3.0 cm H2O), and 33 had low inflection points (mean, 3.9 cm H2O; SD, 0.98 cm H2O). No outcome measures differed between groups. CONCLUSIONS: In patients with short intubation times and predictable postoperative course, general use of a lung recruitment strategy involving sustained inflations and adjustment of positive end-expiratory pressure based on the lower inflection point is difficult to justify.
Tobacco Dependence Curricula in Acute Care Nurse Practitioner Education
Authors: Heath Janie , Andrews Jeannette , Thomas Sue Ann , Kelley Frances J. , Friedman Erika
Published: November 2019

• Background Tobacco dependence is the leading preventable cause of death in the United States, yet healthcare professionals are not adequately educated on how to help patients break the deadly cycle of tobacco dependence.

• Objective To assess the content and extent of tobacco education in the curricula of acute care nurse practitioner programs in the United States.

• Methods A survey with 13 multiple-choice items was distributed to the coordinators of 72 acute care nurse practitioner programs. The survey was replicated and modified from previous research on tobacco dependence curricula in undergraduate medical education.

• Results Fifty programs (83%) responded to the survey. Overall, during an entire course of study, 70% of the respondents reported that only between 1 and 3 hours of content on tobacco dependence was covered. Seventy-eight percent reported that students were not required to teach smoking-cessation techniques to patients, and 94% did not provide opportunities for students to be certified as smoking-cessation counselors. Sixty percent reported that the national guidelines for smoking cessation were not used as a curriculum reference for tobacco content.

• Conclusions The majority of acute care nurse practitioner programs include brief tobacco education. More in-depth coverage is required to reduce tobacco dependence. Acute care nurse practitioners are in a prime position to intervene with tobacco dependence, especially when patients are recovering from life-threatening events. National recommendations for core tobacco curricula and inclusion of tobacco questions on board examinations should be developed and implemented.
Monitoring Urinary Bladder Temperature in the Intensive Care Unit: State of the Science
Authors: Fallis Wendy M.
Published: November 2019

Body temperature of patients in critical care units can be monitored with a variety of devices and at a variety of body sites. In recent years, monitoring of urinary bladder temperature has become more common. Temperature-sensing indwelling urinary catheters allow continuous drainage of urine and continuous measurement of body temperature. This article provides a comprehensive and critical review of research undertaken in intensive care units to compare body temperatures measured in the urinary bladder with temperatures measured at a core site, the pulmonary artery. The studies support the use of urinary bladder temperature as a reliable index of core temperature during times of thermal stability. For critically ill patients who are already under considerable stress and whose condition necessitates the use of an indwelling urinary catheter, bladder temperature monitoring is an easy and convenient method that eliminates the need to use alternative sites. Further studies on the effects of shivering and urinary flow rate on temperatures measured in the bladder in critical care patients are needed. The economics of monitoring urinary bladder temperature also should be studied.
“Nurse, I Only Had a Couple of Beers”: Validity of Self-reported Drinking Before Serious Vehicular Injury
Authors: Sommers Marilyn Sawyer , Dyehouse Janice M. , Howe Steven R. , Wekselman Kathryn , Fleming Michael
Published: November 2019

• Background Of the more than 40 000 Americans killed each year in vehicular crashes, 40% are involved in alcohol-related collisions. Although self-reported alcohol use has become an anchor for alcohol intervention after traffic crashes, clinicians are often skeptical about the truthfulness of self-reporting.

• Objective To determine the validity of self-reported alcohol consumption of vehicular occupants hospitalized for a serious, alcohol-related injury.

• Methods Non-alcohol–dependent subjects 18 years and older who were injured in motor vehicle crashes were interviewed. The self-reported number of standard drinks, time that drinking commenced, sex, and weight were used to calculate estimated blood alcohol concentration. This value was compared with the blood alcohol concentration measured at admission.

• Results Of the 181 subjects, 60% provided sufficient data to calculate the estimated concentration. Seven men with admission concentrations of 10 mg/dL or more denied drinking. Among the 113 subjects with estimated concentrations who acknowledged drinking (excluding the 7 who denied drinking), the mean concentration at admission was 158.67 mg/dL, and mean estimated concentration was 83.81 mg/dL. According to multiple regression analyses, weight and number of drinks accounted for 3% of the variance in alcohol concentration at admission for women (R =0.174, F2,40 = 0.623, P = .54) and for 29% of the variance in men (R=0.543, F2,128 =26.71, P< .001).

• Conclusions Most persons who drink before vehicular injury acknowledge drinking. Self-reported data from men generally reflect the overall trend of alcohol consumption but with systematic underreporting. Reports from women are less predictable.
Bacterial Growth in Secretions and on Suctioning Equipment of Orally Intubated Patients: A Pilot Study
Authors: Sole Mary Lou , Poalillo F. Elizabeth , Byers Jacqueline F. , Ludy Jeffery E.
Published: November 2019

• Background Contamination of equipment, colonization of the oropharynx, and microaspiration of secretions are causative factors for ventilator-associated pneumonia. Suctioning and airway management practices may influence the development of ventilator-associated pneumonia.

• Objectives To identify pathogens associated with ventilator-associated pneumonia in oral and endotracheal aspirates and to evaluate bacterial growth on oral and endotracheal suctioning equipment.

• Methods Specimens were collected from 20 subjects who were orally intubated for at least 24 hours and required mechanical ventilation. At baseline, oral and sputum specimens were obtained for culturing, and suctioning equipment was changed. Specimens from the mouth, sputum, and equipment for culturing were obtained at 24 hours (n = 18) and 48 hours (n = 10).

• Results After 24 hours, all subjects had potential pathogens in the mouth, and 67% had sputum cultures positive for pathogens. Suctioning devices were colonized with many of the same pathogens that were present in the mouth. Nearly all (94%) of tonsil suction devices were colonized within 24 hours. Most potential pathogens were gram-positive bacteria. Gram-negative bacteria and antibiotic-resistant organisms were also present in several samples.

• Conclusions The presence of pathogens in oral and sputum specimens in most patients supports the notion that microaspiration of secretions occurs. Colonization is a risk factor for ventilator-associated pneumonia. The equipment used for oral and endotracheal suctioning becomes colonized with potential pathogens within 24 hours. It is not known if reusable oral suction equipment contributes to colonization; however, because many bacteria are exogenous to patients’ normal flora, equipment may be a source of cross-contamination.
Recovering From Cardiac Surgery: What Patients Want You To Know
Authors: Doering Lynn V. , McGuire Anthony W. , Rourke Darlene
Published: November 2019

• Background Care of cardiac surgery patients has changed substantially in the past decade, with an emphasis on streamlined procedures and shortened hospital stays. The few qualitative reports of patients’ perspectives of this experience focus primarily on physical complications and discomforts during the immediate postoperative period.

• Objective To examine patients’ perceptions of the quality of the nursing and medical care they received during their hospital stay after cardiac surgery.

• Methods Data were collected from a consecutive sample of 89 cardiac surgical patients who consented to participate in 2 telephone interviews at 1 week and 6 weeks after hospitalization. Patients responded to a single open-ended question: “What do you want your nurses and doctors to know to help them do a better job?” Thematic extraction analysis of patients’ responses was conducted by using commercially available statistical software. Extracted themes were applied to the structure-process-outcome framework of quality of care.

• Results Four major themes (and 12 subthemes) were identified: (1) being satisfied (having a positive experience, getting information), (2) not being cared for (feeling depersonalized, having expectations that did not match recovery experiences, not being listened to, experiencing unprofessional behavior by care providers, experiencing continued care needs after going home), (3) physical needs unmet (sleep, pain, complications, physical environment), and (4) informational needs unmet (needing more or different information).

• Conclusions Patients want nurses and doctors to provide a smooth transition to home, recognize the patients as individuals, prepare them honestly for their experiences with specific information, and manage pain and sleep.
Predictors of Quality of Life at 1 Month After Implantation of a Left Ventricular Assist Device
Authors: Grady Kathleen L. , Meyer Peter , Mattea Annette , Dressler Diane , Ormaza Sophia , White-Williams Connie , Chillcott Suzanne , Kaan Annemarie , Todd Barbara , Loo Alice , Klemme Annette L. , Piccione William , Costanzo Maria Rosa
Published: November 2019

• Objectives To describe quality-of-life outcomes; determine relationships between quality of life and demographic, physical, psychosocial, and clinical variables; and identify predictors of quality of life at 1 month after implantation of a left ventricular assist device.

• Methods Patients who received either an implantable pneumatic (n = 38) or a vented electric (n = 54) left ventricular assist device as a bridge to heart transplantation between August 1, 1994, and August 31, 1999, completed 6 instruments used to measure quality of life and factors related to quality of life. Data were analyzed by using descriptive statistics, Pearson correlations, Mann-Whitney U tests, and forward, stepwise multiple regression.

• Results Overall satisfaction with quality of life was quite high as determined from the total score on the Quality of Life Index (mean = 0.69). Patients were very satisfied with the implantation and thought that they would do well after future heart transplant surgery. Patients had a moderate level of stress. Significant predictors of overall quality of life were psychological symptoms, stress, and race; these accounted for 46% of variance in quality of life.

• Conclusions Patients were satisfied with their quality of life at 1 month after implantation of a left ventricular assist device. However, they were least satisfied with their health and functioning and yet were optimistic about how well they thought they would do after heart transplantation. Psychological factors were the strongest predictors of satisfaction with overall quality of life.
Weaning Older Patients From Long-term Mechanical Ventilation: A Pilot Study
Authors: Epstein Carol Diane , El-Mokadem Naglaa , Peerless Joel R.
Published: November 2019

• Background As older persons in the intensive care unit increasingly require long-term mechanical ventilation, accurate indications of readiness for weaning from ventilatory support are needed to avoid premature extubation.

• Objective To describe temporal changes in pulmonary and systemic variables in older adults receiving long-term mechanical ventilation.

• Methods After 3 days of unsuccessful attempts at weaning from ventilatory support, 10 trauma and surgical patients more than 60 years old were monitored daily. Previously reported predictors of the duration of mechanical ventilation and weaning outcome were measured, including hemodynamic and gas exchange variables, oxygen cost of breathing, and the score on the Burns Weaning Assessment Program.

• Results The 6 patients who could be weaned from ventilatory support were younger (median age, 71.5 years) than the 4 patients who could not be weaned (median age, 80 years). Patients who could be weaned were ready for weaning by day 11 of their stay in the intensive care unit and required an additional 5.5 days of mechanical ventilation; those who could not be weaned were not ready for weaning until day 17. All patients initially had increases in oxygen consumption during weaning; those who were successfully weaned had decreases before extubation. Respiratory rate, maximal inspiratory pressure, the ratio of Pao2 to fraction of inspired oxygen, and mean arterial pressure were higher in patients who could be weaned, and oxygen cost of breathing and central venous pressure were lower.

• Conclusion Further study of weaning in older adults is warranted.
Use of Intercostal Bupivacaine With Epinephrine After Surgery to Decrease Use of Narcotics and Duration of Intubation
Authors: Fox William J. , Hughes Thomas A.
Published: November 2019

• Background Postoperative pain plays a significant part in the recovery of patients after open heart surgery.

• Objective To determine if the use of intercostal bupivacaine with epinephrine is associated with decreases in use of narcotics and intubation times after open heart surgery.

• Methods A randomly selected experimental group of 25 patients received injections of bupivacaine with epinephrine in the intercostal tissues before chest closure in open heart surgery. A control group of 22 patients received no bupivacaine, only standard care. Postoperative use of narcotics and intubation times were determined for both groups.

• Results Compared with the control group, the group given bupivacaine with epinephrine used significantly less narcotics (P = .008) and had significantly shorter intubation times (P = .003).

• Conclusion Injection of intercostal bupivacaine with epinephrine before chest closure in open heart surgery decreases use of narcotics and length of intubation postoperatively, thus speeding up recovery times.
An Educational Project to Improve Knowledge Related to Pulse Oximetry
Authors: Attin Mina , Cardin Suzette , Dee Vivien , Doering Lynn , Dunn Dieula , Ellstrom Kathi , Erickson Virginia , Etchepare Maria , Gawlinski Anna , Haley Theresa , Henneman Elizabeth , Keckeisen Maureen , Malmet Marcia , Olson Lisa
Published: November 2019

• Background Pulse oximetry is a frequently used, noninvasive monitoring tool for assessing arterial blood oxygenation. Physicians, registered nurses, and respiratory therapists are responsible for the accurate interpretation of pulse oximetry data as part of the evaluation and management of acutely and critically ill patients.

• Objectives (1) To evaluate the extent of current knowledge about pulse oximetry and (2) to increase clinicians’ knowledge of research-based practices related to the appropriate use of pulse oximetry and interpretation of its results.

• Methods A test/survey of 17 true-false questions based on the research-based practice protocol of the American Association of Critical-Care Nurses was developed to evaluate current knowledge of pulse oximetry. A convenience sample of medical, nursing, and respiratory therapy staff was invited to complete the test/survey before and several months after an educational program to improve staff members’ knowledge of pulse oximetry. The program included educational forums, policy changes, competency checklists, and verification of inclusion of research-based principles in orientation programs.

• Results A total of 442 staff members completed the test/survey given before the educational program: 331 nurses, 82 physicians, and 29 respiratory therapists. The overall mean percentage of correct answers was 66%. Differences between disciplines were significant: respiratory therapists scored slightly higher (76%) than did nurses (64%) and physicians (66%) (P = .01). The scores on the test/survey given after the educational program increased significantly, from 66% to 82% (P < .01).

• Conclusions This educational project improved staff members’ knowledge of pulse oximetry monitoring.
Continuous arteriovenous ultrafiltration: a monitoring guide for ICU nurses
Authors: Price CA
Published: November 2019

CAVU has been demonstrated to be a therapeutic intervention for certain critically compromised patients. The objectives of this therapy can be achieved if nurses and physicians are aware of the procedural considerations before, during, and after therapy that enhance effective management. Continuing in-service education, established departmental protocols, and comprehensive guidelines for monitoring are not only extremely helpful but necessary to assure quality patient care.
Ethylene glycol toxicity
Authors: Robinson D , McCoy CA
Published: November 2019

Ingestion of ethylene glycol is a rare occurrence, but it is an attractive agent for intoxication and suicide. Treatment is aimed at rapid excretion of the EG, prevention of the formation of metabolites, and the prevention and treatment of renal failure. Prior to discharge, Mr K revealed that he had drunk the antifreeze because he was despondent about his work situation. He had a short, but intensive trajectory that followed the three-system-involvement classic to EG poisoning, with the renal system most severely affected. Mr K was discharged from the hospital one week after admission and referred to appropriate community resources for counseling. The critical care nurse plays a key role in alleviating the hazards of this complex disorder through complete and ongoing assessment of all systems.
The use of naloxone in treating endotoxic shock
Authors: Schumann LL , Remington MA
Published: November 2019

The use of naloxone to reverse the hypotension caused by endotoxins and endogenous opiates is currently under investigation. This report provides a description of the pathophysiology of endotoxic shock and the therapeutic use of naloxone in order to provide the critical care nurse with the scientific rationale, research-based clinical trials, and the clinical implications for its use.
Respiratory syncytial viral infection in infants: nursing implications
Authors: Adams DA , McFadden EA
Published: November 2019

Respiratory syncytial viral infection is the leading cause of acute lower respiratory tract disease in infants and young children. Presenting symptoms include rhinorrhea, nasal congestion, a low grade fever, and a cough. Hypoxemia and respiratory acidosis are the most common presentation for infants requiring intensive care. Critical care nurses must skillfully assess the infant's clinical status and response to medical treatment, implement and enforce isolation procedures, and remain sensitive to the emotional and psychologic needs of RSV-infected infants and their families. They must be knowledgeable regarding the latest research and recommendations concerning isolation policies and safe administration of ribavirin therapy in order to maximize the care for infants experiencing acute respiratory distress caused by RSV infection.
Blunt renal trauma
Authors: Sommers MS
Published: November 2019

Severe blunt renal injuries threaten the patient's life with severe complications such as hemorrhage, infection, and the loss of renal function. The critical care nurse's role in the assessment of the patient focuses on evaluating the patient's response to the initial injury, the ongoing assessment of the patient's urinary function, assessing the degree and quality of the patient's pain, and observing the patient's trend in vital signs. The nurse is also responsible for determining the patient's response to diagnostic procedures, providing emotional support, and explaining diagnostic tests and procedures. By supporting compensatory mechanisms, the critical care nurse minimizes the potential for hemodynamic compromise, infection, and diminished renal function. Another important patient care consideration is the maintenance of urinary drainage, to allow assessment of urine and promote excretion of wastes. In all of these aspects of patient care, the critical care nurse is a key member of the trauma team who has a strong impact on the recovery of the patient with blunt renal trauma.
Measuring intraabdominal pressure
Authors: Lameier D , NeCamp D
Published: November 2019

This article is intended to help nurses understand the physiologic rationale for the measurement of IAP. We were able to see a time relationship between increasing IAP and decreasing urine output in our patients. When measures were taken to reduce IAP, urine output improved. No causal relationship is implied because no formal study was done and many other factors may have influenced the IAP measurement and the renal function of these patients. Critical care nurses may be called upon to measure this clinical parameter more frequently in the future. Our experience with IAP may help other critical care nurses when they begin to measure the IAP of their patients.
Injectate temperature: effects on thermodilution CO measurements
Authors: Groom L , Elliott M , Frisch S
Published: November 2019

The present study has confirmed the findings of other research and indicates that current technology permits accurate CO determination using room temperature injectate. Some patients, especially those with high output, temperature, or blood pressure, may continue to require iced injectate measures to ensure accuracy; more research is needed here. Room temperature measures may be less reproducible than iced. Several ways of compensating for this have been suggested, depending on the technology available. At present, these methods are preferable to using a correction formula based on regression analyses.
Discharge planning for the patient with a new tracheostomy
Authors: Wilson EB , Malley N
Published: November 2019

A patient with a new tracheostomy will face threatening changes upon discharge from hospital support. Nurses, particularly in the critical care unit, frequently and closely support a patient and family through new and often difficult situations during hospitalization. The patient leaving the hospital with a new tracheostomy will face problems with secretion management, increased risk of infections, alterations in body image, and impaired vocalization. To ensure a safe transition from the hospital to home, the patient and family must demonstrate competence in all aspects of tracheostomy care, must be able to recognize signs and symptoms that should be reported to the physician, and must have adequate support at home (such as homecare nurses, properly functioning equipment, and access to necessary supplies). These "musts" form the basis of the discharge care plan. Nurses can help a patient successfully manage these problems through comprehensive discharge planning. Although the critical care nurses who initiate the multidisciplinary discharge planning process may not remain involved in that process throughout the patient's hospitalization, their early efforts can provide an orderly, comprehensive discharge plan optimally suited to ensure that the patient and family acquire the necessary skills, confidence, supplies, and support for the eventual transition home. The information, encouragement, skills demonstrations, and referrals to other resources that critical care nurses provide help the patient adjust to a new tracheostomy.
Interpretation of the cervical spine X-ray: a simplified approach
Authors: Unkle DW , Armstrong JF , Ross SE , WGJr DeLong
Published: November 2019

Because many nursing interventions require mobilization of the patient, cervical spine film interpretation should be a necessary tool of the critical care nurse. This article provides the fundamentals necessary for initial interpretation of the cervical spine, plus a review of the common radiographic views of the cervical spine, abnormalities, and a systematic approach to the interpretation of these studies.
Cocaine-induced acute myocardial infarction
Authors: Coniglio K
Published: November 2019

The use of cocaine as a recreational drug is rapidly escalating in this country. Because of this, an increase in cocaine-related morbidity and mortality is occurring. Cocaine toxicity has been recognized for several years and was thought to be related to high doses or repeated use. Now several researchers have reported that even recreational use of cocaine may cause serious injury and even death by precipitating an acute myocardial infarction (MI). This paper explores the relationship between cocaine abuse and acute MI as well as the care of the patient with a cocaine-induced MI.
Shock, a clinical syndrome: an update. Part 1. An overview of shock
Authors: Rice V
Published: November 2019

Shock is a major critical illness that involves almost every organ system. It is not simply a problem of decreased blood pressure. It is a problem of inadequate tissue perfusion. Part 1 presents an overview of the shock syndrome, including definitions, classifications, and cellular changes in shock.
CATR: a new generation of autologous blood transfusion
Authors: Sympson GM
Published: November 2019

As the field of surgery advances and the conservative use of banked blood transfusion increases the need for postoperative autotransfusion has increased. By using the CATR, the patient's demands for blood can be more adequately met without causing further complications for the patient. This article presents one method for postoperative cardiothoracic autotransfusion and describes its advantages and risks. A Nursing Plan of Care is included.
Colloids vs crystalloids
Authors: Kuhn MM
Published: November 2019

The choice of colloid or crystalloid solutions for resuscitation of a patient in shock remains controversial. Colloids quickly restore plasma volume along with stabilizing hemodynamics. Almost the entire volume is retained within the vascular space after 1 hour. However, only 8 percent of infused water and less than 25 percent of infused saline are retained in intravascular fluid compartments after 1 hour. When using crystalloids for resuscitation, two to four times as much fluid is required for fluid repletion. The very young or old or persons with cardiac or renal dysfunction may have an increased risk of developing pulmonary edema when crystalloids are administered.
Pathologic pupillary signs: self-learning module, Part 1
Authors: Bishop BS
Published: November 2019

Designed for independent study, this module explores some of the common, but often missed, pupillary abnormalities and eye movement irregularities. Part 1 presents an introduction to the module, a prerequisite test (with answer key and study references), module objectives, and a pretest.
Advances in patient care management: the NRCU
Authors: Patterson PA , Elpern EH , Silver MR
Published: November 2019

The noninvasive respiratory care unit has become an important advance in patient management. The NRCU allows for better use of special-care beds and represents a more cost-effective approach to the care of a number of ventilator-dependent patients or other respiratory patients. This article describes the NRCU, discusses clinical experiences and focuses on practical issues related to patient management in the NRCU.
Thrombolytic therapy: a case study
Authors: Moseley MJ
Published: November 2019

Nursing care for Mr J evolved around his actual and potential problems. The actual problems were: an alteration in comfort (chest pain) related to myocardial ischemia, decreased cardiac output related to reperfusion dysrhythmias, and knowledge deficit regarding treatment with thrombolytic therapy. The potential problems were: fluid volume deficit related to lysis of clots in the cerebral vasculature, and alteration in myocardial tissue perfusion related to reocclusion of the coronary artery. Objectives focused on relief of chest pain, prompt initiation of thrombolytic therapy, maintenance of hemodynamics and cardiac output with early interventions, prevention of bleeding and initiation of patient education.
Dealing with advance directives for critically ill adolescents
Authors: Rushton CH , Lynch ME
Published: November 2019

Respecting the values and preferences of adolescents regarding treatment is an essential dimension of nursing practice. As public policy and societal thinking about the role of minors in healthcare decisions evolves, critical care nurses are in a pivotal position to provide leadership and guidance. Critical care nurses who care for adolescents should embrace the opportunity created by the PSDA to implement creative strategies for involving minors in decision making, seek improved methods of assessing decision-making capacity, and document the values and preferences of minors.
Thyroid-induced cardiac disorders
Authors: Coffland FI
Published: November 2019

Signs and symptoms of thyroid disease are varied and often vague. ICU patients may have cardiac disorders directly related to altered levels of thyroid hormone rather than inherent cardiac disease. Cardiac manifestations of thyroid disease result from a decrease or an increase in circulating hormone and are usually reversible with treatment. Accurate, ongoing assessment, especially after treatment has begun, is important to help guide safe and effective therapy. Patient education is another priority of nursing care and can be a major factor in helping the patient to achieve and maintain a euthyroid state.
Critical care nurse internships: in theory and practice
Authors: Kopp ME , Schell KA , Laskowski-Jones L , Morelli PK
Published: November 2019

The CCNIP is a 6-month program that provides didactic instruction and supervised clinical experience to graduate nurses desiring critical care staff nurse positions. During rotations through four critical care units, interns are cross-trained to handle a variety of patient care scenarios. Upon completion of the program nurses are required to fulfill an 18-month service commitment to a critical care unit within the institution. During its 6 years of operation the CCNIP has promoted clinical competency and assisted in the recruitment and retention of staff nurses in critical care. Considering these outcomes, other critical care educators and administrators may want to consider implementing nurse internships as an alternative to traditional orientation programs.
Nursing Potpourri: one unit's way of sharing needed information
Authors: Price MM
Published: November 2019

The end product has been a more organized approach to communication with staff. Nursing Potpourri on Paper has replaced many notes, flyers and memos formerly posted on various boards and doors in the unit. Once the mechanism to generate it was in place, a small time commitment has been needed for production and distribution. Staff response has been positive, as evidenced by verbal comments and responses to offers in the newsletter. Some nurses save each issue. Many have contributed information or ideas. The newsletter has become a solution to some problems discussed in staff and management meetings. "We can put something about it in Nursing Potpourri" has been a frequent solution to communication needs.
Procainamide-induced psychosis
Authors: Harrington L
Published: November 2019

The occurrence of procainamide-induced psychosis has not been mentioned previously in the nursing literature and is rarely reported in the medical literature. With the increasing use of procainamide in patients with both atrial and ventricular dysrhythmias, it is quite possible that nurses may encounter the phenomenon more frequently. It is also possible that it has been mistaken previously for ICU or psychologically-induced psychosis. Nurses routinely monitoring patients for physiologic effects of procainamide should also be alert for psychological effects as well. The onset of acute psychological sequelae such as procainamide-induced psychosis further complicates care of physiologically compromised patients. Rapid identification and intervention is important. It is especially important to listen to patient and family cues.
Multiple organ failure syndrome
Authors: Reilly E , Yucha CB
Published: November 2019

Although many new areas of research are directed at the regulatory aspects of the metabolic response, the prognosis of MOF remains poor. Critical care nurses, challenged to provide a supportive environment during this life-threatening syndrome, must understand its onset, clinical patterns, and prolonged support required by patients. Such knowledge will enable critical care nurses to detect subtle changes while monitoring clinical status, and facilitate timely interventions in order to decrease the morbidity and mortality associated with MOF.
Addiction to surgery: a nursing dilemma
Authors: Miller M , Cabeza-Stradi S
Published: November 2019

Factitious disorder is either a rare or underdiagnosed disorder and therefore, not one the nursing staff anticipates. Once the disorder is diagnosed, the intense feelings of the nursing staff may overwhelm them. Therefore, the staff should be able to participate in discussion sessions conducted by a psychiatric clinical nurse specialist or another qualified person. Such sessions should focus on recognition of feelings, comparison of one's feelings with those of other staff members, and sharing of perceptions about the situation.
High-dose methylprednisolone after acute spinal cord injury
Authors: Nayduch D , Lee A , Butler D
Published: November 2019

The spinal cord-injured patient has presented a dilemma for nursing care since the earliest survivor of such an injury. Recent research has identified a means of improving neurologic recovery for these patients. Proper administration of high-dose MP within 8 hours after injury provides the patient with the best potential for improvement. Ensuring immobilization and prevention of the complications of immobility are the next most significant actions the nurse can undertake to assist such a patient through a devastating injury toward optimal functional outcome. With continued research and education of caregivers, the residual effects of spinal cord injury may be further abated.
Peripheral intra-arterial thrombolytic therapy for acute arterial occlusion
Authors: Coen SD , Silverman E
Published: November 2019

Because of the success of urokinase therapy, the expectation is that more patients with peripheral vascular disease will be treated with urokinase or another thrombolytic agent. For that reason, nurses must become proficient in caring for these patients. The standing orders and care map, along with the appropriate nursing diagnoses, offer the nurse concrete guidelines for the care of these patients.
Epidural analgesia for effective pain control
Authors: Naber L , Jones G , Halm M
Published: November 2019

Over the past decade, awareness of the harmful effects of postoperative pain has increased. These effects seem to be intensified in critically ill patients. Epidural analgesia has been shown to improve pulmonary function in the critically ill, including a reduction in frequency of intubation and tracheostomies and decreased length of mechanical ventilatory support. In addition, the heightened metabolic-stress response associated with pain may be averted, thereby reducing problems with fluid retention that may further compromise pulmonary status. As a result, epidural analgesia can lead to: shortened length of stay in the ICU overall decreased mortality rate improvement in quality of life As a pain-control method, epidural analgesia is gaining popularity in a variety of ICU patient populations. Therefore, critical care nurses need to update their knowledge base and nursing practice to provide safe and effective nursing care. State nurse practice acts and agency policies dictate the amount and type of involvement nurses have in caring for patients receiving epidural pain therapy. Potential life-threatening problems with epidural analgesia are rare. Many side effects can be controlled or prevented with appropriate patient selection and nursing management.
Understanding the oxyhemoglobin dissociation curve
Authors: Dickson SL
Published: November 2019

The oxyhemoglobin dissociation curve helps critical care nurses to better understand how various factors affect the oxygenation status of patients. Disease processes or treatment modalities that may cause shifts in the curve should be identified and the effects of the increased or decreased affinity assessed. Knowledge of conditions that affect hemoglobin-oxygen affinity, results of careful patient assessment, and oxygenation monitor readings allow critical care nurses to intervene and attempt to correct tissue hypoxia of critically ill patients.
Thrombotic thrombocytopenic purpura: pathophysiology, treatment, and related nursing care
Authors: Kajs-Wyllie M
Published: November 2019

The patient diagnosed with TTP presents to the critical care unit with myriad life-threatening problems. Knowledge of the pathophysiology and treatment of this rare syndrome is essential to plan care appropriately. However, despite immediate diagnosis and intervention, the outcome may not be successful. Critical care nurses play a vital role in caring for these patients, as well as helping family members deal with this devastating disease.
Use of the nursing interventions classification by critical care nurses
Authors: Titler MG , Bulechek GM , McCloskey JC
Published: November 2019

A survey of 111 critical care nurses was carried out to determine the frequency with which they perform each of the 336 interventions in the NIC. Forty-nine interventions were used at least daily, indicating a set of core interventions unique to critical care practice. These findings have implications for critical care practice, education, and research.
The pathophysiology of potassium balance
Authors: Braxmeyer DL , Keyes JL
Published: November 2019

Knowledge of the mechanisms causing potassium imbalance provides tools for the nurse to assess symptoms and intervene with appropriate and timely action for patients with potassium imbalance. Figure 5 provides a flow chart as a guide for carrying out assessment of potassium balance in those individuals who are at risk.
Psychosocial and functional outcomes in women after coronary artery bypass surgery
Authors: Cronin SN , Logsdon C , Miracle V
Published: November 2019

In this longitudinal study of women after CABS, the women were coping admirably with good psychosocial and functional outcomes up to 3 months postoperatively. It is suggested that women be instructed how to find and use their support systems and be told that most women do well and return to normal activities of daily living after CABS.
Laryngeal mask airway: indications and management for critical care
Authors: Fetzer SJ
Published: November 2019

The laryngeal mask airway is the newest tool for airway management during the perianesthesia period. This device has joined other resuscitation equipment on emergency carts. Critical care nurses must be prepared to care for patients for whom laryngeal mask airways are indicated and used. A solid understanding of the purpose and placement of the laryngeal mask airway is necessary for safe removal of the device. Policies and procedures should be developed to define standards of care and responsibilities for care of patients with a laryngeal mask airway.
Maximizing cardiopulmonary resuscitation in patients with intra-aortic balloon pumps
Authors: Osborn C , Quaal SJ
Published: November 2019

Improved hemodynamics and blood flow have been reported in patients with IABPs who experience cardiopulmonary arrest and require CPR. The following research questions, however, remain unanswered: Is there a more effective method of using IABP to prevent cardiac arrest and the need for CPR? Is the timing of balloon inflation and deflation the same for patients undergoing CPR as it is for patients who do not require CPR? Would earlier or later inflation or deflation further enhance cerebral or systemic blood flow? What are the most effective ways for healthcare staff to maintain competency skills in CPR in patients with IABPs?
Use of pulmonary rehabilitation strategies to wean a difficult-to-wean patient: case study
Authors: Jacavone J , Young J
Published: November 2019

The primary purpose of this article is to describe the effectiveness of an interdisciplinary team and innovative interventions by a pulmonary rehabilitation specialist in addressing one patient's failure to wean from mechanical ventilation. This case study shows the importance of considering both physical and psychological factors that may hinder weaning. An interdisciplinary approach was used to address the patient's anxiety, sleep deprivation, lack of appetite, decreased communication, decreased activity, dyspnea, knowledge deficit about dyspnea and weaning, lack of self-confidence, and decreased verbalization. The pulmonary rehabilitation RCP effectively implemented the following strategies: biofeedback by using a flow-volume display, positive reinforcement, teaching about dyspnea and weaning, and use of the modified Borg scale. The patient's family participated in providing some of these interventions. With a concerted effort by all involved, the patient was successfully weaned from mechanical ventilation.