Critical Care Nursing Quarterly最新文献

Ischemic stroke represents 87% of all strokes. As global initiatives move forward with stroke care, health care providers and institutions will be called on to deliver the most current evidence-based care. The American Heart Association/American Stroke Association (AHA/ASA) estimates that 795 000 strokes occur each year; 610 000 are new strokes, and 185 000 are recurrent strokes. Eighty-seven percent are ischemic strokes; the overall mortality rate from stroke was 273 000, which makes stroke the fifth leading cause of death and the leading cause of disability in the United States. Stroke costs the United States an estimated $34 billion each year. This article outlines a nursing intervention regarding the use of intravenous thrombolytic therapy for treating acute ischemic stroke, the risk factors related to IV-alteplase, best-practice protocols, and the nursing role in efforts to deliver safe care. The conclusion reveals the need for health care organizations to explore opportunities, continually inspire innovation at the bedside, highlight nursing's essential contribution to acute stroke care, and encourage publishing improvements in patient care and the nurse practice environment.

Pain management in the intensive care unit can be challenging. It is important to assess and reassess the patient for pain using the appropriate pain assessment tool for the patient's condition. It is critical to use these tools for compliance to best practice recommendations by The Joint Commission, the Society of Critical Care Management, and the American Association of Critical Care Nurses. Critical care nurses need to know the types of pain and how everyday nursing care and procedures affect the patient's pain level. This article reviews the types and characteristics of pain, the best practice guidelines, and shares a pathway for the best management of a patient's pain.

Continuous quality improvement using Lean methodology engages and values the expertise of the staff close to the patient and the everyday work of caring for them. The patients are not safe if the staff is not safe. Finding the appropriate methodology, where the problem is deeply investigated, respect is visible in the process, and evidence-based decision-making takes place to find safe patient handling solutions for moving lifting and transferring patients was a key objective in this Lean process improvement effort. This article describes the journey taken, the collaboration of 2-unit based councils, and the successful implementation of an air-assisted moving, lifting, and transferring system at a large level 1 quaternary tertiary intercity hospital.

Despite the many advancements in infection prevention, catheter-associated urinary tract infections (CAUTI) continue to be problematic for many hospitals. The large urban teaching hospital featured in this article developed a team that consisted of a registered nurse quality Lean coach, bedside nurses from each inpatient nursing unit, physicians, an infection prevention specialist nurse, an education specialist nurse, and members of the quality department to study this matter. The team focused on understanding current practice related to the use and duration of indwelling urinary catheters. It was discovered that while some indwelling urinary catheters were justified, others could have been avoided altogether or removed earlier. Multifaceted measures were instituted at this hospital to decrease indwelling urinary catheter days and reduce CAUTI rates. The team's journey to successfully decreasing indwelling urinary catheter days by 19.79% and CAUTI rates by 38% is highlighted.

Acute kidney injury or acute renal failure is commonly observed in the critically ill patient with hemodynamic compromise. Dialysis is frequently used in the intensive care units as part of the critical care management of metabolic derangements fluid status and electrolyte issues. It is imperative that the bedside critical care nurse is able to identify acute kidney injury and is familiar with the modalities used to manage the metabolic consequences of renal failure, particularly important as the bedside nurse is operating the continuous renal replacement machine at the bedside. This article will review the common risks and causes of acute kidney injury in the critically ill patient, indications for conservative management versus initiation of renal replacement therapy, prevention of acute kidney injury, and important consequences of renal failure such as electrolyte disturbances and uremia. We will also briefly touch on specific conditions where acute kidney injury is common such as hepatorenal syndrome, cardiorenal syndrome, rhabdomyolysis, and tumor lysis syndrome.

Acute liver failure (ALF) is a rare but life-threatening disease process that can result in rapidly progressive encephalopathy, elevated intracranial pressure, and multiorgan failure. In the United States, the 2 most common causes of ALF in the intensive care unit (ICU) are acetaminophen overdose and hypoxic-ischemic hepatopathy. Less common causes of ALF include alcoholic hepatitis, nonacetaminophen drug-induced liver injury, acute viral hepatitis, Wilson's disease, autoimmune hepatitis, and acute fatty liver of pregnancy. Unfortunately, there are many cases in which the cause of liver failure is indeterminate. ALF is an ICU emergency that requires close monitoring, extensive workup to determine etiology, frequent support of hemodynamic, respiratory, and renal function, administration of targeted therapies depending on the cause, utilization of N-acetylcysteine if appropriate, and consideration for liver transplant in select cases. The primary objective of this article is to define, diagnose, and detail the management of ALF in an ICU setting.

Respiratory failure is one of the most common reasons for hospitalization and intensive care unit (ICU) admissions, and a diverse range of etiologies can precipitate it. Respiratory failure can result from various mechanisms such as hypoventilation, diffusion impairment, shunting, ventilation-perfusion mismatch, or a combination of those mentioned earlier. Hence, an accurate understanding of different pathophysiologic mechanisms is required for appropriate patient care. Prompt identification and treatment of various respiratory emergencies such as tension pneumothorax, massive hemoptysis, and high-risk pulmonary embolism lead to fewer complications, shorter ICU and hospital stay, and improved survival. This review article entails common respiratory failure pathologies encountered in the ICU and addresses their epidemiology, pathophysiology, clinical presentation, and management.