Critical Care Nursing Quarterly最新文献

Coagulopathy of liver disease is a complex pathology that may result in thrombosis and/or bleeding complications. Routine laboratory values are not always reflective of the degree of these risks. Additionally, prophylaxis and treatment of venous thromboembolism in patients with cirrhosis require careful evaluation when selecting and monitoring drug therapy for these indications. Therefore, this article aims to provide insight regarding coagulopathy of liver disease, influence on laboratory values, and anticoagulant therapy considerations for critical care nurses assuming care for patients with cirrhosis.

Bleeding related to direct oral anticoagulants accounts for nearly half of emergency department visits annually and until recently there were no reversal antidotes available. As there continues to be a shift in prescribing practices away from warfarin, it is essential to have these reversal agents readily available for the treatment of life-threatening bleeds associated with these anticoagulants. In addition, for agents that continue to lack a targeted reversal agent (eg, low-molecular-weight heparin, antiplatelets, and new antithrombotics), it is imperative that research continues to evaluate improved reversal strategies. This review focuses on target-specific anticoagulation reversal agents currently available in the United States (protamine, idarucizumab, and andexanet alfa) and summarizes agents that are in the pipeline for these anticoagulants and antiplatelets.

Management of anticoagulation in individuals undergoing operative procedures is a complex situation. Each case should be assessed individually with proper risk assessment, monitoring, and plan for perioperative and postoperative anticoagulation. Clinical evidence for the management of these patients is relatively scarce, and clinicians are often assessing each individual case with minimal guidance. This review provides nurses with a summary of available literature on the assessment, laboratory monitoring, timing of adjusting anticoagulation, and bridging prior to procedures. In addition to general perioperative anticoagulation management, this review discusses perioperative management in special populations and provides a summary on principles when anticoagulation should be resumed following a procedure.

Severe bleeding remains the most significant adverse effect associated with both warfarin and the direct oral anticoagulant agents. Due to the life-threatening nature of these bleeds, knowledge and understanding of agents that are able to rapidly overcome the anticoagulation effects of these medications is paramount to their use. Worldwide, the most commonly used agent for this indication is prothrombin complex concentrate (PCC). This review summarizes the evidence on the use of PCC in this population and provides practical information regarding patient-specific administration considerations.

Innovative catheter-based therapies are increasingly being used for the treatment of patients with submassive pulmonary embolism. These patients may be monitored in the intensive care unit following insertion of specialized pulmonary artery catheters. However, the infusion catheters utilized in catheter-based therapies differ greatly from traditional pulmonary artery catheters designed for hemodynamic monitoring. As such, the critical care team will have to be familiar with the monitoring and management of these novel catheters. Important distinctions between the catheters are illustrated using a clinical case report.

Heparin-induced thrombocytopenia (HIT) is a life-threatening adverse drug reaction that relies on quick assessment and treatment by the health care team to prevent poor outcomes. Nurses can play a critical role in recognizing disease, advocating for patients, and facilitating treatment by being familiar with current guideline recommendations and risk stratification approaches. The purpose of this article is to review management of HIT including pathogenesis, clinical presentation, current guideline recommendations for risk assessment, laboratory testing, and treatment, as well as discuss nonheparin anticoagulation options that may be ordered when HIT is suspected.

The aim of this article is to identify quality improvement nursing strategies that have been implemented to safeguard COVID-19 patients from harm while being cared for in the intensive care unit (ICU). This article incorporates a literature review on the experiences of nurses working at a large urban teaching hospital in the areas of critical care, quality, safety, and regulatory. As leaders in the delivery of health care, nurses have always pioneered innovative ways to deliver care despite difficult circumstances. COVID-19 is a novel viral disease with many unknowns, and it required nurses to integrate innovative approaches with evidence-based practice in order to meet the needs of the patient and to ensure patient safety. While in the critical care setting, COVID-19 patients are at an increased risk for various hospital-acquired injuries, threats to personal safety, and decline in mental health. Through ingenuity and adaptability, successful nursing strategies have been identified in the delivery of quality, evidence-based nursing care to safeguard the vulnerable COVID-19 patient population from harm while in the ICU.

The topic of sepsis has been realized among the last 20 years. A majority of patients with sepsis enter the health system through the emergency department, and health professionals need to provide evidence-based care. Within the health system, interdepartmental teams were formed with the purpose to set a system-wide standard to meet the evidence-based practice standards for sepsis. Participants were recruited from every department that was involved with the care delivery of emergency department patients with sepsis. The team developed a team charter to state the group objectives. A gap analysis was completed to set group priorities. The first priority was to develop a system-wide sepsis alert process. The Operational Excellence coach conducted direct observations and interviews at each system facility and then a sepsis alert plan was developed. Two hospitals volunteered to pilot the sepsis alert within their emergency departments, and education was completed at each hospital. Informatics nurses developed electronic medical record workflow and outcome elements to help the team with the process. The pilot process showed an increase in compliance for core measures and laid the groundwork for each hospital to develop an individualized process.

Sepsis affects 1.7 million Americans annually and often requires an intensive care unit (ICU) stay. Survivors of ICU can experience long-term negative effects. This quality improvement initiative was designed to increase compliance with ABCDEF bundle elements and improve clinical outcomes. A significant improvement was seen in the completion of spontaneous awakening and breathing trials (P = .002), delirium assessment (P = .041), and early mobility (P = .000), which was associated with a reduction in mortality and 30-day readmission rates. Findings were consistent with other research that demonstrated an improvement in care delivery and some clinical outcomes.

Vaccines are effective measures that can mitigate the high burden of diseases. However, vaccine refusal poses serious challenges for achieving coverage for population immunity. With the availability of coronavirus disease-2019 (COVID-19) vaccines, limited information is available about the university students' acceptability and attitudes toward COVID-19 vaccines. This article reports study findings regarding factors that influence university students' decision of acceptability to the COVID-19 vaccine in Jordan. Results highlight the continued need for clear and consistent information about the vaccine by health care decision-makers and university administrations.