Pub Date : 2018-07-01DOI: 10.1097/01.CCN.0000534919.47806.75
Nicole Schroeder, Danielle R. Castiello, Laura A. Siemianowski
Abstract: Acute respiratory distress syndrome (ARDS) is associated with high rates of mortality. Inhaled nitric oxide and inhaled epoprostenol (iEPO) are inhaled pulmonary vasodilators used for adjunctive management in patients with severe ARDS. This article describes the safe and effective use of iEPO in patients with refractory hypoxemia.
{"title":"Inhaled epoprostenol for acute respiratory distress syndrome","authors":"Nicole Schroeder, Danielle R. Castiello, Laura A. Siemianowski","doi":"10.1097/01.CCN.0000534919.47806.75","DOIUrl":"https://doi.org/10.1097/01.CCN.0000534919.47806.75","url":null,"abstract":"Abstract: Acute respiratory distress syndrome (ARDS) is associated with high rates of mortality. Inhaled nitric oxide and inhaled epoprostenol (iEPO) are inhaled pulmonary vasodilators used for adjunctive management in patients with severe ARDS. This article describes the safe and effective use of iEPO in patients with refractory hypoxemia.","PeriodicalId":19344,"journal":{"name":"Nursing Critical Care","volume":" ","pages":"6–13"},"PeriodicalIF":0.0,"publicationDate":"2018-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1097/01.CCN.0000534919.47806.75","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"48757421","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2018-07-01DOI: 10.1097/01.CCN.0000532368.48473.17
S. Pasternak, N. Schwab, Vickie Thun
Enhanced recovery after surgery (ERAS) is an iterative, multidisciplinary approach used to achieve improved surgical outcomes, such as decreasing length of hospitalization, complications, readmission rates, and overall cost, while improving patient care quality. These results are achieved when current evidence-based best practices are used to decrease practice variability and improve multidisciplinary team coordination. The idea for ERAS, or a “fasttrack” recovery program, was initially described in the 1990s, and the first widely used application of ERAS was in recovery from coronary artery bypass surgery.1 Over the last 20 plus years, the ERAS concept has expanded to many different services and surgeries. At the authors’ institution, the median total length of stay (LOS) for patients undergoing colorectal surgery was 6.4 days with a readmission rate of 21%. Evidencebased best practices were not being used with this patient population. A review of the literature indicated that this was an opportunity for improvement. There is a great deal of literature regarding ERAS in the colorectal surgery population, which guided the start of this new program. The literature indicated potential LOS reductions of 30% to 50% with similar reductions in complications, while reducing readmissions and cost.2 For these reasons, the authors piloted this ERAS program in the colorectal surgery division of general surgery and have since expanded it to gynecology-oncology, benign gynecology, urology, and spinal surgery (adults and pediatrics). This article reviews the implementation of a quality initiative and development of an ERAS program, called the ERAS pathway, as well as some of the challenges and successes the ERAS pathway has experienced, specifically from a nursing perspective.
{"title":"Implementation of an enhanced recovery after surgery program","authors":"S. Pasternak, N. Schwab, Vickie Thun","doi":"10.1097/01.CCN.0000532368.48473.17","DOIUrl":"https://doi.org/10.1097/01.CCN.0000532368.48473.17","url":null,"abstract":"Enhanced recovery after surgery (ERAS) is an iterative, multidisciplinary approach used to achieve improved surgical outcomes, such as decreasing length of hospitalization, complications, readmission rates, and overall cost, while improving patient care quality. These results are achieved when current evidence-based best practices are used to decrease practice variability and improve multidisciplinary team coordination. The idea for ERAS, or a “fasttrack” recovery program, was initially described in the 1990s, and the first widely used application of ERAS was in recovery from coronary artery bypass surgery.1 Over the last 20 plus years, the ERAS concept has expanded to many different services and surgeries. At the authors’ institution, the median total length of stay (LOS) for patients undergoing colorectal surgery was 6.4 days with a readmission rate of 21%. Evidencebased best practices were not being used with this patient population. A review of the literature indicated that this was an opportunity for improvement. There is a great deal of literature regarding ERAS in the colorectal surgery population, which guided the start of this new program. The literature indicated potential LOS reductions of 30% to 50% with similar reductions in complications, while reducing readmissions and cost.2 For these reasons, the authors piloted this ERAS program in the colorectal surgery division of general surgery and have since expanded it to gynecology-oncology, benign gynecology, urology, and spinal surgery (adults and pediatrics). This article reviews the implementation of a quality initiative and development of an ERAS program, called the ERAS pathway, as well as some of the challenges and successes the ERAS pathway has experienced, specifically from a nursing perspective.","PeriodicalId":19344,"journal":{"name":"Nursing Critical Care","volume":"13 1","pages":"40–45"},"PeriodicalIF":0.0,"publicationDate":"2018-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1097/01.CCN.0000532368.48473.17","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"45989596","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2018-05-01DOI: 10.1097/01.CCN.0000529944.38466.AB
Destiny R Brady, C. Macleod
Ms. K, 59, has a history of type 2 diabetes, depression, heart failure (HF) with reduced ejection fraction (HFrEF), and renal insufficiency. Three months ago, she experienced a myocardial infarction (MI) that led to HF. Ms. K’s ejection fraction during her last hospitalization was 30%, and she is New York Heart Association (NYHA) functional class III. She was admitted for placement of an implantable cardioverter-defibrillator (ICD).
{"title":"Implantable transvenous cardioverter-defibrillators in adults","authors":"Destiny R Brady, C. Macleod","doi":"10.1097/01.CCN.0000529944.38466.AB","DOIUrl":"https://doi.org/10.1097/01.CCN.0000529944.38466.AB","url":null,"abstract":"Ms. K, 59, has a history of type 2 diabetes, depression, heart failure (HF) with reduced ejection fraction (HFrEF), and renal insufficiency. Three months ago, she experienced a myocardial infarction (MI) that led to HF. Ms. K’s ejection fraction during her last hospitalization was 30%, and she is New York Heart Association (NYHA) functional class III. She was admitted for placement of an implantable cardioverter-defibrillator (ICD).","PeriodicalId":19344,"journal":{"name":"Nursing Critical Care","volume":"13 1","pages":"34–38"},"PeriodicalIF":0.0,"publicationDate":"2018-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1097/01.CCN.0000529944.38466.AB","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"49105380","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2018-05-01DOI: 10.1097/01.ccn.0000525933.96254.89
Susan M. Politsky
There are many ways for critical care nurse leaders to maximize the effectiveness of their roles. In healthcare, almost everything today is metricsdriven. But are metrics the only way nurse leaders should monitor their leadership assessment? The answer is no. Nursing, and critical care in particular, has many other tools that can provide a snapshot of leadership potential. This arsenal includes evaluation, which is the vehicle that nurse leaders should incorporate into their own self-appraisal to help identify strengths and opportunities to become even better nurse leaders.
{"title":"Professional leadership assessment for critical care nurse leaders","authors":"Susan M. Politsky","doi":"10.1097/01.ccn.0000525933.96254.89","DOIUrl":"https://doi.org/10.1097/01.ccn.0000525933.96254.89","url":null,"abstract":"There are many ways for critical care nurse leaders to maximize the effectiveness of their roles. In healthcare, almost everything today is metricsdriven. But are metrics the only way nurse leaders should monitor their leadership assessment? The answer is no. Nursing, and critical care in particular, has many other tools that can provide a snapshot of leadership potential. This arsenal includes evaluation, which is the vehicle that nurse leaders should incorporate into their own self-appraisal to help identify strengths and opportunities to become even better nurse leaders.","PeriodicalId":19344,"journal":{"name":"Nursing Critical Care","volume":"13 1","pages":"41–42"},"PeriodicalIF":0.0,"publicationDate":"2018-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1097/01.ccn.0000525933.96254.89","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"44632504","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2018-05-01DOI: 10.1097/01.CCN.0000529939.25897.77
Carrie L. Griffiths, Spencer J. Livengood, K. Hertel
Abstract: Patients receiving treatment in the ICU are frequently agitated and subject to pain, so they commonly require sedation. Management of these patients requires a strategic, interdisciplinary approach, including proper monitoring, appropriate sedative selection, and the use of nonpharmacologic interventions. Patient-focused sedation leads to an improvement in patient care and outcomes.
{"title":"Sedation in the ICU: A mindful approach to achieving a balance","authors":"Carrie L. Griffiths, Spencer J. Livengood, K. Hertel","doi":"10.1097/01.CCN.0000529939.25897.77","DOIUrl":"https://doi.org/10.1097/01.CCN.0000529939.25897.77","url":null,"abstract":"Abstract: Patients receiving treatment in the ICU are frequently agitated and subject to pain, so they commonly require sedation. Management of these patients requires a strategic, interdisciplinary approach, including proper monitoring, appropriate sedative selection, and the use of nonpharmacologic interventions. Patient-focused sedation leads to an improvement in patient care and outcomes.","PeriodicalId":19344,"journal":{"name":"Nursing Critical Care","volume":"13 1","pages":"28–33"},"PeriodicalIF":0.0,"publicationDate":"2018-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1097/01.CCN.0000529939.25897.77","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"47480932","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2018-05-01DOI: 10.1097/01.CCN.0000532360.64613.10
A. Rowe
Abstract: Sodium and chloride are primarily responsible for fluid movement across the compartments of the body. Neurologic, hormonal, and renal factors combine to regulate sodium levels and preserve fluid volume homeostasis. This article covers the causes, signs and symptoms, and available treatments for the following sodium and chloride imbalances associated with morbidity and mortality in critically ill patients: hyponatremia, hypernatremia, hyperchloremia, and hypochloremia.
{"title":"Electrolyte series: Sodium and chloride","authors":"A. Rowe","doi":"10.1097/01.CCN.0000532360.64613.10","DOIUrl":"https://doi.org/10.1097/01.CCN.0000532360.64613.10","url":null,"abstract":"Abstract: Sodium and chloride are primarily responsible for fluid movement across the compartments of the body. Neurologic, hormonal, and renal factors combine to regulate sodium levels and preserve fluid volume homeostasis. This article covers the causes, signs and symptoms, and available treatments for the following sodium and chloride imbalances associated with morbidity and mortality in critically ill patients: hyponatremia, hypernatremia, hyperchloremia, and hypochloremia.","PeriodicalId":19344,"journal":{"name":"Nursing Critical Care","volume":"13 1","pages":"20–27"},"PeriodicalIF":0.0,"publicationDate":"2018-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1097/01.CCN.0000532360.64613.10","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"47785562","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2018-05-01DOI: 10.1097/01.CCN.0000532362.87484.62
R. Macintyre, M. Ciechanowski
Abstract: Hyperglycemia has been associated with poor outcomes in patients with acute ischemic stroke. Blood glucose management becomes critical during the acute period following an ischemic stroke. This article evaluates the latest evidence in hyperglycemia treatment for consideration in the acute ischemic stroke population.
{"title":"Hyperglycemia management in patients with acute ischemic stroke","authors":"R. Macintyre, M. Ciechanowski","doi":"10.1097/01.CCN.0000532362.87484.62","DOIUrl":"https://doi.org/10.1097/01.CCN.0000532362.87484.62","url":null,"abstract":"Abstract: Hyperglycemia has been associated with poor outcomes in patients with acute ischemic stroke. Blood glucose management becomes critical during the acute period following an ischemic stroke. This article evaluates the latest evidence in hyperglycemia treatment for consideration in the acute ischemic stroke population.","PeriodicalId":19344,"journal":{"name":"Nursing Critical Care","volume":"13 1","pages":"14–19"},"PeriodicalIF":0.0,"publicationDate":"2018-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1097/01.CCN.0000532362.87484.62","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"46791724","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2018-04-01DOI: 10.1097/01.CCN.0000532361.49366.04
Vincent M. Vacca
Cerebral venous thrombosis is an underrecognized but serious thrombotic disorder that affects cerebral veins and sinuses. Clinical presentation varies based on extent and location of thrombosis within the cerebral venous system, and can include headache, focal neurologic deficits, focal or generalized seizures, stroke, and coma. Diagnosis is confirmed by brain and cerebral vascular imaging. Treatment focuses on anticoagulation, and outcomes are generally favorable.1,2
{"title":"Recognizing cerebral venous thrombosis in adults","authors":"Vincent M. Vacca","doi":"10.1097/01.CCN.0000532361.49366.04","DOIUrl":"https://doi.org/10.1097/01.CCN.0000532361.49366.04","url":null,"abstract":"Cerebral venous thrombosis is an underrecognized but serious thrombotic disorder that affects cerebral veins and sinuses. Clinical presentation varies based on extent and location of thrombosis within the cerebral venous system, and can include headache, focal neurologic deficits, focal or generalized seizures, stroke, and coma. Diagnosis is confirmed by brain and cerebral vascular imaging. Treatment focuses on anticoagulation, and outcomes are generally favorable.1,2","PeriodicalId":19344,"journal":{"name":"Nursing Critical Care","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2018-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1097/01.CCN.0000532361.49366.04","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"43485413","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2018-03-01DOI: 10.1097/01.CCN.0000527222.11558.c3
Gayle McGlory, A. Davis, K. Kirksey
Abstract: Pain is one of the most common patient complaints in the critical care setting. Multimodal analgesia is increasingly supported by scientific evidence and should be the preferred mechanism for addressing pain with a combination of opioid, nonopioid, and adjuvant analgesics, and nonpharmacologic interventions. This article reviews the problems associated with monomodal analgesic administration, evidence-based methods for adequately assessing pain and implementing interventions, the use of multimodal pharmacology, complementary and alternative medicine, and nursing considerations for patients with acute pain.
{"title":"Multimodal analgesia in critical care","authors":"Gayle McGlory, A. Davis, K. Kirksey","doi":"10.1097/01.CCN.0000527222.11558.c3","DOIUrl":"https://doi.org/10.1097/01.CCN.0000527222.11558.c3","url":null,"abstract":"Abstract: Pain is one of the most common patient complaints in the critical care setting. Multimodal analgesia is increasingly supported by scientific evidence and should be the preferred mechanism for addressing pain with a combination of opioid, nonopioid, and adjuvant analgesics, and nonpharmacologic interventions. This article reviews the problems associated with monomodal analgesic administration, evidence-based methods for adequately assessing pain and implementing interventions, the use of multimodal pharmacology, complementary and alternative medicine, and nursing considerations for patients with acute pain.","PeriodicalId":19344,"journal":{"name":"Nursing Critical Care","volume":"13 1","pages":"18–23"},"PeriodicalIF":0.0,"publicationDate":"2018-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1097/01.CCN.0000527222.11558.c3","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"46784609","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
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