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Anxiety Symptoms and Disease Severity in Parkinson Disease. 帕金森病患者的焦虑症状与疾病严重程度
Pub Date : 2024-10-01 Epub Date: 2024-07-01 DOI: 10.1097/JNN.0000000000000770
Ainslie Whitmarsh, Suzy Protea, Jessie S Gibson

Abstract: BACKGROUND: Anxiety is prevalent in Parkinson disease (PD), negatively affecting quality of life for patients and their families. Targeted anxiety interventions are needed that account for variables such as disease severity; however, there is insufficient evidence regarding the trajectory of anxiety along the disease course. OBJECTIVE: The aim of this study was to investigate the association between disease severity and anxiety symptoms in a PD sample. METHODS: This descriptive study used secondary data analyses of data from a web-based survey study of individuals with PD in the United States. Participants were 21 years or older, had access to the Internet, and were given a diagnosis of PD (N = 72). We performed multiple regression analyses to assess the relationship between patient-reported disease severity and anxiety symptoms. RESULTS: There was a statistically significant association between disease severity and anxiety symptoms in people with PD, after controlling for all 5 explanatory variables (sex, age, wearing off, disease severity, and disease duration) ( P < .001). Age and wearing off PD medication also had statistically significant, although smaller, effects on anxiety symptoms ( P < .05). CONCLUSION: Disease severity was related to increased anxiety symptoms among individuals with PD. Anxiety intervention research is needed, and future studies should account for variations in disease severity and medication effects in both intervention and study design.

摘要:背景:焦虑症在帕金森病(PD)中十分普遍,对患者及其家人的生活质量造成了负面影响。需要考虑到疾病严重程度等变量,采取有针对性的焦虑干预措施;然而,关于焦虑在疾病过程中的轨迹,目前还没有足够的证据。目的:本研究旨在调查帕金森病样本中疾病严重程度与焦虑症状之间的关联。方法:这一描述性研究使用了二手数据分析,这些数据来自一项针对美国帕金森病患者的网络调查研究。参与者年龄在 21 岁或以上,可以上网,并被诊断为帕金森病(N = 72)。我们进行了多元回归分析,以评估患者报告的疾病严重程度与焦虑症状之间的关系。结果:在控制了所有 5 个解释变量(性别、年龄、服药时间、疾病严重程度和病程)后,帕金森病患者的疾病严重程度与焦虑症状之间存在统计学意义上的显著关联(P < .001)。年龄和停用帕金森病药物对焦虑症状的影响也有统计学意义,但影响较小(P < .05)。结论:疾病严重程度与帕金森病患者焦虑症状的增加有关。需要进行焦虑干预研究,未来的研究应在干预和研究设计中考虑疾病严重程度和药物效果的变化。
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引用次数: 0
Management of Idiopathic Intracranial Hypertension: A Case Report. 特发性颅内高压的治疗:病例报告。
Pub Date : 2024-10-01 Epub Date: 2024-06-17 DOI: 10.1097/JNN.0000000000000774
Xiang-Ling Huang, Pao-Hui Tseng, Wan-Hsiang Wang, Sheng-Tzung Tsai

Abstract: BACKGROUND: Idiopathic intracranial hypertension (IIH) is a neurological disorder characterized by elevated intracranial pressure, affecting predominantly obese women of childbearing age. Early recognition and comprehensive management are vital for preventing severe complications, particularly vision loss. METHODS: This study reports a case of a 27-year-old woman who presented with chronic headaches and blurred vision. Notable findings included headaches that were intensified upon waking and exacerbated by activities that elevated intracranial pressure. The patient also reported nausea, vomiting, transient visual obscurations, and pulsatile tinnitus. After a clinical examination, she was given a diagnosis of IIH. RESULTS: The patient underwent a lumbar-peritoneal shunt procedure to alleviate her symptoms in conjunction with medication treatment. This case study highlights the importance of a multidisciplinary approach in diagnosing and treating IIH. In particular, weight management emerged as a crucial preventive measure against IIH recurrence. CONCLUSION: A multidisciplinary team strategy can enhance outcomes and quality of life, accentuating the need for continued research into IIH recurrence, treatments, and wider implications.

摘要:背景:特发性颅内高压(IIH)是一种以颅内压升高为特征的神经系统疾病,主要影响育龄期肥胖妇女。早期识别和综合治疗对于预防严重并发症,尤其是视力丧失至关重要。方法:本研究报告了一例 27 岁女性的病例,她曾出现慢性头痛和视力模糊。值得注意的是,患者的头痛在起床后加剧,并在颅内压升高的活动中加剧。患者还报告了恶心、呕吐、一过性视物模糊和搏动性耳鸣。经过临床检查,她被诊断为 IIH。结果:患者在接受药物治疗的同时,还接受了腰腹分流术,缓解了症状。本病例研究强调了多学科方法在诊断和治疗 IIH 中的重要性。尤其是体重管理是预防 IIH 复发的关键措施。结论:多学科团队策略可提高治疗效果和生活质量,因此有必要继续研究 IIH 复发、治疗方法和更广泛的影响。
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引用次数: 0
A Multidisciplinary Approach to Increase Dysphagia Compliance in Stroke Patients. 提高中风患者吞咽困难顺应性的多学科方法。
Pub Date : 2024-10-01 Epub Date: 2024-07-05 DOI: 10.1097/JNN.0000000000000778
Stacy L Serber, Noah Wachtel, Madison Fox, Corrine Petrushonis

Abstract: BACKGROUND: The objective was to optimize conditions that increase dysphagia compliance after stroke-a measure recognized by The Joint Commission in designating institutions as primary or comprehensive stroke centers and by the American Heart Association that promotes stroke treatment adherence and bestows achievement and quality awards. Failure to meet stroke measures, including medication documentation, may produce poor patient outcomes that directly affect consumer confidence and choice of treatment facility. Stroke patient care requires multidisciplinary team collaboration to manage multiple factors; variations in practice create fallouts that need correction, the absence of which jeopardizes standards for maintaining stroke center designation. PURPOSE: Aims were to determine the nature of dysphagia fallouts in our quaternary academic teaching hospital, assess multidisciplinary workflows and barriers to success, and develop strategies to enhance dysphagia compliance. DESCRIPTION: We used a multidisciplinary approach using James Reason's Swiss cheese model to examine compliance. The clinical nurse specialist interviewed physicians, advanced practice providers, pharmacists, speech-language pathologists (SLPs), nurses, and informaticists to ascertain discipline-specific success barriers, targeting top issues for each discipline to develop solutions. Unit educators unified their dysphagia reduction strategies; physicians, pharmacists, and informaticists collaborated to clarify standardized medication route orders and to increase electronic health record swallow screen visibility to multidisciplinary users; and SLPs adjusted workflow and documentation. EVALUATION: Outcomes included reinforcing correct nursing charting, pharmacy oral-to-feeding tube conversion order revision, optimization of delivery and awareness of medication routes, electronic health record system enhancements, and SLPs aligning documentation with nursing medication administration. The multidisciplinary approach proved successful and increased dysphagia compliance by 9.6% ( P = .001). These outcomes contributed to a successful The Joint Commission survey, redesignation as a comprehensive stroke center, and American Heart Association Gold Plus achievement award.

摘要:背景:目的是优化提高中风后吞咽困难依从性的条件--这是联合委员会在指定机构为初级或综合中风中心时以及美国心脏协会在促进中风治疗依从性和授予成就与质量奖时所认可的一项措施。不遵守包括用药记录在内的卒中治疗措施可能会导致不良的患者预后,直接影响消费者的信心和对治疗机构的选择。脑卒中患者的治疗需要多学科团队的合作,以管理多种因素;实践中的差异会造成需要纠正的问题,而不纠正则会危及维持脑卒中中心称号的标准。目的:旨在确定我们四级学术教学医院中吞咽困难脱落的性质,评估多学科工作流程和成功的障碍,并制定提高吞咽困难依从性的策略。说明:我们使用詹姆斯-里森的瑞士奶酪模型,采用多学科方法来检查依从性。临床护理专家采访了医生、高级医疗服务提供者、药剂师、言语病理学家 (SLP)、护士和信息学家,以确定各学科的成功障碍,并针对各学科的首要问题制定解决方案。科室教育者统一了吞咽困难减少策略;医生、药剂师和信息学家通力合作,明确了标准化用药路径指令,并提高了电子健康记录吞咽屏幕对多学科用户的可见性;言语语言病理学家调整了工作流程和文档。评估:成果包括加强正确的护理图表制作、药房口服管到喂食管转换单的修订、优化给药和了解用药路径、增强电子健康记录系统,以及 SLPs 调整文档与护理用药管理。事实证明,多学科方法取得了成功,吞咽困难患者的依从性提高了9.6%(P = .001)。这些成果促成了联合委员会调查的成功、综合中风中心的重新认定以及美国心脏协会金牌成就奖的获得。
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引用次数: 0
Do You Believe in Speed Limits? 您相信限速吗?
Pub Date : 2024-10-01 Epub Date: 2024-08-09 DOI: 10.1097/JNN.0000000000000780
DaiWai M Olson
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引用次数: 0
Assessing Outcome Measurements and Impact of Simulation in Neurocritical Care Training: A Systematic Review. 评估神经重症监护模拟培训的成果测量和影响:系统回顾。
Pub Date : 2024-08-01 Epub Date: 2024-06-11 DOI: 10.1097/JNN.0000000000000767
Khalil M Yousef, Ibrahim Alananzeh, Shameena Beegom, Jose Chavez, Sarah Hatahet, Heba Khalil, Zachary Krom, Olena Svetlov

Abstract: AIM: The use of simulation training in neurocritical care is increasing. Yet, the pooled impact on patient and trainee outcomes remains unclear. This systematic review aims to determine the outcome measurements used after simulation training in neurocritical care and to synthesize the current evidence about the impact of simulation training on these outcomes. METHODS: A 3-step search was conducted in CINAHL, Cochrane, MEDLINE, PsychINFO, and Scopus. The inclusion criteria were composed of studies exploring simulation training in neurocritical care, published in English between 2000 and 2023. Two reviewers independently conducted screening, critical appraisal, and data extraction, using standardized Joanna Briggs Institute tools. Meta-analysis was precluded because of clinical, methodological, and statistical heterogeneity. RESULTS: Nine relevant studies were found: 1 quality improvement project and 8 quasi-experimental studies. The overall quality of the relevant studies was moderate to high (61.1%-77.8%). Three types of outcome measurements for simulation in neurocritical care were identified: knowledge and clinical performance; confidence and comfort; and teamwork, communication, and leadership skills. Simulation training was associated with a significant improvement in knowledge and clinical performance, and confidence and comfort, but not in communication and leadership skills. CONCLUSION: Significant improvement in trainees' outcomes was observed. The current literature includes significant heterogeneity in the methods of evaluating simulation outcomes, although no patient outcomes were observed. Investigating the effect of simulation in neurocritical care training on patient outcomes in future studies is warranted.

摘要:目的:在神经重症监护中使用模拟训练的情况越来越多。然而,其对患者和受训者结果的综合影响仍不明确。本系统性综述旨在确定神经重症护理模拟训练后使用的结果测量方法,并综合模拟训练对这些结果影响的现有证据。方法:在 CINAHL、Cochrane、MEDLINE、PsychINFO 和 Scopus 中进行了三步检索。纳入标准包括 2000 年至 2023 年间发表的有关神经重症护理模拟培训的英文研究。两名审稿人使用乔安娜-布里格斯研究所的标准化工具独立进行筛选、批判性评估和数据提取。由于存在临床、方法学和统计学异质性,因此排除了荟萃分析。结果:共发现 9 项相关研究:1 项质量改进项目和 8 项准实验研究。相关研究的总体质量为中高水平(61.1%-77.8%)。神经重症护理模拟的结果测量分为三类:知识和临床表现;信心和舒适度;团队合作、沟通和领导技能。模拟训练在知识和临床表现、信心和舒适度方面有显著改善,但在沟通和领导技能方面没有改善。结论:受训者的学习效果得到了显著改善。尽管没有观察到对患者的治疗效果,但目前的文献在评估模拟结果的方法上存在很大的异质性。在未来的研究中,有必要调查模拟在神经重症监护培训中对患者疗效的影响。
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引用次数: 0
Book Review: Anatomic Basis of Neurologic Diagnosis. 书评:神经学诊断的解剖学基础》。
Pub Date : 2024-08-01 Epub Date: 2024-06-05 DOI: 10.1097/JNN.0000000000000768
Tiffany O Sheehan, Margaret Olsen
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引用次数: 0
Association Between Pupil Light Reflex and Delirium in Adults With Traumatic Brain Injury: Preliminary Findings. 创伤性脑损伤成人瞳孔光反射与谵妄之间的关系:初步研究结果。
Pub Date : 2024-08-01 Epub Date: 2024-05-31 DOI: 10.1097/JNN.0000000000000763
Alexandra Lapierre, Annie Proulx, Céline Gélinas, Stéphanie Dollé, Sheila Alexander, David Williamson, Francis Bernard, Caroline Arbour

Abstract: BACKGROUND: Delirium is a common neurological complication in patients admitted to the intensive care unit (ICU) after moderate to severe traumatic brain injury (TBI). Although current clinical guidelines prioritize delirium prevention, no specific tool is tailored to detect early signs of delirium in TBI patients. This preliminary 2-phase observational study investigated the correlation between the pupillary light reflex (PLR), measured with a pupillometer during mechanical ventilation, and the development of postextubation delirium in TBI patients. METHODS: A convenience sample of 26 adults with moderate to severe TBI under mechanical ventilation was recruited during their ICU stay. In phase I, PLR measurements were performed in the first 3 days of ICU admission using automated infrared pupillometry. In phase II, 2 raters independently extracted delirium data in the 72 hours post extubation period from medical records. Delirium was confirmed with a documented medical diagnosis. Point-biserial correlations ( rpb ) were used to examine the association between PLR scores and the presence of postextubation delirium. Student t tests were also performed to compare mean PLR scores between patients with and without delirium. RESULTS: Ten TBI patients (38%) were diagnosed with postextubation delirium, whereas 16 (62%) were not. Significant correlations between delirium and 2 PLR variables were found: pupil constriction percentage ( rpb (24) = -0.526, P = .006) and constriction velocity ( rpb (24) = -0.485, P = .012). The t test also revealed a significant difference in constriction percentage and velocity scores between TBI patients with and without delirium ( P ≤ .01). CONCLUSION: Our findings suggest that the use of pupillometry in the first 3 days of mechanical ventilation during an ICU stay may help identify TBI patients at risk for delirium after extubation. Although further research is necessary to support its validity, this technological tool may enable ICU nurses to better screen TBI patients for delirium and prevent its development.

摘要:背景:谵妄是中重度创伤性脑损伤(TBI)后入住重症监护室(ICU)的患者常见的神经系统并发症。尽管目前的临床指南优先考虑预防谵妄,但没有专门的工具来检测创伤性脑损伤患者的早期谵妄症状。这项分两个阶段进行的初步观察性研究调查了机械通气期间使用瞳孔计测量的瞳孔光反射(PLR)与创伤性脑损伤患者拔管后谵妄发展之间的相关性。方法:在重症监护病房住院期间,招募了 26 名接受机械通气的中重度创伤性脑损伤成人患者。在第一阶段,使用自动红外瞳孔测量仪在患者入住重症监护室的前三天测量瞳孔回缩率。在第二阶段,两名评分员从医疗记录中独立提取拔管后 72 小时内的谵妄数据。谵妄需经有据可查的医学诊断证实。点-线性相关(rpb)用于检验 PLR 评分与拔管后谵妄存在之间的关联。还进行了学生 t 检验,以比较有谵妄和无谵妄患者的 PLR 平均得分。结果:10 名创伤性脑损伤患者(38%)被诊断为插管后谵妄,而 16 名患者(62%)未被诊断为谵妄。谵妄与两个 PLR 变量之间存在显著相关性:瞳孔收缩百分比(rpb(24) = -0.526,P = .006)和收缩速度(rpb(24) = -0.485,P = .012)。t 检验还显示,有谵妄和无谵妄的创伤性脑损伤患者在收缩百分比和收缩速度评分方面存在显著差异(P ≤ .01)。结论:我们的研究结果表明,在重症监护病房机械通气的前 3 天使用瞳孔测量法可能有助于识别拔管后有谵妄风险的 TBI 患者。尽管还需要进一步的研究来支持其有效性,但这一技术工具可使重症监护室护士更好地筛查创伤性脑损伤患者的谵妄并防止其发展。
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引用次数: 0
Sustainability of a Pediatric Neurointensive Care Unit Model Within a Mixed Pediatric Intensive Care Unit and Its Effect on Nursing Sentiment. 混合型儿科重症监护病房内儿科神经重症监护病房模式的可持续性及其对护理情绪的影响。
Pub Date : 2024-08-01 Epub Date: 2024-05-31 DOI: 10.1097/JNN.0000000000000766
Nathan Chang, May Casazza, Amelia Sperber, Leslie Ciraulo, Jennifer Rodriguez, Katherine Marquiss, Lisa D'Anjou, Prathyusha Teeyagura, Anne-Laure Chaillou, Andrew Palmquist, Lindsey Rasmussen

Abstract: BACKGROUND: Pediatric neurocritical care (PNCC) and pediatric neurointensive care units (neuro-PICU) are growing fields. Although some institutions have established independent neuro-PICUs meeting most Neurocritical Care Society (NCS) standards for neurocritical care units, many centers lack the resources to do so. We describe an alternative neuro-PICU model as a designated unit within a mixed pediatric intensive care unit (PICU) and its effects on nursing sentiment. METHODS: We established a 6-bed neuro-PICU within a 36-bed noncardiac PICU. Charge nurses were tasked with admitting PNCC patients into these beds. For nursing expertise, we used a core group of 12 PNCC specialty nurses and instituted PNCC nursing education to PICU nurses. We observed the number of PNCC patients admitted to neuro-PICU beds and surveyed charge nurses to identify barriers to assigning patients. We surveyed PICU nursing staff to explore sentiment regarding PNCC before and after establishing the neuro-PICU. Nursing criteria were compared with NCS standards. RESULTS: In the 40-month period, our PICU saw 2060 PNCC admissions. Overall, occupied neuro-PICU beds housed PNCC patients 74.1% of the time. The biggest barriers to patient placement were too many competing placement requests, not enough neuro-PICU beds when specialty census was high, and difficulty assigning one nurse to two PNCC patients. In surveys after establishing the neuro-PICU, compared to before, experienced nurses reported being more interested in obtaining Emergency Neurological Life Support certification (94.2% vs 80.6%, P = .0495), and inexperienced nurses reported being more familiar with PNCC clinical pathways (53.5% vs 31.7%, P = .0263). Most NCS criteria related to nursing organization were met. CONCLUSIONS: Focused neuro-PICUs should be developed to complement advances in the field of PNCC. Alternative neuro-PICU models are possible and can increase nursing interest in further education and awareness of clinical pathways, but barriers exist that require institutional commitment to nursing development to sustain the delivery of specialized care to this population.

摘要:背景:儿科神经重症监护(PNCC)和儿科神经重症监护病房(neuro-PICU)是一个不断发展的领域。尽管一些机构已经建立了独立的神经重症监护病房(neuro-PICU),符合神经重症监护协会(NCS)关于神经重症监护病房的大多数标准,但许多中心缺乏这样做的资源。我们描述了作为混合儿科重症监护病房(PICU)内指定病房的另一种神经重症监护病房模式及其对护理情感的影响。方法:我们在一个拥有 36 张床位的非心脏重症监护病房内设立了一个拥有 6 张床位的神经重症监护病房。责任护士的任务是将 PNCC 患者收治到这些病床上。在护理专业知识方面,我们使用了一个由 12 名 PNCC 专科护士组成的核心小组,并对 PICU 护士开展了 PNCC 护理教育。我们观察了神经重症监护病房病床收治的 PNCC 患者人数,并对责任护士进行了调查,以确定分配患者时遇到的障碍。我们对 PICU 护理人员进行了调查,以了解他们在神经重症监护病房成立前后对 PNCC 的看法。护理标准与 NCS 标准进行了比较。结果:在 40 个月的时间里,我们的 PICU 共收治了 2060 名 PNCC 患者。总体而言,神经重症监护病房 74.1% 的床位都安置了 PNCC 患者。安置病人的最大障碍是有太多相互竞争的安置请求,在专科人数较多时没有足够的神经重症监护病房床位,以及很难为两名 PNCC 病人指派一名护士。在神经重症监护室成立后进行的调查中,与成立前相比,有经验的护士表示更有兴趣获得紧急神经生命支持认证(94.2% vs 80.6%,P = .0495),而无经验的护士表示更熟悉 PNCC 临床路径(53.5% vs 31.7%,P = .0263)。符合大多数与护理组织相关的 NCS 标准。结论:应发展重点神经重症监护病房,以补充 PNCC 领域的进展。神经重症监护病房的替代模式是可行的,可以提高护理人员对进一步教育的兴趣和对临床路径的认识,但也存在一些障碍,需要机构对护理发展做出承诺,以持续为这一人群提供专业护理。
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引用次数: 0
Intranasal Delivery of Medications for the Treatment of Neurologic Conditions: A Pharmacology Update. 鼻内给药治疗神经系统疾病:药理学更新。
Pub Date : 2024-08-01 Epub Date: 2024-06-11 DOI: 10.1097/JNN.0000000000000769
Patricia Osborne Shafer, Patricia Dean, Lai Brooks, Barry Gidal, Sunita N Misra, Enrique Carrazana

Abstract: INTRODUCTION: Nurses have a central role in educating patients and families about treatment options and how to integrate them into action plans for neurologic conditions. In recent years, a growing number of intranasal formulations have become available as rescue therapy for neurologic conditions or symptoms including migraine, opioid overdose, and seizures. Rescue therapies do not replace maintenance medications or emergency care but are designed to enable rapid treatment of urgent or disabling conditions in community settings. Yet, discussion of rescue therapies for neurologic conditions remains limited in nursing literature. CONTENT: Intranasal formulations are specifically formulated for delivery and absorption in the nose and have several characteristics that are well suited as rescue therapies for neurologic conditions. Intranasal formulations include triptans for migraine, naloxone and nalmefene for opioid overdose, and benzodiazepines for seizure clusters in patients with epilepsy. Therapeutic attributes discussed here include ease of use in community settings by nonmedical professionals, relatively rapid onset of action, and favorable safety profile and patient experience. This information is critical for nurses to make informed decisions about rescue therapy options, incorporate these into plans of care, and educate patients, care partners, and other healthcare providers. CONCLUSION: Rescue therapies are increasingly important in the care of people with neurologic conditions. Various formulations are available and continue to evolve, offering easy and quick ways for nurses, patients, and nonmedical care partners to administer critical rescue medications. For nurses overseeing medication management, the attributes of intranasal rescue therapies should be considered in the context of providing patients with the right care at the right time.

摘要:引言:护士在教育患者和家属了解治疗方案以及如何将这些方案纳入神经系统疾病的行动计划方面发挥着核心作用。近年来,越来越多的鼻内制剂可作为神经系统疾病或症状(包括偏头痛、阿片类药物过量和癫痫发作)的抢救疗法。抢救疗法并不能取代维持用药或急救护理,而是为了在社区环境中快速治疗紧急或致残性疾病。然而,护理文献中对神经系统疾病抢救疗法的讨论仍然有限。内容:鼻内制剂是专为鼻腔给药和吸收而配制的,具有非常适合作为神经系统疾病抢救疗法的几个特点。鼻内制剂包括治疗偏头痛的曲坦类药物、治疗阿片类药物过量的纳洛酮和纳美芬,以及治疗癫痫患者发作群的苯二氮卓类药物。本文讨论的治疗特性包括:非医疗专业人员在社区环境中使用方便、起效相对较快、安全性和患者体验良好。这些信息对于护士做出有关抢救疗法选择的明智决定、将其纳入护理计划以及教育患者、护理伙伴和其他医疗服务提供者至关重要。结论:抢救疗法在神经系统疾病患者的护理中越来越重要。目前有多种配方可供选择,而且还在不断发展,为护士、患者和非医疗护理伙伴提供了方便快捷的关键抢救用药方法。对于负责用药管理的护士来说,在为患者提供及时正确的护理时应考虑到鼻内抢救疗法的特性。
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引用次数: 0
Neuroscience Nursing Orientation. 神经科学护理方向。
Pub Date : 2024-08-01 Epub Date: 2024-05-24 DOI: 10.1097/JNN.0000000000000761
Salomé M Loera, Holly Wirth
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引用次数: 0
期刊
The Journal of neuroscience nursing : journal of the American Association of Neuroscience Nurses
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