AACN advanced critical care
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Review Case Reports
What's the "hyper" in hyperacute stroke? Strategies to improve outcomes in ischemic stroke patients presenting within 6 hours.
Ischemic stroke patients presenting to acute care hospitals require an organized response from multiple disciplines and clinical areas. Patients presenting within 6 hours of stroke onset constitute a category of stroke patient known as the "hyperacute stroke patient." This category of stroke patients is eligible for treatment using intravenous recombinant tissue plasminogen activator when treated within 3 hours, or interventional treatment options when treated within 6 hours of stroke onset. ⋯ Recommended interventions are highlighted to assist critical care practitioners in the delivery of care for stroke patients. Coordinated teams using an evidence-based approach can optimize the outcomes of the stroke patient population.
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Mechanical ventilation is one of the most commonly applied interventions in intensive care units. Despite its life-saving role, mechanical ventilation is associated with additional risks to the patient and additional healthcare costs if not applied appropriately. ⋯ Advances in ventilator modes include dual control modes that enable guaranteed tidal volume and inspiratory pressure, pressure-style modes that permit spontaneous breathing at high- and low-pressure levels, and closed-loop systems that facilitate ventilator manipulation of variables based on measured respiratory parameters. Clinicians need to develop a thorough understanding of these modes including their effects on underlying respiratory physiology to be able to deliver safe and appropriate patient care.
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Clinically induced hypothermia is an evidence-based intervention strategy that can improve the neurological outcome of unconscious patients after sudden cardiac arrest. Until recently, clinically induced hypothermia has been primarily used during surgery as a mechanism of preserving cardiovascular and neurologic stability of patients. ⋯ The purpose of this article is to review current literature and evidence-based nursing practice implications for managing the induction of a hypothermic state in adult patients who remain comatose after initial resuscitation from sudden cardiac arrest. Physiologic benefits of hypothermia, complications, and nursing care considerations will be presented.
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Nurse clinicians may experience moral distress when they are unable to translate their moral choices into moral action. The costs of unrelieved moral distress are high; ultimately, as with all unresolved professional conflicts, the quality of patient care suffers. As a systematic process for change, this article offers the AACN's Model to Rise Above Moral Distress, describing four A's: ask, affirm, assess, and act. To help critical care nurses working to address moral distress, the article identifies 11 action steps they can take to develop an ethical practice environment.
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Sepsis is a multifaceted and complex medical condition that consumes a vast array of critical care resources and creates an exceptionally difficult clinical challenge for critical care clinicians. As a result, many initiatives over the past decade have been set in motion with the goal of improving the clinical care of patients with sepsis. This article provides a review of the consensus definitions of sepsis and the status of current treatment initiatives for sepsis. ⋯ These parameters were chosen because they are recommended by both current consensus practice guidelines and early goal-directed therapy practice. In addition, they are continuously or frequently monitored in the setting of critical care, and though nonspecific for sepsis, as a group they may identify septic patients or those at risk for sepsis. Because critical care nurses are responsible for the continuous monitoring of patients at risk for developing sepsis, they may be able to observe the convergence of nonspecific diagnostic criteria and physical assessment cues early in the development of the condition and positively affect outcomes.