AACN advanced critical care
-
Evaluating, diagnosing, and managing patients with consumptive thrombocytopenia is challenging because of the overlapping nature of many of the diseases that reduce platelet counts. Immune thrombocytopenia (and its variations), drug-induced immune thrombocytopenia, and heparin-induced thrombocytopenia result from autoimmune antibody-mediated destruction of platelets. ⋯ Platelet-associated coagulopathies are infrequently encountered by most providers, and limited exposure to these types of patients, combined with the wide variety of treatment options for reversing bleeding or thrombotic sequelae, makes management difficult. This article reviews the pathophysiology, patient presentation, diagnostic testing, and specific management strategies and challenges of these thrombocytopenias.
-
Patients hospitalized with neurologic and medical issues in the neuroscience critical care unit have widely varying and complex disease states that can change rapidly. The large amount of data that must be reviewed regularly by medical staff members presents a challenge to the provision of high-quality care to these patients. ⋯ Nurses have reported that the tool provides a comprehensive summary of the patient's hospital stay that facilitates handoff during shift changes. A survey of nursing staff members demonstrated high levels of satisfaction with the tool during both multidisciplinary rounds and handoffs.
-
Venous thromboembolism is a preventable medical condition associated with significant morbidity and mortality. It can lead to deep vein thrombosis, pulmonary embolism, and stroke. Thrombi develop when intravascular conditions promote activation of the coagulation system or when there is an imbalance between endogenous anticoagulants and procoagulants. ⋯ Historically, anticoagulants were limited to heparins and vitamin K antagonists. Over the past 15 years, however, several new anticoagulant medications have been introduced. This article describes commonly prescribed and newer anticoagulants available to health care professionals, including their mechanism of action, therapeutic use, unique characteristics, and available reversal agents in the event of life-threatening bleeding.
-
Comparative Study
Burnout in Brazilian Intensive Care Units: A Comparison of Nurses and Nurse Technicians.
Job-related burnout has been reported by intensive care nurses worldwide; this study was performed to examine burnout in intensive care unit bedside nurses and nurse technicians in Brazil. A cross-sectional survey that included the Practice Environment Scale and the Maslach Burnout Inventory was completed by 209 nurses and nurse technicians working in 4 Brazilian intensive care units in 3 teaching hospitals. ⋯ Each additional patient added to a nurse's workload was associated with an increase in high emotional exhaustion and low personal accomplishment. Approximately one-third of Brazilian nurses working in intensive care units report job-related burnout; the practice environment and staffing appear to be contributing factors.
-
Extracorporeal membrane oxygenation is a rapidly emerging treatment for respiratory or cardiac failure and is used as a bridge to recovery, transplant, or destination therapy. Adult patients receiving extracorporeal membrane oxygenation also receive significant amounts of pharmacotherapy. ⋯ Understanding pharmacokinetics in adult patients receiving extracorporeal membrane oxygenation is important to correctly select and dose medications in this patient population. This article reviews published studies of the effects of extracorporeal membrane oxygenation on pharmacokinetics in adults.