Critical care nurse
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Critical care nurse · Jun 2019
ReviewUsing Valid and Reliable Tools for Pain and Sedation Assessment in Pediatric Patients.
Pain management and sedation strategies have become more complex in recent years, with accompanying documented increases in morbidity and mortality. Consequently, various government agencies and professional associations have issued requirements or recommendations designed to ensure optimal and safe pain management in different populations. The pediatric nurse must understand the rationale behind these guidelines, which pain and sedation assessment tools are valid and reliable, how and when to use these tools, and the purpose and limitations of each tool. This article summarizes the recent recommendations, identifies valid and reliable pediatric pain and sedation assessment tools, and describes the appropriate use of these tools to provide safe and high-quality patient care.
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Critical care nurse · Jun 2019
Randomized Controlled Trial Multicenter Study Comparative StudyImplementation and Analysis of a Free Water Protocol in Acute Trauma and Stroke Patients.
Free water protocols allow patients who aspirate thin liquids and meet eligibility criteria to have access to water or ice according to specific guidelines. Limited research is available concerning free water protocols in acute care settings. ⋯ Larger-scale studies are needed to reach decisive conclusions on the positive outcomes and negative indicators of a free water protocol in the acute care setting.
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Critical care nurse · Jun 2019
ReviewEarly Mobility in the Intensive Care Unit: Evidence, Barriers, and Future Directions.
Early mobility is an element of the ABCDEF bundle designed to improve outcomes such as ventilator-free days and decreased length of stay. Evidence indicates that adherence to an early mobility protocol can prevent delirium and reduce length of stay in the intensive care unit and the hospital and may decrease length of stay in a rehabilitation facility. ⋯ This article focuses on aspects of care that can affect patient outcomes, such as preventing delirium, reducing sedation, monitoring the patient's ability to wean from the ventilator, and encouraging early mobility. It also addresses the effects of immobility as well as challenges in achieving mobility and how to overcome them.
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Critical care nurse · Jun 2019
ReviewReversing Direct Oral Anticoagulants in Acute Intracranial Hemorrhage.
Intracerebral hemorrhage is a major source of morbidity and mortality, accounting for 10% of all strokes. Oral anticoagulation therapy, while necessary to prevent thromboembolic complications, increases the risk of intracerebral hemorrhage and can potentially worsen bleeding in cases of acute hemorrhage. ⋯ Anticoagulation reversal in the setting of acute intracerebral hemorrhage is an evolving field. This article covers the most common direct oral anticoagulant medications, various available anticoagulant reversal strategies, and the latest guidelines for anticoagulation reversal in patients with acute intracranial hemorrhage.