Critical care nurse
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Delirium in older adults in critical care is associated with poor outcomes, including longer stays, higher costs, increased mortality, greater use of continuous sedation and physical restraints, increased unintended removal of catheters and self-extubation, functional decline, new institutionalization, and new onset of cognitive impairment. Diagnosing delirium is complicated because many critically ill older adults cannot communicate their needs effectively. ⋯ Nurses often have primary responsibility for detecting and treating delirium, which can be extraordinarily complicated because patients are often voiceless, extremely ill, and require high levels of sedatives to facilitate mechanical ventilation. An aggressive, appropriate, and compassionate management strategy may reduce the suffering and adverse outcomes associated with delirium and improve relationships between nurses, patients, and patients' family members.
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Critical care nurse · Aug 2012
ReviewSpontaneous coronary artery dissection: a rare threat to young women.
Spontaneous coronary artery dissection not associated with underlying coronary artery disease is rare. When the dissection does occur, it most often is manifested as an acute ST-elevation myocardial infarction in young women. Although the condition can occur in men, most often it involves women who are in their third trimester of pregnancy or the early postpartum period or are engaging in vigorous exercise. Because little is known about spontaneous coronary artery dissection in this population of women, recommendations for treatment are the same as for treatment of acute myocardial infarction associated with atherosclerotic coronary disease.
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Case histories--rich, anecdotal narratives--are theorized to support the acquisition of cognitive, social, cultural, and emotional knowledge and motor skills through active learning. This manuscript focuses on the value of case histories in teaching and evaluating acute and critical care advanced practice nursing students. ⋯ Case histories support student-centered learning and development of clinical reasoning. An exemplar of a case history is provided, and application of case histories to both electronic and classroom settings is explored.
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Errors related to health care devices are not well understood. Nurses in intensive care and progressive care environments can benefit from understanding manufacturer-related error and device-use error, the principles of human factors engineering, and the steps that can be taken to reduce risk of errors related to health care devices.
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Critical care nurse · Aug 2012
Comparative StudyUse of a 1-piece chlorhexidine gluconate transparent dressing on critically ill patients.
New transparent dressings with chlorhexidine gluconate in the dressing are available. ⋯ A low rate of catheter-related bloodstream infections can be maintained, nurses' satisfaction achieved, and cost savings realized with the new dressing.