Critical care nurse
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Critical care nurse · Aug 2019
Improving Safety of Intravenous Prostacyclin Administration to Pediatric Patients With Pulmonary Hypertension.
Pulmonary hypertension is a rare, life-threatening disease with limited therapeutic options and no definitive cure. Continuous intravenous prostacyclin therapy is indicated for treatment of severe disease. These medications have a narrow therapeutic index and a brief half-life; therefore, administration errors can be lethal. ⋯ The trend in reduction of continuous intravenous prostacyclin therapy errors suggests that proactive processes to standardize its administration, emphasizing both policy and education, reduce medication errors and increase patient safety.
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Critical care nurse · Aug 2019
ReviewDelirium in the Intensive Care Unit: Is Dexmedetomidine Effective?
Delirium in the intensive care unit affects approximately 30% of patients despite vigorous efforts to encourage the use of effective screening tools and preventive strategies. The success of pharmacological treatment of delirium remains equivocal; moreover, a paucity of research supports the use of atypical antipsychotic medications. ⋯ Published research related to the use of dexmedetomidine in the management of delirium is also discussed. The authors make recommendations for critical care nurses on dexmedetomidine use in the context of providing evidence-based nursing care to intensive care unit patients with delirium.
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Teamwork is essential for health care providers, who must work together to ensure safe and effective patient care. The ability to function effectively as a team is especially important in critical care, where ad hoc teams are brought together for short-term management of crisis situations. Teamwork training has been widely implemented, but ongoing education and practice are needed to maintain and improve competency. ⋯ Strategies such as ensuring multidisciplinary participation, clarifying team resources and goals, and creating practice scenarios can increase the effectiveness of training for critical care teams. Evaluation can provide immediate feedback on learning outcomes and may facilitate subsequent transfer of learning to the clinical setting. Interventions that improve a team's ability to work toward a common goal can improve outcomes for critically ill patients.
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Critical care nurse · Aug 2019
Comparative StudyOutcomes Associated With Stage 2 Pressure Injuries Among Surgical Critical Care Patients: A Retrospective Cohort Study.
Hospital-acquired pressure injuries are a serious problem among critical care patients. Although most hospital-acquired pressure injuries are stage 2 (partial-thickness skin loss with exposed dermis), no studies have examined outcomes of stage 2 pressure injuries among critical care patients. ⋯ Stage 2 hospital-acquired pressure injuries were not healed at discharge in 63% of the patients in our sample. Nurses should be especially vigilant in treating pressure injury patients who are older, have altered oxygenation or perfusion (elevated serum lactate level or decreased oxygenation), or have evidence of renal compromise.
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Critical care nurse · Aug 2019
Reducing Hypoglycemia in Critical Care Patients Using a Nurse-Driven Root Cause Analysis Process.
Successful blood glucose control is associated with improved outcomes of critically ill patients. However, insulin treatment can cause hypoglycemia, an important patient safety concern. The Joint Commission has recommended that all episodes of hypoglycemia be evaluated with a root cause analysis. ⋯ The nurse-driven root cause analysis was associated with a substantial reduction in hypoglycemia, with concomitant decreases in mean blood glucose level among patients without diabetes and glucose variability in patients without and with diabetes.