Dimensions of critical care nursing : DCCN
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Dimens Crit Care Nurs · Nov 2010
ReviewSubglottic secretion aspiration in the prevention of ventilator-associated pneumonia: a review of the literature.
Ventilator-associated pneumonia is a common nosocomial infection that results in both negative patient outcomes and increased health care costs. Recently, many efforts have been targeted at ventilator-associated pneumonia prevention, including the practice of subglottic secretion aspiration. ⋯ Despite these findings, this practice is limited in clinical settings. This clinical practice should be implemented in individuals requiring mechanical ventilation to reduce the incidence of ventilator-associated pneumonia.
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Dimens Crit Care Nurs · Nov 2010
Multicenter Study Comparative StudyComparison of two pain scales for the assessment of pain in the ventilated adult patient.
The assessment of pain experienced by the patient requiring mechanical ventilation can be a challenge for critical care nurses. This study was conducted to assess the reliability and validity of two pain behavior assessment tools. ⋯ The findings suggest that both tools have adequate reliability and validity. Use of a pain behavior tool is one strategy to improve assessment of pain experienced by the mechanically ventilated adult patient who is unable to provide a self-report.
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Dimens Crit Care Nurs · Nov 2010
Critical care nurses' perceptions of obstacles, supports, and knowledge needed in providing quality end-of-life care.
In response to critical care nurses' perceptions of increasing stress and conflict in difficult end-of-life (EOL) situations, the researchers conducted a study to identify perceived obstacles, supports, and knowledge needed to provide quality EOL care. The conclusions were as follows: (1) families and patients need clear, direct, and consistent information to make EOL decisions; (2) physician-related issues affect nurses' ability to provide quality EOL care; (3) critical care nurses need more knowledge, skill, and a sense of cultural competency to provide quality care; and (4) having properly completed advance directives can reduce confusion about the goals of care. Recommendations for improving EOL care were made as a result of the study.
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Dimens Crit Care Nurs · Nov 2010
Case ReportsElectrocardiogram lead selection using critical thinking: concerning women and heart disease and a case of wellens syndrome.
When a patient enters the acute or critical care environment, it is imperative that the nurse select the best lead for monitoring the patient based on initial interpretation of the 12-lead electrocardiogram. Understanding that significant electrocardiogram changes can occur in the absence of chest pain presents a challenge, supporting the need for ongoing vigilant monitoring throughout the critical care stay. The purposes of this article were to (1) discuss the leading cause of death in the United States, (2) highlight the significance related to the population of women, and (3) present the physiology of Wellens syndrome along with monitoring recommendations to prevent unexpected outcomes for this patient population. A case study of Wellens syndrome is included.
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Dimens Crit Care Nurs · Nov 2010
Case ReportsHypertrophies and intraventricular conduction defects: causes, presentation, and significance.
There is an increasing need for nurses to interpret a 12-lead electrocardiogram, both in critical care units and in other areas. This can be a challenging task, especially in the presence of hypertrophies, bundle-branch blocks, and fascicular blocks. This article reviews the pathophysiology of intraventricular blocks and hypertrophy, characteristics found in the 12-lead electrocardiogram, and discusses what the significance of these findings may be.