The Journal of neuroscience nursing : journal of the American Association of Neuroscience Nurses
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Performance improvement measures in achieving glycemic control in the acute brain injury population.
Glycemic control is becoming a standard practice in the intensive care environment because it has been shown to produce positive patient outcomes and benefits. A 14-bed neurointensive care unit initiated a strict glycemic protocol and evaluated the results over a 1-year period through a performance improvement initiative. ⋯ The purpose of this article was to explain how a strict glycemic protocol was safely implemented. Further research is necessary to determine long-term benefits of glycemic control in the population with neurocritical illness.
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Mannitol has long been the "gold standard" for treatment of cerebral edema and refractory intracranial hypertension in traumatic brain injury, subarachnoid hemorrhage, and stroke. Studies performed in animals have shown that hypertonic saline (HS), in doses ranging from 3% to 10%, may be more effective than mannitol in treating these populations. Recently, randomized clinical trials have evaluated the efficacy and safety of HS versus mannitol in the treatment of elevated intracranial pressure (ICP). ⋯ These studies have shown that not only is HS a safe drug (no patients experienced adverse effects), it is also more efficient in reducing ICP. Efficiency is defined as the drug's ability to decrease ICP to acceptable levels and to maintain lower ICPs for a longer duration of time. It is important for nurses who administer osmotic diuretics to evaluate and understand the current research to provide educated and appropriate care.
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Stroke is the third leading cause of death in the United States and the leading cause of serious, long-term disability. Patients who sustain a sudden ischemic stroke can benefit from the administration of intravenous recombinant tissue plasminogen activator (rt-PA). rt-PA may reduce disability, yet few patients arrive in emergency departments in time to be eligible for rt-PA administration. The purpose of this study was to discover factors that influence patients' decision-making process when seeking treatment for acute-stroke symptoms. ⋯ Five themes emerged for patients who presented late for treatment: lack of knowledge, fear of hospitals, denial, living alone, and preexisting health concerns. The theme that emerged from the group that presented early for treatment was previous history or knowledge of stroke. The most significant implication for practice identified in this study is that nurses must take a leading role in educating the public regarding symptoms, risk factors, and available treatments for stroke.
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Randomized Controlled Trial
Oral care intervention to reduce incidence of ventilator-associated pneumonia in the neurologic intensive care unit.
Ventilator-associated pneumonia (VAP) is a preventable secondary consequence of intubation and mechanical ventilation. VAP is pneumonia that develops in an intubated patient after 48 hours or more of mechanical ventilator support. Mechanically ventilated patients in neurologic and other intensive care units (ICUs) are at an increased risk of VAP due to factors such as decreased level of consciousness; dry, open mouth; and microaspiration of secretions. ⋯ Patients were randomized into a control group that performed usual oral care or an intervention group that brushed teeth every 8 hours. The results were immediate and startling, as the VAP rate dropped to zero within a week of beginning the every-8-hours toothbrushing regimen in the intervention group. The study was so successful that the control group was dropped after 6 months, and all intubated patients' teeth were brushed every 8 hours, maintaining the zero rate until the end of the study.
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Deep brain stimulators (DBS) may be affected by electromagnetic interference (EMI). Little research has been conducted regarding this phenomenon, although supportive background information and a literature review offer implications of EMI for persons who have this device. The warning information on Medtronic's Web site that is specific to the DBS device indicates that theft detectors and security screening devices may cause the stimulation to turn on or off and may cause some patients to experience a momentary increase in perceived stimulation. ⋯ EMI with DBS does not appear to present an immediate safety issue even though it may cause device malfunction and a resulting temporary interruption in therapeutic benefit for persons who have the device. However, the absence of sound research on the effects of EMI on DBS does not permit the exclusion of EMI as a potential health concern. Meanwhile, healthcare professionals who care for patients with DBS should routinely educate them about potential interactions and appropriate accommodations.