Critical care nursing clinics of North America
-
In 2002, the Joint Commission on Accreditation of Health Care Organizations (JCAHO) reviewed 23 reports of death or injury that were related to mechanical ventilation. Nineteen of those events resulted in death, and 4 resulted in coma; 65% were related to alarms. ⋯ This review prompted JCAHO to include alarm safety in the National Patient Safety Goals for 2003. This article examines the components of an alarm safety program, from the complex to the common sense.
-
Traditionally, bedside evaluation of tissue oxygenation has been accomplished by assessing mixed venous oxygen saturation (SvO2) using a fiberoptic pulmonary artery catheter. It may not always be feasible to place a pulmonary artery catheter early in resuscitation or outside of the ICU. Introduction of continuous central venous oxygen saturation (ScvO2) monitoring that uses a modified, central venous catheter is making it possible to evaluate ongoing tissue oxygenation in nontraditional settings, such as the Emergency Department. Continuous measurement of ScvO2 will alert the clinician to major derangements in oxygen balance, which allows for timely implementation of appropriate interventions.
-
Crit Care Nurs Clin North Am · Jun 2006
Impact of bispectral index monitoring on sedation and outcomes in critically ill adults: a case series.
In situations in which clinical assessment of sedation level is compromised, such as deep sedation/analgesia with and without neuromuscular blockade (NMB), electroencephalogram-based monitoring may potentially assist in achieving balance between inadequate and excessive levels of sedation. To validate the bispectral index (BIS) for use in clinical practice, correlation and possible differences in outcome using clinical assessment versus clinical assessment augmented by electroencephalogram-based monitoring were determined. BIS monitoring was decisive in ICU care in 9 of 15 patients in this series. The most significant potential benefit was obtained in the subset of patients receiving NMB.
-
Crit Care Nurs Clin North Am · Mar 2006
ReviewApplication of the Synergy Model with the surgical care of smokers.
The Synergy Model for Patient Care, developed by the American Association of Critical-Care Nurses (AACN), demonstrates that positive patient outcomes are achieved when patient characteristics are matched with nurse competencies. This article describes how effective nursing practice, whether providing smoking cessation counseling or evaluating preoperative laboratory tests, must be centered around the needs and characteristics of patients. Smokers requiring surgical intervention have unique needs and require nurses with competent skills to help promote optimal pulmonary, cardiovascular, and wound healing outcomes.
-
Crit Care Nurs Clin North Am · Mar 2006
Providing smoking cessation counseling: a national survey among nurse anesthetists.
Current research has demonstrated that smokers have an increased incidence of intraoperative and postoperative complications. Certified registered nurse anesthetists (CRNAs) have knowledge of a patient's smoking status and are in a unique position to provide smoking cessation counseling (SCC). The results from a national survey about SCC practice among CRNAs is revealed in this article.