American journal of critical care : an official publication, American Association of Critical-Care Nurses
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Confusion about how to assess for intolerance to feedings often results in unnecessary feeding interruptions. ⋯ Practice among the 2298 critical care nurses varied widely. Many of the survey respondents are practicing in ways that can unnecessarily diminish the delivery of calories to patients. Protocols based on current enteral nutrition guidelines must be developed and implemented in practice settings.
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Peripartum cardiomyopathy, a type of dilated cardiomyopathy of unknown origin, occurs in previously healthy women in the final month of pregnancy and up to 5 months after delivery. Although the incidence is low-less than 0.1% of pregnancies -morbidity and mortality rates are high at 5% to 32%. The outcome of peripartum cardiomyopathy is also highly variable. ⋯ In acute care, treatment may involve the use of intravenous vasodilators, inotropic medications, an intra-aortic balloon pump, ventricular-assist devices, and/or extracorporeal membrane oxygenation. Survivors of peripartum cardiomyopathy often recover from left ventricular dysfunction; however, they may be at risk for recurrence of heart failure and death in subsequent pregnancies. Women with chronic left ventricular dysfunction should be managed according to guidelines of the American College of Cardiology Foundation and the American Heart Association.
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Implementation of the ruling on the Inpatient Prospective Payment System by the Centers for Medicare and Medicaid has challenged nurses to focus on the prevention of pressure ulcers. Despite years of research, pressure ulcers are still one of the most common complications experienced by patients in health care facilities. ⋯ Scores on the Braden Scale at admission can be used to identify patients at increased risk for pressure ulcers. For other high-risk factors, such as low body mass index and long operative procedures, appropriate clinical interventions to manage these conditions can help prevent pressure ulcers.
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Randomized Controlled Trial Comparative Study
Effect of a computerized insulin dose calculator on the process of glycemic control.
Glycemic control is important to patients' outcomes. However, the process of maintaining glycemic control is risk laden and labor intensive for nurses. ⋯ Management of glycemic control and nurse satisfaction were improved with use of the dose calculator. Improving nurses' processes of care may improve nurses' use of time and patient care overall. Studies with larger sample sizes over time are needed to determine these relationships.