American journal of critical care : an official publication, American Association of Critical-Care Nurses
-
Tooth brushing in critically ill patients has been advocated by many as a standard of care despite the limited evidence to support this practice. Attention has been focused on oral care as the evidence accumulates to support an association between the bacteria in the oral microbiome and those respiratory pathogens that cause pneumonia. It is plausible to assume that respiratory pathogens originating in the oral cavity are aspirated into the lungs, causing infection. ⋯ Possible reasons for the lack of benefit of tooth brushing demonstrated in clinical trials are discussed. Recommendations for future trials in critically ill patients are suggested. With increased emphasis being placed on oral care, the evidence that supports this intervention must be evaluated carefully.
-
Continuous ischemia monitoring helps identify patients with acute, but often silent, myocardial ischemia. Evidence suggests nurses do not activate ischemia monitoring because they think it is difficult to use. ST-Map software incorporates graphic displays to make monitoring of ongoing ischemia easier. ⋯ ST Map was associated with more frequent use of ischemia monitoring, improved attitudes of nurses toward ischemia monitoring, and shorter time to obtaining 12-lead electrocardiograms.
-
Fat embolism syndrome is a life-threatening condition that can develop after orthopedic injury and surgery. This syndrome developed in a 19-year-old man after a traumatic femoral fracture that was surgically repaired with intramedullary nailing. ⋯ Although minimization of the syndrome focuses primarily on prehospital care and early stabilization of a patient's condition, prevention of the potential consequences requires early detection by bedside nurses who care for trauma and orthopedic patients. Detailed nursing assessment and rapid recognition and reporting of the signs and symptoms associated with fat embolism syndrome are key to improving the outcomes of these patients.
-
Accurate measurements for determining cardiac index can be obtained while patients are supine in bed at various backrest elevations. It is not clear if these measurements are accurate when patients are in a bedside chair. ⋯ The practice of putting cardiac surgical patients whose hemodynamic status is stable back to bed before obtaining measurements for calculation of cardiac index may not be required for accurate values.