American journal of critical care : an official publication, American Association of Critical-Care Nurses
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Clinical Trial
Ulnar peripheral nerve stimulation by train-of-four technique in adult nonmedicated patients.
Peripheral nerve stimulation is necessary to quantify the level of neuromuscular blockade and prevent prolonged paralysis related to drug accumulation. Some nurses and physicians are hesitant to administer nerve stimulation because of concerns about inflicting pain on the patient. ⋯ Nerve stimulation by train-of-four method was moderately uncomfortable but not painful. Heart rate response could not be relied on as a measurement of discomfort. Protocols for stimulation should include testing at level 4 and increasing as necessary to cause thumb adduction.
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To identify and prioritize research questions of importance to trauma patient care and of interest to trauma nurses. ⋯ These research priorities provide impetus and direction for nursing and collaborative investigation in trauma care.
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This literature review was done to explore the use of master's-prepared nurse practitioners to manage critically ill patients. Data-based, anecdotal, clinical, analytic, and position papers published over the past 10 years in the medical and nursing literature were reviewed. This article synthesizes findings on the use of nurse practitioners in clinical settings including primary and specialty care settings, describes favorable outcomes of advanced practice nurses, and identifies factors that must be addressed as these roles increase in use in critical care settings. ⋯ Additional federal support to ensure the preparation of these practitioners in adequate numbers is needed. Attention to issues of direct reimbursement, salaries, impact of changing role boundaries, malpractice coverage, and prescription privileges must be addressed. Research programs to examine the effect of nurse practitioners in specialized care should continue.
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Comparative Study Clinical Trial Controlled Clinical Trial
Effect of oxygen insufflation during endotracheal suctioning on arterial pressure and oxygenation in coronary artery bypass graft patients.
BACKGROUND Numerous studies have demonstrated the need for increased inspired oxygen with endotracheal suctioning to prevent hypoxemia; however, increased arterial pressure has been reported as a consequence of lung hyperinflation/inflation used to deliver hyperoxygenation. OBJECTIVES To compare insufflation during endotracheal suctioning with a standard procedure of hyperoxygenation using a ventilator on arterial pressure, pulmonary artery pressure, heart rate, arterial oxygen saturation, and blood gases in intubated, mechanically ventilated coronary artery bypass graft patients. METHODS A within-subjects, repeated-measures design was used to measure arterial pressure (systolic, diastolic, and mean), pulmonary artery pressure (systolic, diastolic, and mean), airway pressure, heart rate and rhythm, arterial oxygen tension, arterial carbon dioxide tension, pH, and arterial oxygen saturation during an oxygen insufflation protocol and a hyperoxygenation protocol via the ventilator. ⋯ CONCLUSIONS Oxygen insufflation resulted in less increase in arterial pressure than did the hyperoxygenation protocol. The hyperoxygenation protocol resulted in hyperoxia. Based on this study, oxygen insufflation is a safe alternative for providing oxygen during endotracheal suctioning.
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Research in human coronary heart disease has been conducted primarily on males; however, investigators have begun to focus research efforts on female subjects as well. A literature review that identified studies on women and coronary heart disease was done to describe modifiable risk factors for coronary heart disease in women. Several modifiable risk factors such as smoking, hypertension, and disorders of lipid metabolism previously identified for men are also risk factors for women. ⋯ Moreover, women have additional risk factors related to menopause and, in some cases, the use of oral contraceptives. Significant initial information has been gained concerning women and coronary heart disease risk factors. However, gaps persist in information regarding the individual and synergistic effects of risk factors for CHD in women.