The American journal of nursing
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Review Case Reports
PAIN Control: IV opioid range orders for acute pain management.
Patients have the right to adequate and safe pain relief in hospitals, but many continue to experience unrelieved pain. Range orders for the delivery of IV opioids give nurses the flexibility needed to treat patients' pain in a timely manner while allowing for differences in patient response to pain and to analgesia. To ensure safety and effectiveness, and to meet the requirements of accreditation agencies, hospitals should develop prescribing guidelines for IV opioid range orders and clear protocols for their implementation. Range orders should, for example, take into consideration the patient's age, pain intensity, and comorbidities; avoid frequency ranges; and prescribe a maximum dose that is at least two times but no more than four times the minimum dose in the range.
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Survival rates for cardiac arrests that occur in hospitals and outside them continue to be low (17% and 6%, respectively), and fewer than one-third of patients who have an out-of-hospital cardiac arrest receive cardiopulmonary resuscitation (CPR). Consequently, a number of changes were made to the 2005 American Heart Association Guidelines for Cardiopulmonary Resuscitation and Emergency Cardiovascular Care. The changes were intended to simplify CPR in order to increase its use and effectiveness by both clinicians and nonprofessionals. This article summarizes the primary changes to the recommendations, including a universal 30-to-2 compression-to-ventilation ratio for all lone rescuers, the need for compressions of sufficient depth and number, and the replacement of the three-shock model of initial defibrillation with one that recommends a single shock, now seen as an adequate precursor to CPR.
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Nurses deal with the fallout of a nation with more than 46 million uninsured. Affecting the patients and families they care for, the hospitals and clinics they work in and manage, and the communities they serve, nurses have a credible standing from which to debunk any myths about who the uninsured are, why they are uninsured, and the difference that health insurance makes in their health and well-being. This article on the uninsured and health insurance coverage among low-income Americans outlines key facts about the uninsured and the primary cause of the problem--the affordability of health insurance.
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The field of wound care has been inundated with "active" dressings--those that deliver biologically active substances to the wound site--and much attention has been given to those containing silver. Silver is a broad-spectrum agent: it is bactericidal to a large number of Gram-positive and Gram-negative microorganisms, many aerobes and anaerobes, and several antibiotic-resistant strains. ⋯ But research findings on silver's antimicrobial efficacy are often inconclusive or contradictory. How, therefore, can clinicians decide which dressing is most appropriate for each patient? A grading system for reviewing the literature is presented.