Prognostic indicators of short-term survival of ineffective airway clearance in children with acute respiratory infection: a longitudinal study.

Background: Studies that establish the indicators of clinical status deterioration of Ineffective airway clearance remain scarce. Prognostic studies provide data for nurses identify clinical indicators that suggest a higher chance of early development of a nursing diagnosis. Objective: To identify the prognostic indicators of short-term survival of ineffective airway clearance (IAC) in children with acute respiratory infection (ARI). Design: A prospective open cohort study. Methods: This study was with a group of 136 children with acute respiratory infection who were followed for a minimum of six and a maximum of ten consecutive days. Children who had not completed six days of monitoring or who were carriers of diseases that would alter the specific symptoms of respiratory infection were excluded. The survival rate of ineffective airway clearance was calculated using Nelson-Aalen's method. A Cox regression model was used to analyze the influence of clinical indicators on survival time of this diagnosis. Results: The diagnosis survival rate was extremely low (only 0.4% on the 5th day of follow-up). The greatest reduction in survival rate was observed in the first 48 h (survival rate = 2.5%). Four defining characteristics associated with a worse prognosis of IAC among children with ARI: ineffective cough (RR = 5.86; 95% CI: 3.53-9.72), absence of cough (RR = 2.92; 95% CI: 1.68-5.08), adventitious breath sounds (RR = 2.47; 95% CI: 2.01-3.03), and diminished breath sounds (RR = 1.23; 95% CI: 1.05-1.45). Conclusion: Four clinical indicators showed a strong relationship with an increased risk of worsening clinical status associated with this nursing diagnosis. Impact statement: Clinical deterioration related to ineffective airway clearance among children with acute respiratory infection is fast and requires particular attention from nurses.

Cut to Air.

A "cannot ventilate, cannot intubate" scenario is a rare, high-risk anesthesia event. Cricothyrotomy is the final step, but anesthesia training and maintenance of surgical airway skills is variable. The ability to "cut to air" when one performs a cricothyrotomy may be all that prevents a patient from experiencing anoxic brain injury or death. Forty-three Certified Registered Nurse Anesthetists (CRNAs) performed emergency cricothyrotomies on a simulation manikin. Three techniques were available: (1) cricothyrotomy kit, (2) scalpel and tracheostomy, and (3) scalpel/bougie/endotracheal tube. Technique selection and performance were recorded until successful confirmation of placement was achieved in less than 2 minutes. Confidence levels performing cricothyrotomy were also measured before and after simulation. Most CRNAs (53.5%) selected the cricothyrotomy kit, and all but 1 completed the cricothyrotomy in under 2 minutes. The scalpel/bougie/endotracheal tube combination was the fastest, with an average completion time of 86.6 seconds. The confidence of CRNAs in performing a successful cricothyrotomy in less than 2 minutes was significantly increased (P ≤ .001). Simulating airway skills improved performance, speed, and confidence. Because not all CRNAs have had extensive education in performing surgical airways and practicing these skills, simulation may have additional value in developing and maintaining skills and confidence.

Gestão da permeabilidade das vias aéreas à pessoa com patologia respiratória crónica: intervenção do enfermeiro especialista em enfermagem de reabilitação / Management of airway permeability to the person with chronic respiratory disease: intervention of the nurse specialist in rehabilitation nursing

O presente relatório teve como principal objetivo a descrição e análise reflexiva das competências adquiridas ao longo do estágio clínico, realizado em dois campos distintos, num serviço de Medicina de um Hospital central de Lisboa e numa Unidade de Cuidados de Média Duração e Reabilitação (UMDR) na zona confinante de Lisboa, de acordo com a área de especialização em Enfermagem de Reabilitação (ER), para a obtenção do título de grau de mestre na respetiva área. A prática clínica desenvolvida foi sustentada ao abrigo da Teoria do Autocuidado de Orem (2001), constructo teórico que ajudou na estruturação do pensamento e planeamento das intervenções. A patologia respiratória crónica é presentemente identificada como um problema emergente a nível mundial. Em Portugal, constitui uma das principais causas de morbilidade e mortalidade, bem como, a sua forte correspondência em relação aos internamentos e reinternamentos hospitalares. O destaque para a gestão da permeabilidade das vias aéreas foi o foco da minha intervenção, uma vez que a acumulação de secreções é uma forte condicionante à aquisição de prováveis infeções respiratórias, muito evidente na pessoa com patologia respiratória crónica. A reabilitação respiratória, incidindo nos mecanismos de limpeza das vias aéreas, irá possibilitar a libertação de secreções e consequente melhoria da permeabilidade das vias aéreas, reduzindo agudizações da patologia. O Enfermeiro Especialista em Enfermagem de Reabilitação (EEER) deve assegurar a eficácia desses mecanismos, adequando-os o melhor possível a cada pessoa/família, sendo primordial a sua integração e participação no processo de reabilitação. De salientar, o quão me foi possível crescer a nível pessoal e profissional, como futura EEER, pelos conhecimentos e competências adquiridas, destacando outras áreas de intervenção, como a reeducação motora e cognitiva.

The aim of this report is the description and reflexive analysis of the competences acquired during the clinical internship, carried out in two different fields belonging to the area of rehabilitation nursing´s specialization, and with the objective to obtain the title of master's degree in this main area. Both phases of this internship were performed in Lisbon, the first one in the Medicine Service of Lisbon's Central Hospital and the second one in a Medium-Term Care and Rehabilitation Unit. The clinical practice developed was sustained under the Orem's Self-Care Theory (2001), a theoretical construct that helped in structuring the thinking and planning of interventions. The chronic respiratory disease is currently identified as an emerging worldwide problem. In Portugal, it is one of the main causes of morbidity and mortality, as well as, the strong relation with hospitalizations and rehospitalizations. The focus of my intervention was the airway permeability management, since the accumulation of secretions is a strong conditioning for the acquisition of probable respiratory infections, and very evident in the person with chronic respiratory disease. Respiratory rehabilitation focusing on the airway cleaning mechanisms, will release secretions and consequently improve airway permeability, reducing acute pathologies. The rehabilitation nurse specialist must ensure the effectiveness of these mechanisms, adapting them as well as possible to each person/family, being primordial for its integration and participation in the rehabilitation process. It should be also noted that this experience allowed me to grow not only professionally but also personally, as a future rehabilitation nurse specialist, by the knowledge and skills acquired, highlighting other areas of intervention, such as motor and cognitive reeducation.

Risk factors and nursing strategies to manage choking in adults with mental illness: a systematic review protocol.

REVIEW QUESTION/OBJECTIVE: The review objectives are:Specifically, this review seeks to answer the following questions.

How to manage a choking adult.

Rationale and key points Choking, or foreign body airway obstruction, is a common, yet treatable, cause of accidental death. This article aims to provide an overview of the skills required when faced with this emergency in adults, including how to recognise this emergency, the immediate management and treatment required, and the necessary aftercare. ¼ Choking usually occurs when a person is eating or drinking. ¼ An obstruction may classified as mild or severe. ¼ For a severe obstruction in a conscious person, it may be necessary to administer back blows and/or abdominal thrusts to remove the obstruction from the airway. Reflective activity 'How to' articles can help to update your practice and ensure it remains evidence based. Apply this article to your practice. Reflect on and write a short account of: 1. How this article might change your practice when managing adults who are choking. 2. Positive elements of your current practice and those that could be enhanced.

Clinical indicators of ineffective airway clearance in children with acute respiratory infection.

The identification of clinical indicators with good predictive ability allows the nurse to minimize the existing variability in clinical situations presented by the patient and to accurately identify the nursing diagnosis, which represents the true clinical condition. The purpose of this study was to analyze the accuracy of NANDA-I clinical indicators of the nursing diagnosis ineffective airway clearance (IAC) in children with acute respiratory infection. This was a prospective cohort study conducted with a group of 136 children and followed for a period of time ranging from 6 to 10 consecutive days. For data analysis, the measures of accuracy were calculated for clinical indicators, which presented statistical significance in a generalized estimated equation model. IAC was present in 91.9% of children in the first assessment. Adventitious breath sounds presented the best measure of accuracy. Ineffective cough presented a high value of sensitivity. Changes in respiratory rate, wide-eyed, diminished breath sounds, and difficulty vocalizing presented high positive predictive values. In conclusion, adventitious breath sounds showed the best predictive ability to diagnose IAC in children with respiratory acute infection.

Clinical Differentiation of Respiratory Nursing Diagnoses among Children with Acute Respiratory Infection.

The aim of this study was to identify the defining characteristics that allow clinical differentiation of the nursing diagnoses, ineffective breathing pattern (IBP), ineffective airway clearance (IAC), and impaired gas exchange (IGE). A secondary analysis with a cohort design was developed from 1128 records obtained during the hospital stay of 136 children with acute respiratory infection. Groups of defining characteristics with greater differentiation capacity were identified by multiple correspondence analyses. The results showed that the defining characteristics that better differentiate the studied diagnoses are agitation, irritability and diaphoresis for IGE; dyspnea, use of accessory muscles to breathe, orthopnea, and abnormal breathing pattern for IBP and excessive sputum, absence of cough, difficulty verbalizing, nasal flaring, and adventitious breath sounds for IAC. Twelve defining characteristics that can assist clinicians to differentiate the three main respiratory nursing diagnoses among children with acute respiratory infection were identified in this study.

Breastfeeding and delivery room neonatal collapse.

Sudden unexpected neonatal collapse in the delivery room is a rare occurrence in healthy term infants. Upper airway obstruction may occur from improper positioning of the newborn even while breastfeeding. Such occlusion may have dire consequences if not recognized immediately. We report 2 healthy term neonates who suffered respiratory arrest while in the mother's arms and attempting breastfeeding. In each case, rapid response by the delivery room nurse averted tragedy. Metabolic and infectious evaluations were unremarkable. Both babies have been well on subsequent examinations. We conclude that proper education of mothers and safe positioning of neonates is critical during the initiation of breastfeeding.

Understanding the challenges during transitions of care for children with critical airway conditions.

PURPOSE: The specific aim of this qualitative descriptive study was to gain an understanding of the challenges occurring during transitions of care between two institutions for children with critical airway conditions. METHODS: Qualitative descriptive methodology was utilized to analyze data from two focus groups conducted with nurses from two adjacent institutions. RESULTS: The focus groups were composed of 19 staff nurses, three case managers, one clinical nurse specialist and two nurse directors. Three themes emerged from the nurses' focus groups: Uncertainty with Diagnosis, Communication Between Healthcare Facilities and Family Members, and Parental Acceptance/Readiness to Learn. CONCLUSION: Nurses are in a unique position to improve both the quality and coordination of care to these children and their family members. An effort to improve transfer of care between institutions and nurses could reduce the combined length of stay for patients and reduce avoidable readmissions. Nurses are in a key position to enhance the competence, confidence, and comfort for family members and caretakers to exercise their post-discharge responsibilities. IMPLICATIONS FOR PRACTICE: Consistent, clear communication among health care providers and family members can improve care in this vulnerable population. These data identified need for further education of nurses.

First aid provision in nightclubs and other entertainment venues.

This article discusses the role and responsibilities of the registered nurse in providing first aid in challenging environments, such as crowded nightclubs. Basic assistance for common emergencies, including substance misuse, wounds, choking and anaphylaxis, are discussed. This article emphasises the importance of risk assessment and reminds readers of the need to maintain personal safety.

[Nursing intervention in a child diagnosed with ineffective airway clearance: a case report]. / Descripción de un caso: intervención de enfermería en un niño diagnosticado de limpieza ineficaz de las vías aéreas.

The nursing diagnosis of inefficient airway clearance is prevalent in children. The present report describes the airway management intervention carried out over 5 consecutive days in a child admitted to a pediatric unit, using an instrument based on the indicators of respiratory rate, respiratory ease, respiratory rhythm, and adventitious breath sounds, included in the nursing outcome of "respiratory status: airway patency" of the Nursing Outcomes Classification. Monitoring was started after informed consent was obtained. The anonymity and confidentiality of the data were guaranteed. The monitoring started with a baseline evaluation of the child, followed by implementation of each activity in a pre-established order. On the following days, the nursing interventions implemented were evaluated once a day in the morning by the researcher. After implementing the selected activities, an improvement of 75% in health status was observed, generating an ascendant tendency line. The difference in means per follow-up day showed variations of 0.25 and 0.5. The final health status mean, i.e. the mean difference between the value of the last follow-up day and the initial status, showed a variation of 0.25. In conclusion, the intervention was satisfactory and hastened recovery, reduced length of hospital stay and the associated economic costs, and was painless and easy to perform.

Clinical indicators of ineffective airway clearance in children with congenital heart disease.

AIMS AND OBJECTIVES: To analyse the sensitivity and specificity of clinical indicators of ineffective airway clearance in children with congenital heart disease and to identify the indicators that have high predictive power. BACKGROUND: The precise establishment of nursing diagnoses has been found to be one of the factors contributing to higher quality of care and cost reduction in healthcare institutions. The use of indicators to diagnose ineffective airway clearance could improve care of children with congenital heart disease. Design. Longitudinal study. METHODS: Participants consisted of 45 children,