Recognizing the Role of the Adult-Gerontology NP.

Whether certified in acute or primary care, AGNPs are prepared for many practice settings.

Effects of patient-level noise abatement orders on sound levels experienced by critically ill subarachnoid hemorrhage patients: an observational study.

BACKGROUND/OBJECTIVE: Patients with aneurysmal subarachnoid hemorrhage (aSAH) may be at risk for complications related to excessive environmental noise. Our ICU utilizes a variety of universal interventions to minimize ambient noise levels, but patients with aSAH additionally have specific orders intended to further minimize physiologic stress and noise exposure. It is unknown whether such orders can have a supplementary reductive effect on noise exposure. METHODS: Sound levels were measured for at least three consecutive days in the rooms of 17 patients with aSAH and implemented 'subarachnoid precautions' orders. Sound levels were similarly recorded in the rooms of 11 geographically-proximate, critically-ill control patients without aSAH. RESULTS: Linear mixed models were used to assess the difference in measurements between groups. Observations were combined into fifteen-minute windows, then group means and their differences were calculated and plotted to help identify what times of the day had significant differences. aSAH patients consistently experienced lower sound levels than control patients, with a statistically significant difference (p < 0.05) in mean sound levels at 62 of 96 intervals throughout the day. Overall, the mean sound level for aSAH patients was always between 62-63dBA, while the mean sound level experienced by control patients ranged between 64-66dBA. CONCLUSIONS: Implementation of patient-specific orders can have a supplementary reductive effect on noise exposure for aSAH patients in an intensive care unit that already utilizes universal noise abatement interventions.

A culturally informed lower-extremity complication prevention program for people living with diabetes in south India.

BACKGROUND: Diabetes and its complications are increasing in frequency worldwide. Lower-extremity complications carry a high risk for morbidity and mortality, yet are largely preventable through education and self-monitoring. In India, rural areas lack access to education, care, and treatment. Despite existing evidence-based programs to reduce diabetes-related lower-extremity complications in areas with limited resources, uptake and sustainability may be hampered by the lack of translation to the local cultural context. AIMS: To address this gap, this study used the Culturally Informed Healthy Aging nursing process to develop a lower extremity complication prevention program in a rural village. The paper describes the results of a community health needs assessment conducted annually from 2009 to 2014, and subsequent pilot test of an intervention incorporating these results. METHODS: The Culturally Informed Healthy Aging process is a naturalistic, inductive method used to identify and address health needs. Components include community partnership, community assessment, program planning, selection of health priorities, workgroup formation and translation of evidence, and program outcome evaluation. The programming is assessed using process evaluation, which allows for continuous monitoring and program modification. RESULTS: Community assessment revealed a number of values, beliefs, and practices related to foot care and assessment in rural south India. These were incorporated into culturally informed programming and evidence-based protocols were adapted for use in the local context. Programming resulted in increased community capacity for lower extremity complication prevention, accessible population screening, and culturally informed foot care education. DISCUSSION: Strengths, limitations and implications for care in rural India and other areas are discussed.

No Decrease in Early Ventilator-Associated Pneumonia After Early Use of Chlorhexidine.

BACKGROUND: Oral chlorhexidine prophylaxis can decrease occurrence of ventilator-associated pneumonia. However, the importance of timing has never been fully explored. OBJECTIVE: To see if early administration of oral chlorhexidine is associated with lower incidence of early ventilator-associated pneumonia (within 5 days of admission to intensive care unit) in intubated air ambulance patients. METHODS: A single-center, retrospective cohort study of intubated adults transported by a university-based air ambulance service and admitted to a surgical intensive care unit from July 2011 through April 2013. Primary exposure was time from helicopter retrieval to the first dose of oral chlorhexidine in the intensive care unit. Early chlorhexidine was defined as receipt of the drug within 6 hours of helicopter departure. The primary outcome was clinical diagnosis of early ventilator-associated pneumonia. Patients who were less than 18 years old, died within 72 hours of admission, or had pneumonia at admission were excluded. RESULTS: Among 134 patients, 49% were treated with chlorhexidine before 6 hours, 84% were treated before 12 hours, and 11% were treated for early pneumonia. Early chlorhexidine (before 6 hours; 15%) was not associated (P = .21) with early pneumonia (8%). Furthermore, median times to chlorhexidine did not differ significantly (P = .23) between patients in whom pneumonia developed (5.2 hours) and patients with no pneumonia (6.1 hours). CONCLUSIONS: Early administration of oral chlorhexidine in intubated patients was not associated with a reduction in the incidence of ventilator-associated pneumonia in a surgical intensive care unit with high rates of chlorhexidine administration before 12 hours.

Correlation of leukocytosis with early neurological deterioration following supratentorial intracerebral hemorrhage.

Intracerebral hemorrhage (ICH) is a devastating and common admitting diagnosis to intensive care units in the USA. Despite advances in critical care, patients with ICH often experience early neurological deterioration (END) in the first 72 hours after admission due to a variety of factors, including hematoma and cerebral edema evolution. The purpose of this study was to determine factors associated with END after ICH. Using the Duke University Hospital Neuroscience Critical Care Unit Database, we retrospectively identified patients with an admitting diagnosis of supratentorial ICH from January to December 2010, verified by CT imaging. END was defined as a decrease in the Glasgow Coma Scale score of ≥3 or death within the first 72 hours after hemorrhage. The chi-squared or t-test analysis was used to compare the groups, as appropriate. Multiple logistical regression modeling was performed to test for associations between likely predictors of END. Of the 89 subjects admitted with supratentorial ICH, we included 83 in the analysis based on complete datasets. Of these, 31 experienced END within 72 hours after onset of symptoms. ICH score, presence of midline shift on imaging, and white blood cell (WBC) count were used in a regression model for predicting END. WBC count demonstrated the greatest association with END. Patients with ICH are prone to END within the first few days after hemorrhage. Elevated WBC count appears predictive of deterioration. These data demonstrate that heightened inflammatory state after ICH may be related to early deterioration after injury.