A Prospective Study of Pressure Injury Healing Rate and Time and Influencing Factors in an Acute Care Setting.

OBJECTIVE: To determine pressure injury (PI) healing rate and time and identify influencing factors. METHODS: A prospective cohort research design was used. Data collection was performed between May 2015 and August 2018. The study participants were 77 inpatients who developed at least one PI during their stay in a university hospital. Researchers assessed participants' demographic (age, sex); physical (incontinence, activity of daily living, and nutrition status); physiologic (serum total protein, albumin, and creatinine, blood glucose, and hemoglobin levels); and disease- (diagnosis, number of comorbidities, and cardiovascular comorbidity), wound- (PI stage and size at first detection, and Pressure Ulcer Scale for Healing score), and treatment-related (IV nutrition supply and albumin infusion) factors. RESULTS: Across the 77 patients, 91 PIs developed. Of these, 54 (59.3%) healed with a mean healing time of 17.63 days. The healing rate was better, and the healing time was shorter for stage 2 PIs compared with unstageable or deep-tissue PIs. Factors influencing PI healing rate were number of comorbidities, cardiovascular comorbidity, incontinence, PI stage at first detection, IV nutrition supply, and mean serum creatinine level. Factors influencing PI healing time were number of comorbidities, cardiovascular comorbidity, and PI stage at first detection. CONCLUSIONS: To reduce hospital stays, PI-related complications, and mortality, evidence-based management strategies for PIs are needed. The findings of the present study may contribute to the development of such strategies.

Correlates of cognitive impairment in patients with chronic kidney failure on haemodialysis: Systematic review and meta-analysis.

AIM: To review and identify correlates of cognitive impairment in patients with chronic kidney failure (CKF) on haemodialysis. BACKGROUND: The literature is consistent with regard to the high prevalence of cognitive impairment among patients with CKF on haemodialysis and its dependence on multidimensional risk factors. DESIGN: Systematic review and meta-analysis based on Cochrane Handbook and PRISMA. DATA SOURCES: Electronic searches of the MEDLINE, EMBASE, Cochrane Library databases and major Korean databases were used. Only original research that assessed correlates of cognitive impairment in patients with CKF on haemodialysis and published between 2004-2016 in English or Korean were included. REVIEW METHODS: Studies were selected according to the PICOS: Population (chronic kidney failure patients with cognitive impairment on haemodialysis); Intervention (not applicable); Comparison (healthy controls or patients with chronic kidney failure on haemodialysis without cognitive impairment); Outcome (cognitive impairment); and Study design (primarily nonexperimental correlational studies and studies with experimental, quasi-experimental, or pre-post cohort designs). Q-test and I2 index were used to examine study homogeneity. RESULTS: A total of 39 studies were finally included. Age, gender, stroke history, difficulties in activities of daily life, haemoglobin levels, pain, sleep difficulties, and depression were found to be significant correlates of cognitive impairment. CONCLUSIONS: Nurses should be aware that the risk of cognitive impairment in patients with CKF on haemodialysis can be significantly higher for elders, women and in patients with a stroke, greater difficulties in activities of daily living, lower haemoglobin concentrations, higher pain levels, sleep difficulties, or depression.

Construct validity and reliability of the Full Outline of UnResponsiveness (FOUR) score in spontaneous subarachnoid haemorrhage caused by aneurysm rupture.

AIMS AND OBJECTIVES: This study aimed at examining the construct validity and reliability of the Full Outline of UnResponsiveness score in patients with spontaneous subarachnoid haemorrhage caused by aneurysm rupture. BACKGROUND: The Full Outline of UnResponsiveness score is known to be a valid and reliable consciousness assessment tool and provides comprehensive information not given by the Glasgow Coma Scale. However, the validity and reliability of this tool have not been tested in patients with spontaneous subarachnoid haemorrhage. DESIGN: A nonexperimental, descriptive, correlational study design was adopted. METHODS: The STROBE statement was used for reporting this study. The study participants were 72 patients with spontaneous subarachnoid haemorrhage caused by aneurysm rupture, admitted to an intensive care unit in a university hospital between August 2016-July 2017. Data on demographic characteristics, Hunt-Hess clinical stage scores, Fisher CT stage scores, disease-related characteristics, Full Outline of UnResponsiveness scores and 1-month Glasgow Outcome Scale scores were subjected to analysis. RESULTS: Full Outline of UnResponsiveness scores were found to have significant correlations with scores on Hunt-Hess clinical or Fisher CT stage tool and adequately predict 1-month recovery. This tool also exhibited excellent inter-rater agreement and internal consistency. CONCLUSIONS: The Full Outline of UnResponsiveness score is valid and reliable for consciousness evaluation in spontaneous subarachnoid haemorrhage. It has been believed that use of this tool may help prevent negative consequences arising from impaired consciousness and improve the outcomes of patients with spontaneous aneurysmatic subarachnoid haemorrhage. RELEVANCE TO CLINICAL PRACTICE: The Full Outline of UnResponsiveness score is a consciousness assessment tool that provides more neurological detail because it includes consideration of brainstem reflexes, visual tracking, breathing patterns and respiratory drive, and can be applied in cases of spontaneous subarachnoid haemorrhage and other types of brain injury, especially in patients with severe consciousness impairment.

Identification of symptom clusters and their synergistic effects on quality of life in rheumatoid arthritis patients.

AIMS: To examine the presence of symptom clusters and synergistic effects of symptom clusters on quality of life in rheumatoid arthritis patients. BACKGROUND: Rheumatoid arthritis patients frequently experience multiple concurrent symptoms of pain, fatigue, and depression. DESIGN: A nonexperimental, cross-sectional correlation design. METHODS: The study participants were 179 rheumatoid arthritis patients. Data were collected between August and December 2016. A hypothetical model was developed based on the Theory of Unpleasant Symptoms Model: physiological antecedents included disease activity and obesity; symptoms of pain, fatigue, and depression were hypothesized as being clustered, and quality of life was taken as the outcome variable. RESULTS: Disease activity had significant direct effects on pain, fatigue, and depression and indirect effects on fatigue and depression, whereas obesity had a significant direct effect on fatigue alone. Three symptom clusters, namely, pain fatigue, fatigue depression, and pain-fatigue depression were identified and found to have significant synergistic effects on quality of life. CONCLUSIONS: Our findings support the importance of managing clusters of symptoms simultaneously, that is, collective symptom management. Inter-cluster dynamics between symptoms should be considered when nurses develop symptom management strategies or self-management programs to improve the quality of life of rheumatoid arthritis patients.

A 2-year prospective follow-up study of temporal changes associated with post-stroke cognitive impairment.

AIMS: To explore temporal patterns of change in cognitive impairments during the 2 years following stroke and to identify factors that affect these temporal changes. BACKGROUND: Despite the prognostic importance, temporal changes in post-stroke cognitive impairment have not been systematically investigated. DESIGN: A non-experimental, prospective, longitudinal descriptive study design. METHODS: Fifty-two stroke patients were enrolled. Data were collected from April 2015 to September 2017. Cognitive function was evaluated at 5 different times (immediately, and at 3, 6, 12, and 24 months post-stroke). RESULTS: Significant changes in cognitive function following stroke exhibited an "s-shaped" curve, and the most rapid changes were observed between 3 and 6 months after stroke. The incidence of post-stroke cognitive impairment ranged from 23.1% to 42.3% and was highest at 3 months and lowest at 6 months. Gender, educational level, pre-stroke cognitive and functional abilities, haematoma, and brain surgery were associated with incidence of post-stroke cognitive impairment. CONCLUSIONS: The ongoing changes exhibited by patterns of cognitive impairment provide evidence that consistent efforts are required to achieve positive changes in post-stroke cognitive function. Our findings may be helpful to develop nursing care strategies aimed at improving cognitive ability and consequently the quality of life of stroke patients.

A tailored relocation stress intervention programme for family caregivers of patients transferred from a surgical intensive care unit to a general ward.

AIMS AND OBJECTIVES: To develop and examine a relocation stress intervention programme tailored for the family caregivers of patients scheduled for transfer from a surgical intensive care unit to a general ward. BACKGROUND: Family relocation stress syndrome has been reported to be similar to that exhibited by patients, and investigators have emphasised that nurses should make special efforts to relieve family relocation stress to maximise positive contributions to the well-being of patients by family caregivers. DESIGN: A nonequivalent control group, nonsynchronised pretest-post-test design was adopted. METHODS: The study subjects were 60 family caregivers of patients with neurosurgical or general surgical conditions in the surgical intensive care unit of a university hospital located in Incheon, South Korea. Relocation stress and family burden were evaluated at three times, that is before intervention, immediately after transfer and four to five days after transfer. RESULTS: This relocation stress intervention programme was developed for the family caregivers based on disease characteristics and relocation-related needs. In the experimental group, relocation stress levels significantly and continuously decreased after intervention, whereas in the control group, a slight nonsignificant trend was observed. Family burden levels in the control group increased significantly after transfer, whereas burden levels in the experimental group increased only marginally and nonsignificantly. No significant between-group differences in relocation stress or family burden levels were observed after intervention. CONCLUSIONS: Relocation stress levels of family caregivers were significantly decreased after intervention in the experimental group, which indicates that the devised family relocation stress intervention programme effectively alleviated family relocation stress. RELEVANCE TO CLINICAL PRACTICE: The devised intervention programme, which was tailored to disease characteristics and relocation-related needs, may enhance the practicality and efficacy of relocation stress management and make meaningful contribution to the relief of family relocation stress, promote patient recovery and enhance the well-being of patients and family caregivers.

Temporal patterns of change in vital signs and Cardiac Arrest Risk Triage scores over the 48 hours preceding fatal in-hospital cardiac arrest.

AIM: To determine temporal patterns of vital sign and Cardiac Arrest Risk Triage score changes over the 48-hour period preceding cardiac arrest in an ICU setting. BACKGROUND: Vital sign instability usually occurs prior to cardiac arrest. However, few studies have been conducted on the temporal patterns of individual vital signs preceding cardiac arrest. DESIGN: A retrospective case-control study. METHODS: The study subjects were 140 ICU patients (1 June 2011-31 December 2012): 46 died of cardiac arrest (case group), 45 died of other illnesses (control I group) and 49 were discharged after recovering (control II group). RESULTS: Initial detectable changes in blood pressure appeared 18-20 hours and became dramatic at 5-10 hours before cardiac arrest. Noticeable changes in heart rates began at 4 hours and became more prominent at 2 hours pre-arrest. No apparent patterns in respiratory rate changes were observed. Body temperatures usually indicated a hypothermic state pre-arrest. Cardiac Arrest Risk Triage scores were 16-18 at 48 hours pre-arrest and then continuously increased to 20. Only mean values of systolic blood pressures were significantly different between the three study groups. Mean diastolic blood pressures, heart rates, respiratory rates and Cardiac Arrest Risk Triage scores differed between the case and control II groups and between the control I and II groups. CONCLUSION: The study demonstrates vital sign instability preceded cardiac arrest and that the temporal patterns of changes in individual vital signs and Cardiac Arrest Risk Triage scores differed between groups. The findings of this study may aid the development of management strategies for cardiac arrest.

Temporal changes in physiological parameters of systemic inflammatory response syndrome during the three days prior to a diagnosis of sepsis: a case-control study.

AIMS AND OBJECTIVES: This study was conducted to determine temporal patterns of early changes in physiological parameters of systemic inflammatory response syndrome over three days prior to a diagnosis of sepsis. BACKGROUND: Early detection and timely management of systemic inflammatory response syndrome are often not implemented due to a failure to recognise or diagnose systemic inflammatory response syndrome. DESIGN: A retrospective case-control study design was adopted. METHODS: All 81 study subjects in an intensive care unit were included: 33 case subjects who received a definitive diagnosis of sepsis and 48 control patients who were not diagnosed with systemic inflammatory response syndrome or sepsis. Vital signs (temperatures, heart rates, blood pressures and respiratory rates) and white blood cell count, urine output, serum creatinine concentration, platelet count and serum glucose level data were collected for one, two and three days prior to sepsis diagnosis. RESULTS: Homogeneity test revealed greater proportions of the aged and subjects with diabetes mellitus, hypertension and wound in the case group. Analysis also showed significant intergroup differences in systemic inflammatory response syndrome criteria score, heart rates, platelet counts and blood glucose levels, but no intergroup differences in body temperatures, blood pressures, respiratory rates, urine outputs or serum creatinine levels. A larger proportion of case subjects were fitted with a central venous or Foley catheter. CONCLUSIONS: The presence of a wound, hypertension or diabetes mellitus, and the use of an invasive medical device may increase the risk of systemic inflammatory response syndrome. Of the physiological parameters examined, heart rate, platelet counts, and blood glucose levels might serve as significant early signs of systemic inflammatory response syndrome. RELEVANCE TO CLINICAL PRACTICE: Caution should be observed whenever diabetic or hypertension patients develop sudden and persistent hyperglycaemia or tachycardia, and nurses should also be aware of the potential for systemic inflammatory response syndrome in patients with a central venous or indwelling urinary catheter.

A Comprehensive Review of Central Post-Stroke Pain.

Although central post-stroke pain is widely recognized as a severe chronic neuropathic pain condition, its consolidated definition, clinical characteristics, and diagnostic criteria have not been defined due to its clinically diverse features. The present study was undertaken to comprehensively review current literature and provide a more complete picture of central post-stroke pain with respect to its definition, prevalence, pathophysiology, clinical characteristics, and diagnostic problems, and to describe the range of therapies currently available. In particular, nursing care perspectives are addressed. It is hoped that this review will help nurses become knowledgeable about central post-stroke pain and provide valuable information for the drafting of effective nursing care plans that improve outcomes and quality of life for patients with central post-stroke pain.

Clinical validity of a relocation stress scale for the families of patients transferred from intensive care units.

AIMS AND OBJECTIVES: This study was conducted to develop a family relocation stress scale by modifying the Son's Relocation Stress Syndrome Scale, to examine its clinical validity and reliability and to confirm its suitability for measuring family relocation stress. BACKGROUND: The transfer of ICU patients to general wards is a significant anxiety-producing event for family members. However, no relocation stress scale has been developed specifically for families. DESIGN: A nonexperimental, correlation design was adopted. METHODS: The study subjects were 95 family members of 95 ICU patients at a university hospital located in Incheon, South Korea. Face and construct validities of the devised family relocation stress scale were examined. Construct validity was examined using factor analysis and by using a nomological validity test. Reliability was also examined. RESULTS: Face and content validity of the scale were verified by confirming that its items adequately measured family relocation stress. Factor analysis yielded four components, and the total variance explained by these four components was 63·0%, which is acceptable. Nomological validity was well supported by significant relationships between relocation stress and degree of preparation for relocation, patient self-care ability, family burden and satisfaction with the relocation process. The devised scale was also found to have good reliability. CONCLUSIONS: The family relocation stress scale devised in this study was found to have good validity and reliability, and thus, is believed to offer a means of assessing family relocation stress. RELEVANCE TO CLINICAL PRACTICE: The findings of this study provide a reliable and valid assessment tool when nurses prepare families for patient transfer from an ICU to a ward setting, and may also provide useful information to those developing an intervention programme for family relocation stress management.

Patterns and clinical correlates of pain among brain injury patients in critical care assessed with the critical care pain observation tool.

This study was conducted to assess the patterns and clinical correlates of acute pain in brain injury patients during the critical care period using the Critical Care Pain Observation Tool (CPOT). Data were collected from 31 brain-injury patients admitted to an intensive care unit (ICU) at a university hospital located in Incheon, Republic of Korea. Glasgow Coma Scale and CPOT scores were assessed on days 1, 3, 6, 9, and 14 after ICU admission. Results showed that temporal changes in pain intensity displayed a consistent pattern in critical care patients with a brain injury during the first 14 days of ICU admission. Mean pain score was highest on day 1, decreased rapidly to reach a minimum on day 3 or 6, and then increased on day 9. In most patients, pain reduced slightly on day 14. Mean CPOT scores were significantly higher in the nonsurgery group than in the surgery group. There was also a nonsignificant trend of higher pain intensity scores among patients with moderate brain injury compared with those with severe injury. CPOT scores immediately after endotracheal suctioning were significantly higher than before endotracheal suctioning, but CPOT scores 20 minutes after suctioning were similar to those before suctioning. The present study may be meaningful in terms of presenting valid clinical information regarding the patterns and characteristics of acute pain in brain injury patients who are often unable to self-report on the presence and intensity of pain.

Paroxysmal Sympathetic Hyperactivity After Acquired Brain Injury: An Integrative Literature Review.

BACKGROUND: Paroxysmal sympathetic hyperactivity may occur in patients with acute brain injury and is associated with physical disability, poor clinical outcomes, prolonged hospitalization, and higher health care costs. OBJECTIVE: To comprehensively review current literature and provide information about paroxysmal sympathetic hyperactivity for nurses. METHODS: An integrative literature review was conducted according to Whittemore and Knafl's method. The search was conducted from October 2020 through January 2021. The main targets of the literature search were definition, incidence rate, causes, clinical characteristics, pathophysiology, diagnosis, and treatment of paroxysmal sympathetic hyperactivity in pediatric and adult patients. The results were reported using the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. RESULTS: The most characteristic clinical features of paroxysmal sympathetic hyperactivity are hypertension, tachycardia, tachypnea, hyperthermia, diaphoresis, and abnormal motor posturing. Reported incidence rates of paroxysmal sympathetic hyperactivity in patients with brain injury range from 8% to 33%. Various diagnostic criteria have been proposed; most are based on clinical symptoms. Ruling out other causes of the signs and symptoms of paroxysmal sympathetic hyperactivity is important because the signs and symptoms are nonspecific. The major goals of paroxysmal sympathetic hyperactivity management are avoidance of stimuli that may trigger a paroxysmal episode, inhibition of sympathetic overactivity, and prevention of damage to other organs. CONCLUSIONS: Critical care nurses should be aware of the signs and symptoms of paroxysmal sympathetic hyperactivity in patients with acute brain injury. Early identification is important to ensure timely treatment for patients with paroxysmal sympathetic hyperactivity.

Development and Evaluation of a Blended Self-Management Program for Metabolic Syndrome in Patients With Rheumatic Diseases.

Rheumatic diseases are known to be associated with the development of metabolic syndrome, which increases mortality rates due to cardiovascular complications. Although a variety of self-management programs for rheumatic diseases have been developed, few have concentrated on metabolic syndrome. This study aimed to develop and verify a blended (a mixture of telephone and online interventions) metabolic syndrome self-management program. The program was developed in four stages: analysis to identify program contents, website design, website development, and validity testing. A quasi-experimental nonequivalent control group, pretest-posttest design was adopted to verify the program effectiveness in 54 patients with rheumatic disease. The program was initially implemented via telephone for 4 weeks and then self-administered via a web-based platform for 20 weeks. Indices of metabolic syndrome and self-management and quality of life scores were measured as outcome variables. Data were collected three times: before intervention, after 4 weeks of telephone interventions, and after 20 weeks of online self-interventions. The devised program had a significant overall effect on metabolic syndrome indices, metabolic syndrome-related self-management behaviors, and quality of life. Detailed analysis showed the program effectively reduced body mass index, waist circumference, systolic blood pressure, and blood glucose levels and improved metabolic syndrome self-management behaviors. Based on our findings, it can be expected that the use of this program may retard or prevent the progression of metabolic syndrome by improving some metabolic syndrome indices and metabolic syndrome-related self-management behaviors, which are key components of care in rheumatic disease patients with metabolic syndrome. This web-based program appears to be beneficial in public health care settings because it is cost-effective, readily available, and may provide long-term support.

Temporal Changes in Metabolic Syndrome Indices and Factors of Metabolic Syndrome Development in Patients With Rheumatic Disease: A Prospective Cohort Study.

Patients with rheumatic disease have a high prevalence of metabolic syndrome. The purpose of this study was to investigate temporal changes in metabolic syndrome indices and to identify factors influencing metabolic syndrome development. A prospective cohort study design was adopted. The study participants were 68 outpatients with a rheumatic disease at an outpatient clinic of a university hospital. Data on demographics, health-related characteristics, steroid use, serum C-reactive protein levels, and metabolic syndrome indices were collected between December 2017 and March 2021. Temporal changes in body mass indices, serum triglyceride, and cholesterol levels were significant. Body mass indices, diastolic blood pressure, serum triglyceride, high-density lipoprotein, and fasting blood glucose levels at time of diagnosis were found to influence metabolic syndrome development. Temporal changes in serum triglyceride, cholesterol, and fasting blood glucose levels were significantly influenced by inflammatory status. The findings demonstrate the importance of controlling inflammatory activities in the context of inhibiting the progression of metabolic syndrome and rheumatic diseases.

The identification of multiple symptom clusters and their effects on functional performance in cancer patients.

AIMS AND OBJECTIVES: To identify cancer-related symptom clusters, to explore their inter-relationships and to examine the effects of single symptoms and the synergistic effects of symptom clusters on functional performance using path analysis by structural equation modelling in patients with various types of cancer. BACKGROUND: Recent studies suggest that cancer patients frequently experience three or more concurrent related symptoms and that this clustering of symptoms is likely to have negative synergistic impacts on outcomes, because of the complicated dynamics of clusters. DESIGN: A cross-sectional design. METHODS: One hundred and ten patients with various types of cancer were recruited as in- and out-patients at a University Hospital in Incheon, South Korea. Data collection was performed using a questionnaire and by direct interview. Pain, insomnia, fatigue, depression and functional performance were measured. RESULTS: The developed model was composed of antecedents, symptom clusters and outcomes. Of the symptoms often encountered as clusters in cancer patients, insomnia, depression and fatigue were found to have significant single (direct) effects on functional performance. Seven symptom clusters were identified between pain and functional performance, three between insomnia and functional performance and one between depression and functional performance. These single symptoms and symptom clusters were found to have significant synergistic effects on functional performance and to explain 24% of functional performance variance. CONCLUSIONS: Multiple cancer-related symptom clusters may occur and the dynamics within symptom clusters is complicated. Our findings provide sound evidence regarding the importance of assessing and managing clusters of symptoms simultaneously rather than focusing on single symptoms. RELEVANCE TO CLINICAL PRACTICE: A comprehensive understanding of symptom clusters in cancer patients would help establish valid diagnostic symptom cluster entities and aid the development of subjective/objective phenotypic criteria for symptom cluster based diagnoses and of nursing care protocols for managing symptom clusters.

Factors That Influence Sleep Disturbance and the Mediating Effects of Depression on Sleep Disturbance in Patients With Rheumatoid Arthritis.

Little is known about the nature of relationships between sleep disturbance and influencing factors in rheumatoid arthritis. The purpose of this study was to identify factors that influence sleep disturbance and to evaluate mediating effects of depression on sleep disturbance. A nonexperimental, descriptive, correlational study design was adopted. One hundred patients with rheumatoid arthritis were recruited. Inflammatory status and levels of pain, fatigue, functional disability, depression, and sleep disturbance were measured. The factors that directly influenced sleep disturbance were gender, rheumatoid arthritis duration, serum C-reactive protein level, fatigue, and depression. Depression was found to have mediating effects on the relationships between sleep disturbance and arthritis symptoms. Pain, fatigue, and depression were found to have significant direct or indirect impacts on sleep disturbance. Our findings may improve understanding of sleep disturbance and aid the development of effective nursing management strategies for patients with rheumatoid arthritis suffering from sleep disturbance.

Development and Validity Testing of a Morning Stiffness Assessment Scale for Patients with Rheumatoid Arthritis.

Morning stiffness is known to exert a significant impact on functional ability, quality of life, and employment status. There is an increasing need for a valid, reliable tool to comprehensively assess morning stiffness. The purpose of this study was to develop and verify a Morning Stiffness Assessment Scale. Items were developed on the basis of a framework of the conceptual attributes of morning stiffness. Validity and reliability tests were conducted on the devised scale. Eighty-five patients with rheumatoid arthritis were included to verify the devised scale. A 10-item Morning Stiffness Assessment Scale was developed. Its content and construct validities were well supported. The scale was found to have good reliability. The devised scale is simple and brief, but it provides a more comprehensive means of evaluation for morning stiffness. We believe this scale offers a clinically useful means of properly assessing morning stiffness and has potential utility for evaluating the effects of morning stiffness treatments.

Alterations in serum osmolality, sodium, and potassium levels after repeated mannitol administration.

This study was undertaken to evaluate whether significant alterations in serum osmolality, [Na+], and [K+] occur after the repeated dosing of mannitol and whether these imbalances increased accordingly with the progress of mannitol application. This study was conducted by performing a retrospective medical record review of brain injury patients who were admitted to the neurological intensive care units of a university hospital located in Incheon, South Korea. Data on intracranial pressure and serum [Na+], [K+], and osmolality levels were collected from the first to the seventh day of mannitol administration. Our results showed that the highest rate of hyperosmolality occurred on the first day of mannitol administration and that subsequently its rate reduced, although it still maintained high (70-77%). Regarding the serum [Na+], hypernatremia was observed in 10% of the subjects on the first day of mannitol administration and in 10-21% throughout the 7-day mannitol administration period. In this study, hyponatremia was observed in 12.2% of our subjects on the first day of mannitol administration and in 9-24% throughout the 7-day period. In addition, no statistical differences were found between changes in the rates of hypernatremia and hyponatremia throughout the 7-day administration period. The most notable finding was the high rates of hypokalemia observed during mannitol administration. Hypokalemia was observed in 22% of subjects on the first day and continuously increased to 52.3%, and this increase was significant. On the other hand, the rate of hyperkalemia was almost negligible. Our findings appear to provide clear evidence of electrolyte imbalances after repeated mannitol administration. Accordingly, careful monitoring of electrolyte status is essential when repeated doses of mannitol are given. We recommend that the practice of administering repeated dose of mannitol for prophylactic purposes be reevaluated.

Changes in the acute functional and cognitive disability states of severe hemorrhagic stroke patients.

The purpose of this study was to characterize temporal patterns of functional and cognitive disability changes during the acute period in hemorrhagic stroke patients. The study subjects were 62 hemorrhagic stroke patients admitted to a surgical intensive care unit at a university hospital located in Incheon, South Korea. As outcome variables, functional disability, cognitive ability, and employment status were evaluated directly at 1, 3, and 6 months after admission. The results showed that significant improvements in functional and cognitive ability were observed between 1 and 6 months after admission. In terms of functional disability, subjects considered their overall functional ability (dependence on others) to be less recovered than the specific functional abilities (feeding, grooming, or toileting): 75% of the subjects stated that they were completely independent on others, whereas 92.9%, 83.9%, and 83.9% of subjects indicated that they were completely independent for feeding, grooming, and toileting at the 6-month assessments, respectively. In terms of cognitive ability, attention, communication, and memory recovery rates were found to be relatively good. However, the proportion of subjects that achieved complete problem solving and safety and social behavior recovery were lower than those that achieved attention, communication, and memory recovery. Our findings can provide the empirical evidences when neuroscience nurses use educational and supportive strategies for rehabilitation of hemorrhagic stroke patients.

An Integrative Review of Cerebral Salt Wasting Syndrome.

BACKGROUND: Although cerebral salt wasting syndrome (CSWS) is widely recognized, its clinical characteristics, diagnostic criteria, and management have not been clearly defined. This study was undertaken to comprehensively review current literature and provide a more complete picture of CSWS. This review also aimed to provide information for nurses on how to differentiate cerebral salt wasting syndrome from syndrome of inappropriate antidiuretic hormone secretion. METHODS: An integrative review was performed. Searches were conducted between May and July 2018. The primary information sources were CINAHL, Google Scholar, MEDLINE, PubMed, Scopus, and Web of Science. Included articles were published from 1954 to July 2018. RESULTS: The essential features of CSWS are hyponatremia, hypovolemia, and increased urine output. Treatment regimens may be determined based on the acuity and severity of hyponatremia and hypovolemia as well as evident symptoms and signs. CONCLUSION: This review may help neuroscience nurses become knowledgeable about CSWS for the drafting of appropriate nursing care plans and also be able to differentiate CSWS from syndrome of inappropriate antidiuretic hormone secretion as early as possible for timely and proper management.