Residual neuromuscular blockade in critical care.

Neuromuscular blockade is a pharmacological adjunct for anesthesia and for surgical interventions. Neuromuscular blockers can facilitate ease of instrumentation and reduce complications associated with intubation. An undesirable sequela of these agents is residual neuromuscular blockade. Residual neuromuscular blockade is linked to aspiration, diminished response to hypoxia, and obstruction of the upper airway that may occur soon after extubation. If an operation is particularly complex or requires a long anesthesia time, residual neuromuscular blockade can contribute to longer stays in the intensive care unit and more hours of mechanical ventilation. Given the risks of this medication class, it is essential to have an understanding of the mechanism of action of, assessment of, and factors affecting blockade and to be able to identify factors that affect pharmacokinetics.

The mock trial: a collaborative interdisciplinary approach to understanding legal and ethical issues.

To provide high-quality, safe, patient-centered care, RNs must exhibit a strong understanding of legal and ethical issues. The authors describe an interdisciplinary teaching learning strategy, the premock, actual, and postmock trial, to augment student retention of legal and ethical concepts and enhance the development of their personal accountability.

Developing an interactive microsimulation method in pharmacology.

Pharmacology decision making requires clinical judgment. The authors created interactive microsimulation applying drug information to varying patients' situations. The theory-based microsimulation requires situational analysis for each scenario. The microsimulation uses an interactive format that allows the participant to navigate through three separate virtual clients' situations. Correct clinical decisions are rewarded by sounds and by video footage of the patient improving. Conversely, incorrect choices show video footage of the patient decompensating. This micro-simulation was developed to help students learn from the consequences of incorrect medication decision making in the virtual world without harming patients. The feedback of watching an incorrect decision on a patient helps students associate cause and effect on patient outcomes. The microsimulation reinforces the ease with which medication errors can occur and the extent of possible sequalae. The development process used to incorporate the technology in the nursing curriculum is discussed.

Pivotal role of platelets in critical illness: evidence behind clinical interventions.

Arteriosclerosis, chronic renal failure, and diabetes are all diseases in which the platelet cycle plays an important role. Effective interventions for these diseases are emerging from vascular biology in general and from the study of platelets in particular. Platelet cell processes are powerful modulators of immunology, thrombosis, fibrinolysis, and angiogenic responses. Platelet active drugs intervene in platelet activation, adhesion, aggregation, and secretion. The purpose of this article is to link the unfolding of platelet cell processes and the impact of platelet active medication therapy to the care of critically ill patients with selected diseases.