Use of a Digital Air Leak Detection Device to Decrease Chest Tube Duration.

BACKGROUND: The aim of this evidence-based practice project was to determine if a digital air leak detection device could speed the identification of chest tube air leak cessation in patients after pulmonary lobectomy. Staff members assessing air leaks have varying levels of expertise, and the digital device is a limited resource in the study institution. A chest tube management algorithm is necessary to standardize care and determine which patients are most likely to benefit. IMPLEMENTATION: Twenty-five consecutive patients who underwent pulmonary lobectomy during the study period and continued to have a chest tube air leak on postoperative day 3 were monitored with digital air leak detection devices. The Mann-Whitney U test was used to compare chest tube duration and hospital length of stay between patients with digital devices and 259 patients who had traditional analog air leak detection devices (historical data from the departmental database over the previous 2 years). EVALUATION: Median chest tube duration and hospital stay were 1 day less in patients with digital devices than in those with traditional analog devices (P = .01 and P = .004, respectively), with a cost savings of $2659 per hospital day. Reductions in chest tube duration and length of stay aided in the development of a chest tube management algorithm. CONCLUSIONS: Critical care nurses are valued team members who treat patients after lung resections. Digital air leak detection devices can help them assess air leaks more accurately, benefiting the patients in their care.

Remote patient triage: Shifting toward safer telehealth practice.

ABSTRACT: Telehealth is a tool used to diagnose and treat patients at a distance. Telehealth quickly became essential during the COVID-19 pandemic as a result of stay-at-home orders. Regulatory waivers encouraged the use of telehealth as an alternative to the in-person encounter to limit the spread of disease. The pandemic incited a rapid growth in telehealth, and new legislation, new technologies, and providers new to virtual care changed the delivery of traditional telehealth. Postpandemic planning is necessary to support the safe integration of telehealth in the health care system. The purpose of this article is to discuss the current issues affecting telehealth and offer recommendations for safer virtual care. Critical considerations, beginning with an assessment of remote patient acuity, are needed to ensure the standard of care for telehealth is equivalent to the in-person setting. A triage protocol to screen patients seeking virtual services is required to prevent underestimation of severity of illness, sort patients to place of service, and determine if a need exists to escalate to an in-person evaluation or higher level of care. A standard approach to triage may minimize the risks to patient safety and support the appropriate use of telehealth technologies.

The value of faculty during student on-site evaluations.

The American Academy of Nurse Practitioners Certification Board recognizes the value of nurse practitioner faculty in evaluating students at the clinical site. The Board of Commissioners recently approved the awarding of clinical hours to nurse practitioner faculty for clinical site visits. This article outlines the rationale and procedure for conducting and documenting student visits that can be applied to recertification.

Fostering promotion and protection of the professional nurse practitioner role: A call to action.

The professional obligations to protect and promote nursing professional roles stem from the American Nurses Association Code of Ethics. Nurturing new generations of NPs to assume leadership role is foundational to succession planning and is critical to assuring NPs' continued contributions to health care. Making professional role development a priority at various points in educational programs, modeling ways to contribute to the profession, and encouraging professional organization membership are a few of the suggestions presented for the academic environment. In clinical settings, NP meetings are opportunities to engage NPs in legislative and policy issues important to practice. Attaining employee benefits, such as conference attendance, can promote commitment; and precepting NP students forges professional bonds. Present and future generations of NPs must assume responsibility for protecting and promoting the role. Many threats to NPs' scope of practice and other professional conundrums are ongoing. Instilling the values of protecting and promoting the NP role in students and colleagues and then identifying leaders to direct these efforts are essential to succession planning.

Foot care behaviors among adults with type 2 diabetes.

AIM: The aim of the study was to determine factors influencing foot care behaviors among adults with type 2 diabetes. METHODS: A correlational descriptive study was conducted with a random sample of 160 adults with type 2 diabetes from the public hospital between April and July 2014. RESULTS: Just over 15% of the sample had a history of foot ulcers and almost 42% had numbness/tingling and pain in their feet. Positive foot care behaviors were correlated with higher income, higher educational attainment, lower body weight, positive attitude and higher awareness of diabetes and its management. CONCLUSION: Targeting type 2 diabetes people with low level of education, low income and overweight may help to enhance their foot care and reduce foot complications in similar populations, Implications. Those most at risk of foot problems should be targeted for education to increase their awareness of ways to prevent and to manage foot problems.

Health Related Quality of Life among Omani Men and Women with Type 2 Diabetes.

The aim of this study was to explore predictors of health related quality of life (HRQoL) among men and women with type 2 diabetes. This cross-sectional descriptive study consisted of a random sample of 300 adults with type 2 diabetes in a selected public hospital. Euro-QoL and Revised Summary of Diabetes Self-Care Activities scales were used to collect data between January and June 2010. Schooling and ability to manage positively were highly significant predictors of quality of life (QoL) among women as compared to men. Age, prevention of activities of daily living and knowledge/management of diabetes were significant predictors of Health state among women as compared to men. Findings demonstrate that 30.6% (versus 35.7%) of the variance in the total QoL and 14% (versus 23%) of the variance in health state could be explained by personal and clinical characteristics among women and men, respectively. The study underlines the importance for nurse educators to assess HRQoL among men and women and to develop effective self-care management strategies based on personal and clinical characteristics.

Pharyngitis: soothing the sore throat.

Sore throat is a common presentation in primary care. Accurate identification of cause is important for appropriate treatment. Clinical scoring systems and diagnostic tests are recommended to identify group A beta-hemolytic streptococcus, which warrants guideline-driven therapy. The article explores causes, diagnosis, management, and possible complications of pharyngitis.

Tinnitus evaluation in primary care.

Tinnitus is a common, yet poorly understood problem. This symptom has many causes, both benign as well as serious. Patients can experience significant changes in quality-of-life related to symptom severity and duration. This article explores causes of tinnitus, evaluation in a primary care setting, and management strategies.

Management of a patient with severe sepsis.

Severe sepsis and septic shock affect more than 700,000 people annually and represent approximately $17 billion annually in health care costs. Mortality in patients with 3 or more failed organs is up to 70%. Early identification and prevention of severe sepsis and septic shock are key factors in impacting mortality rates. Health care providers must be knowledgeable in early identification and aggressive management. This case presentation outlines the components of care identified in the literature in the early and ongoing management of patients with severe sepsis and septic shock.

Stent thrombosis in a clopidogrel nonresponder.

Stent thrombosis is a known complication of percutaneous coronary intervention (PCI) following coronary stent deployment. Dual antiplatelet therapy is standard of care following PCI, however, recent studies demonstrate marked variability in platelet response to clopidogrel. This case study explores the management of a clopidogrel nonresponder who presented with recurrent stent thrombosis despite traditional pharmacologic management.

Pneumonia and encephalopathy in a patient with progressing Parkinson's disease and dementia.

The aging of the US population poses complex management issues for the health care provider in the acute and subacute setting. Although management guidelines exist to guide the treatment of individual disease processes, addressing goals of care in an aging patient with multiple comorbidities requires conversations unique to each patient and family. This case study examines the care of a patient with Parkinson's disease, dementia, and pneumonia admitted to the intensive care unit for altered mental status and metabolic encephalopathy. The pathophysiology and management of Parkinson's disease, dementia, community-acquired pneumonia, and dysphagia will be reviewed.

Acute chest syndrome of sickle cell disease.

As patients with sickle cell anemia (SCA) are living longer, health care practitioners increasingly manage the chronic effects of the disease. Although significant strides in management of children with SCA over the past decade resulted in decreased mortality, less research exists to guide the care of the adult with complications from the disease. This case study reviews the care of a young woman with SCA admitted to the hospital for vaso-occlusive crisis with subsequent acute chest syndrome and acute respiratory distress syndrome. The pathophysiology and management of SCA, vaso-occlusive crisis, and pulmonary and neurologic complications of the disease are discussed.

Ischemic middle cerebral artery stroke: a case study.

Stroke is the third leading cause of death, ranking lower only to cardiac disease and cancer. Patients with stroke involving large vessels, including the middle cerebral artery, account for almost half of all patients with ischemic strokes and have an increased risk for poor outcomes and mortality at 6 months. Despite the availability and use of published guidelines for the early management of ischemic stroke, evidence to support treatment modalities for cerebral edema is still lacking. This case presentation will include the pathophysiology of an ischemic stroke and outline the established management guidelines. Literature related to the management of cerebral edema will also be discussed.

Acute respiratory distress syndrome--a case study.

This case study explores the management of an unusually complicated case of acute respiratory distress syndrome (ARDS) extending over 52 days of hospitalization. Despite the utilization of conventional medical treatments and optimum respiratory support modalities, the patient's condition worsened and death was imminent without salvage therapy. After cardiovascular surgery consultation and spousal affirmation, extracorporeal membrane oxygenation (ECMO) therapy was initiated for 6 days. The patient recovered and was able to return to regular employment. The collaborative roles of the acute care nurse and intensivist will be discussed in association with clinical evaluation and management.

Ischemic colitis--a case study.

Mesenteric ischemia is a well-documented complication associated with the repair of abdominal aortic aneurysm, especially when it is accomplished on an emergent basis. This case study outlines the roles of the nurse practitioner, working collaboratively with the intensivist, in the management of a complicated case. Medical and surgical care, along with rationale, will be presented and discussed as they relate to the patient subject in this case study.

Evidence-based practice: use of the ventilator bundle to prevent ventilator-associated pneumonia.

PURPOSE: To examine critical care nurses' knowledge about the use of the ventilator bundle to prevent ventilator-associated pneumonia. METHOD: Published reports were reviewed for current evidence on the use of the ventilator bundle to prevent ventilator-associated pneumonia, and education sessions were held to present the findings to 61 nurses in coronary care and surgical intensive care units. Changes in the nurses' knowledge were evaluated by using a 10-item test, given both before and after the sessions. Changes in the nurses' practices related to ventilator-associated pneumonia, including elevation of the head of the bed to 30 degrees to 45 degrees , were observed in 99 intubated patients. RESULTS: After the education sessions, the nurses performed better on 8 of the 10 items tested (P from .03 to <.001). The areas of most significant improvement were elevation of the head of the bed (P < .001), charting of the elevation of the head of the bed (P= .009), oral care (P= .009), checking of the nasogastric tube for residual volume (P = .008), washing of hands before contact with patients (P < .001), and limiting the wearing of rings (P < .001) and nail polish (P = .04). Even after the education sessions, the nurses' compliance with hand-washing recommendations before contact with patients was low, though statistically some improvement was apparent. Contraindications to elevation of the head of the bed did not appear to affect the nurses' practices (P= .38). CONCLUSION: Education sessions designed to inform nurses about the ventilator bundle and its use to prevent ventilator-associated pneumonia have a significant effect on participants' knowledge and subsequent clinical practice.