RESUMEN
PURPOSE: Inadequate anticoagulation among elderly individuals with atrial fibrillation (AF) is a common problem. This synthesis of the literature review describes the pathophysiology of AF, explains the mechanism of action of warfarin (Coumadin), identifies factors that contribute to warfarin (Coumadin)-associated bleeding in the elderly population, and explores alternatives to warfarin (Coumadin) therapy. Implications for advanced practice nurse practice, education, and research will be discussed. METHODS: A literature search was conducted using Academic Search Premier, CINAHL Plus with Full Text, and Medline from 1999 to 2012. Search terms included warfarin (Coumadin), warfarin (Coumadin) genetics, diet, interactions, bleeding, atrial fibrillation, genetics, anticoagulation clinic, dabigatran, apixaban, rivaroxaban, and elderly. RESULTS: The literature indicates that the potential bleeding risk associated with warfarin (Coumadin) therapy limits its use in the elderly population. However, some studies have found warfarin (Coumadin) to be more effective than aspirin in preventing stroke. The safety profiles of both medications were comparable; also, effective alternatives to warfarin (Coumadin) that do not require routine testing are now available. CONCLUSIONS: Atrial fibrillation increases the probability of an embolic stroke, especially for the elderly population. Stroke risk and bleeding risk tools, in conjunction with patient preference, determine the best stroke prevention treatment. Anticoagulant clinics manage long-term warfarin (Coumadin) therapy effectively. Newer anticoagulants offer effective alternatives to warfarin (Coumadin) therapy.
Asunto(s)
Anticoagulantes/uso terapéutico , Fibrilación Atrial/tratamiento farmacológico , Fibrilación Atrial/fisiopatología , Enfermería de Cuidados Críticos , Hemorragia/inducido químicamente , Hemorragia/prevención & control , Warfarina/uso terapéutico , Anciano , Anticoagulantes/efectos adversos , Aspirina/efectos adversos , Aspirina/uso terapéutico , Humanos , Factores de Riesgo , Accidente Cerebrovascular/fisiopatología , Accidente Cerebrovascular/prevención & control , Warfarina/efectos adversosRESUMEN
INTRODUCTION: Delirium continues to be a major issue in intensive care units (ICUs). Sedation and lack of rapid eye movement (REM) sleep could be important factors in the development of delirium. Improper sedation may interfere with a patient's sleep pattern, specifically time spent in REM sleep, and could be a contributor to the development of delirium. The research team has discovered through this pilot study that there is a possible correlation between sedation, disruptions, and sleep. The goal of our research was to determine the relationship between these variables using a sleep monitor to capture actual sleep activity compared with patient characteristics and real-time activity in the ICU environment. MATERIALS AND METHODS: This was a pilot study of 7 new patients, aged 65 years or older, who were intubated and sedated. Data on patient sleep cycles were collected using a wireless sleep monitor. A time sheet was placed outside each room to record time and type of interruption during nighttime hours (9 PM-6 AM). The patients were observed for 1 to 7 nights dependent on their length of stay in the ICU. RESULTS: Preliminary results demonstrated that, on average, between 9 PM and 6 AM, 48% remained awake (range, 8%-88%), 30% were in light sleep (range, 2%-50%), 18.5% were in REM (range, 2%-60%), and 3.4% were in a deep sleep (range, 0%-9%). Subject 1 remained awake 52% to 88% of the time during the entire admission of 7 days, had an Intensive Care Delirium Screening Checklist score of 5, and had a self-extubation; sedation ordered was Versed as needed. Subject 5 had no interventions done between 12 midnight and 4:50 AM, with the exception of turning once, and had an REM recorded of 60% on 1 night, which equals to 4 hours 49 minutes of rest. All patients with the exception of 1 were on fentanyl and Versed drips with varying dose adjustments throughout their admission. IMPLICATIONS: Preliminary results show that there is a relationship between lack of REM sleep and delirium. The pilot study was a useful model to demonstrate the need for further investigation in a larger population.
Asunto(s)
Delirio/etiología , Delirio/enfermería , Unidades de Cuidados Intensivos , Anciano , Anciano de 80 o más Años , Femenino , Humanos , Hipnóticos y Sedantes/administración & dosificación , Hipnóticos y Sedantes/efectos adversos , Masculino , Proyectos Piloto , Polisomnografía , Fases del Sueño , Estudiantes de EnfermeríaRESUMEN
Cardiopulmonary arrest is a major health problem that claims lives daily in the United States. The adoption of a new standard of care or healthcare technology needs to be evaluated based on patient outcomes. This review focuses on this problem and possible solutions. This retrospective study reviews clinical characteristics of cardiac resuscitative events associated with "code blue" team response. Team-based investigations are led by a faculty mentor and typically span 2 to 4 semesters. Students take ownership of their projects and take the risks necessary to solve problems and get answers. This review indicates areas of concern that need to be improved to create better patient outcomes. Findings include that improved documentation will provide data elements for review analysis that then may be utilized to improve care related to cardiac arrest.
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Reanimación Cardiopulmonar/métodos , Desfibriladores/estadística & datos numéricos , Documentación/métodos , Paro Cardíaco/mortalidad , Tiempo de Tratamiento , Anciano , Anciano de 80 o más Años , Reanimación Cardiopulmonar/mortalidad , Bachillerato en Enfermería , Femenino , Paro Cardíaco/terapia , Mortalidad Hospitalaria , Hospitales Universitarios/estadística & datos numéricos , Humanos , Masculino , Persona de Mediana Edad , Estudios RetrospectivosRESUMEN
There is a need to explore and align priorities for building the foundation for nursing research in any institution. The Delphi technique was chosen as means of setting priorities for nursing research. This method enlisted feedback from all levels of nurses from various practice areas and various nursing roles. A series of 3 rounds of surveys provided feedback. Mixed methods were utilized to reach consensus on the various themes/topics that emerged in each round. In the final survey round, nurses ranked the final themes as to the level of importance, which resulted in identification of the key top 5 priorities. The priorities are the foundation for a research agenda for the coming years. The nursing research council, led by the clinical nurse specialist chairperson, reviewed the results and generated a comprehensive review of literature for current evidence on each priority topic. Evidence was critiqued, rated, and resulted in research questions that formulated the research agenda. The priorities were integrated within the pillars of excellence that are the foundation of the institutions' strategic goals. Using this technique provides a beneficial and structured way to gain input from those who need to own the work of building nursing research within an institution. Positive factors, such as beginning with input from all levels, the ease of providing feedback, and using a Delphi method study to bring alignment within an organization, serve to strengthen nursing research into a much broader scope and focus.
Asunto(s)
Relaciones Interprofesionales , Enfermeras Clínicas , Investigación en Enfermería/organización & administración , Personal de Enfermería en Hospital/psicología , Técnica Delphi , Humanos , Rol de la Enfermera , Investigación en Evaluación de Enfermería , Cultura Organizacional , Objetivos Organizacionales , Seguridad del PacienteRESUMEN
Atrial fibrillation is the most common complication occurring after coronary artery bypass graft surgery. The purpose of this article was to examine the incidence of, risk factors related to, and complications caused by postoperative atrial fibrillation. The pathophysiology and treatment of atrial fibrillation and postoperative atrial fibrillation will also be discussed.
Asunto(s)
Amiodarona/uso terapéutico , Antiarrítmicos/uso terapéutico , Fibrilación Atrial/prevención & control , Procedimientos Quirúrgicos Cardiovasculares , Amiodarona/farmacología , Antiarrítmicos/farmacología , Fibrilación Atrial/fisiopatología , Humanos , Magnesio/sangre , Magnesio/uso terapéutico , Complicaciones Posoperatorias/prevención & control , Factores de RiesgoRESUMEN
The interchangeable use of functional status with quality of life has lead to various interpretations when discussing outcomes related to functional status. The literature revealed gaps in the measurement and blurred conceptualization of functional status. Given the prognostic importance of functional status measures, the results highlight the importance of developing a reliable and efficient means of obtaining a measure of functional status resulting in the advancement of nursing science. Having a clear and concise measure of functional status will enable clinicians to implement effect treatment plans that would lead to a faster recovery, higher level of functional status, and a greater well-being.
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Actividades Cotidianas , Evaluación en Enfermería/métodos , Calidad de Vida , Humanos , RehabilitaciónRESUMEN
BACKGROUND: The dissatisfaction of family members with a restrictive visiting policy in a combined intensive care and step-down unit provides an opportunity for staff to develop better ways to meet the needs of patients and their families. A review of the evidence-based practice (EBP) literature as the measure of significance indicated that less restrictive visitation policies enhance patient and family satisfaction and offer many physiologic and psychological benefits to the patient. OBJECTIVE: The purpose of this study was to determine whether a less restrictive visitation policy could be implemented in the adult critical care department of a naval medical center. METHODS: Staff was educated on the use of EBP, specifically the Iowa-based model, and a less restrictive visitation policy was developed and implemented. RESULTS: Evaluation of the postintervention survey findings revealed higher patient and family satisfaction. CONCLUSIONS: The findings from this EBP project suggest that a more open visitation policy is feasible in adult critical care units, with an increase in overall satisfaction of patients and their families with regard to their stay in the intensive care unit.
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Comportamiento del Consumidor , Práctica Clínica Basada en la Evidencia , Unidades de Cuidados Intensivos/organización & administración , Política Organizacional , Visitas a Pacientes , Adulto , Implementación de Plan de Salud , Hospitales Militares , Humanos , Capacitación en Servicio , Modelos Teóricos , VirginiaRESUMEN
Based in Kuwait 3 years apart, the authors recount how nurses and corps staff, along with their physician counterparts, came together to form well-run medical facilities under adverse circumstances. Their respective hospitals became competent organizations because of specific formulas for success, along with preparation, identification of required skill sets, and making improvements based on experience. This article describes the training of medical, nursing, and corps staff, the facilities and resources required for managing casualties, and some of the more commonly encountered combat injuries and conditions.
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Competencia Clínica/normas , Hospitales Militares/organización & administración , Hospitales de Urgencia/organización & administración , Rol de la Enfermera , Personal de Enfermería en Hospital/organización & administración , Adaptación Psicológica , Actitud del Personal de Salud , Conducta Cooperativa , Educación Continua en Enfermería , Humanos , Diseño Interior y Mobiliario , Relaciones Interprofesionales , Guerra de Irak 2003-2011 , Kuwait , Enfermería Militar/educación , Enfermería Militar/organización & administración , Rol de la Enfermera/psicología , Personal de Enfermería en Hospital/educación , Personal de Enfermería en Hospital/psicología , Enfermedades Profesionales/prevención & control , Enfermedades Profesionales/psicología , Grupo de Atención al Paciente/organización & administración , Trastornos por Estrés Postraumático/prevención & control , Trastornos por Estrés Postraumático/psicologíaRESUMEN
In the 43 years since it was first described, cardiopulmonary resuscitation (CPR) has grown from an obscure medical theory to a basic first aid skill taught to adults and is now the near-universal technique used in CPR instruction. This article provides insight into the history of CPR. We explore the phenomenon of sudden cardiac arrest, the historical roots of CPR, current practice data and recommendations, and the society's role in the development of this life-saving technique. We conclude with a review of CPR's economic impact on the healthcare system and the ethical and policy issues surrounding CPR.
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Reanimación Cardiopulmonar , Adolescente , Adulto , Reanimación Cardiopulmonar/economía , Reanimación Cardiopulmonar/ética , Reanimación Cardiopulmonar/historia , Reanimación Cardiopulmonar/tendencias , Niño , Desfibriladores , Paro Cardíaco/mortalidad , Paro Cardíaco/terapia , Historia del Siglo XIX , Historia del Siglo XX , Historia Antigua , Humanos , Tasa de Supervivencia , Resultado del Tratamiento , Estados Unidos/epidemiologíaRESUMEN
This article provides a review of the use of propofol in the mechanically ventilated patient. The indications for the administration of propofol are presented as well as the contraindications, adverse effects, and nursing care.