Cardiorenal Syndromes: Evaluation and Management.

Cardiorenal syndromes (CRS) describe disorders effecting critically ill and hospitalized patients with concurrent heart and kidney dysfunction. The presence of CRS is associated with a poor prognosis. This article is a review of the epidemiology, pathology, and evidence-based evaluation and management strategies for cardiorenal syndromes. All nurses should understand the significance that chronic heart and kidney disease has upon a patient's risk for CRS. Registered and advanced practice nurses should maintain the knowledge and skills of understanding the pathology of CRS to improve the evaluation and management of patients who present with CRS.

Development of the Doctor of Nursing Practice Nurse Practitioner Minimum Data Set (DNP NP MDS).

BACKGROUND: While the number of Doctor of Nursing Practice (DNP) programs has grown steadily, there is limited data on how national organizations are collecting data on DNP-prepared nurse practitioners (NPs) and no standard instrument exists to collect data on DNP-prepared NPs. PURPOSE: The purpose of this study was to develop a universal minimum data set (MDS) for the DNP-prepared NP population. METHOD: Instrument development consisted of several sequential stages, including conceptualization and item generation, preliminary evaluation of items, field testing the survey, and analysis of scale development data. FINDINGS: A set of 16 core variables and 19 additional variables were developed to collect standardized data on the demographics, education, and practice patterns of DNP-prepared NPs. Pilot testing revealed high correlations between the activities DNP-prepared NPs are prepared for and typically participate in a typical workweek and in their career. The MDS demonstrated high reliability in our sample. DISCUSSION: The DNP NP MDS can be used for data collection by various stakeholders, including national organizations, to facilitate improved tracking of outcome data for the DNP-prepared NP workforce. It can also provide data-driven support for the need and significance of the DNP degree for NPs.

Nurse Practitioners Improving Emergency Department Quality and Patient Outcomes.

Emergency departments across the United States struggle to balance the overutilization of emergency services. Nurse practitioners (NPs) practicing in emergency departments improve quality indicators leading to the increased efficiency, timeliness, and effectiveness of care. NPs providing emergency services improve multiple national metrics, such as door-to-provider time, patient satisfaction, diagnostic test ordering, and left without being seen rates. NPs should be aware of the positive impact they make on the quality of care. NPs should monitor and trend patient outcomes they directly effect. More research is needed to identify ways NPs can continue to improve the quality of emergency services provided.

Nursing Management for Patients Postoperative Cardiac Implantable Electronic Device Placement.

As cardiac implantable electronic devices (CIEDs) continue to evolve and patients continue to live longer, the use of these devices increases. CIEDs include permanent pacemakers, implanted cardioverter-defibrillators, and cardiac resynchronization therapy devices. Over the last 2 decades, the functionality of these devices has increased and can be complex. Critical care nurses should be equipped with the knowledge to care for patients immediately postoperative CIED placement and for patients admitted to critical care units with CIEDs already in place. Patients with CIEDs are a vulnerable population with special needs and considerations for management.

Early Identification and Management of the Septic Patient in the Emergency Department.

Sepsis and septic shock affect millions of people around the globe and kills more than 1 in 4 patients worldwide. Emergency departments (EDs) nationwide have implemented evidence-based protocols to facilitate the early detection and treatment of patients with sepsis. Despite these efforts, patients present to the ED undifferentiated and can often have an unclear source of infection. The latest literature provides refined definitions and clinical criteria for sepsis identification and indicates that early detection combined with the appropriate early management improves the septic patients' morbidity and mortality rates.

Antibiotic Trends Amid Multidrug-Resistant Gram-Negative Infections in Intensive Care Units.

Isolates from ICUs most commonly find multidrug-resistant (MDR) gram-negative bacteria. The purpose of this article is to discuss the significant impact MDR gram-negative infections are having on ICUs, the threat on health and mortality, and effective and new approaches aimed to combat MDR gram-negative infections in critically ill populations. Inappropriate antibiotic therapies for suspected or documented infections are the leading cause of the emergence of bacterial resistance. A variety of strategies are aimed at combatting this international burden via antibiotic stewardship programs. Studies are demonstrating promise against the virulence MDR gram-negative infections have posed.

The Role of Liver Function in the Setting of Cirrhosis with Chronic Infection and Critical Illness.

The patient with sepsis in the setting of hepatitis C virus (HCV)-related cirrhosis can have a more rapid decline in other organ dysfunction during critical illness and faces further increase in the risk for death. This article discusses the role of liver function in the patient with a systemic critical illness in contrast to the worsened pathophysiology of the patient with cirrhosis secondary to chronic HCV infection and critical illness, inpatient and posthospitalization management of the critically ill patient with chronic HCV-related cirrhosis, and the nursing implications and recommendations for future research for this population.