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3.
J Emerg Nurs ; 49(5): 654-660, 2023 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-37648367

RESUMO

As multidisciplinary emergency care becomes increasingly complex, all team members must be aware of their respective roles and responsibilities. In the emergency department, nurse practitioners are integral members of the team. They possess a wide range of clinical and leadership competencies that allow them to perform specific and differentiated tasks within the emergency department. A well-defined competency not only contributes to the promotion of a positive work culture but also clarifies performance expectations, identifies skill gaps, and supports team development. Furthermore, it allows the nurse practitioner to adapt to changing conditions while maintaining patient safety. The competencies of emergency nurse practitioners have evolved over the past 2 decades. The authors discuss the importance of establishing clear expectations for emergency nurse practitioner practice in this article and the alignment of competencies with organizational culture and objectives.


Assuntos
Serviços Médicos de Emergência , Profissionais de Enfermagem , Humanos , Tratamento de Emergência , Serviço Hospitalar de Emergência , Liderança
6.
J Am Assoc Nurse Pract ; 35(6): 373-379, 2023 Jun 01.
Artigo em Inglês | MEDLINE | ID: mdl-37159426

RESUMO

ABSTRACT: The nurse practitioner (NP) role within emergency care has grown in recent years and now there are an estimated 25,000 NPs employed in diverse emergency care settings. Despite this significant growth and expansion of the NP within emergency care areas, challenges exist. In addition to the pervasive confusion regarding the NP role in emergency care, data and statistics detailing characteristics and outcomes of NP practice in emergency care are either lacking or misrepresented. This article explores barriers and provides current and accurate information describing the current educational preparation, credentialing, scope of practice, and outcomes among NPs in US emergency departments. The totality of available evidence reviewed supports safe, timely, efficient, and patient-centered care provided by NPs in emergency care.


Assuntos
Profissionais de Enfermagem , Âmbito da Prática , Humanos , Credenciamento , Papel do Profissional de Enfermagem , Serviço Hospitalar de Emergência
12.
Adv Emerg Nurs J ; 44(2): 127-135, 2022.
Artigo em Inglês | MEDLINE | ID: mdl-35476691

RESUMO

SARS-CoV-2 is the virus that causes COVID-19 and COVID pneumonia and is known to cause cardiovascular abnormalities with electrocardiogram (ECG) disturbances in affected patients. A 47-year-old male patient presented to the emergency department (ED) for the management of COVID-like symptoms. Initial diagnostics included an ECG, which showed significant rhythm changes. Progression of COVID-19 disease compounds myocardial injury with corresponding new-onset ECG anomalies such as QT-segment changes, bundle branch blocks, ST-segment disturbances, and other rhythm abnormalities. This case presentation illustrates ECG changes associated with cardiovascular disease progression.


Assuntos
COVID-19 , Arritmias Cardíacas , Eletrocardiografia , Serviço Hospitalar de Emergência , Humanos , Masculino , Pessoa de Meia-Idade , SARS-CoV-2
13.
Adv Emerg Nurs J ; 44(1): 41-45, 2022.
Artigo em Inglês | MEDLINE | ID: mdl-35089281

RESUMO

Health care professionals and hospitals have made tremendous advances in detecting, diagnosing, and treating posterior myocardial infarction over many decades. Electrocardiogram (ECG) alone is used to make a timely diagnosis of ST-segment elevation myocardial infarction in the emergency department. The typical signs of myocardial infarction, left-sided chest discomfort with radiation to the jaw or left arm, rule out a wide range of patient presentations with ST-segment elevation myocardial infarction. This variation in clinical symptoms is exacerbated by the fact that most ECG monitors lack algorithms that account for posterior myocardial infarction interpretation. Therefore, health care practitioners must exercise caution when dismissing nondiagnostic and faint ECG abnormalities as normal or unimportant.


Assuntos
Infarto do Miocárdio , Infarto do Miocárdio com Supradesnível do Segmento ST , Dor no Peito/diagnóstico , Eletrocardiografia , Humanos , Diagnóstico Ausente , Infarto do Miocárdio/diagnóstico , Infarto do Miocárdio com Supradesnível do Segmento ST/diagnóstico
15.
Adv Emerg Nurs J ; 43(3): 212-216, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-34397499

RESUMO

An 87-year-old female patient presented with altered mental status. During the routine workup for altered mental status, an electrocardiogram (ECG) was obtained. The ECG showed T-wave morphology known to be consistent with myocardial infarction. Although the ECG is a crucial diagnostic tool to recognize myocardial ischemia and infarction promptly, it must be understood that T-wave abnormalities can represent noncardiac pathology. A case presentation illustrates a unique ECG change whose presence is associated with catastrophic central nervous system diseases that cause increased intracranial pressure.


Assuntos
Eletrocardiografia , Hipertensão Intracraniana/diagnóstico , Hemorragia Subaracnóidea/diagnóstico , Idoso de 80 Anos ou mais , Diagnóstico Diferencial , Feminino , Humanos
16.
J Emerg Nurs ; 47(1): 33-39, 2021 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-33023789

RESUMO

The transgender population presents a unique challenge for the emergency nurse. There are types of surgeries, medications, complications, and differences in laboratory testing that are unique to transgender people. In addition, emergency nurses are increasingly encountering more transgender patients in the emergency department for care, referrals, and education. Yet, many emergency nurses lack the formal training to care for transgender patients and their families. A complete understanding of the terminology, gender-transforming surgeries, hormonal suppression and augmentation of sexual characteristics, adverse effects, complications of surgeries, and ongoing health risks owing to the altered hormonal milieu and potential risk for acquiring sexually transmitted diseases is important to provide the necessary emergency care for this emerging population.


Assuntos
Enfermagem em Emergência , Serviço Hospitalar de Emergência , Procedimentos de Readequação Sexual/efeitos adversos , Procedimentos de Readequação Sexual/enfermagem , Pessoas Transgênero , Atitude do Pessoal de Saúde , Assistência à Saúde Culturalmente Competente , Feminino , Humanos , Masculino
18.
Adv Emerg Nurs J ; 42(2): 108-118, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32358426

RESUMO

Drug reaction with eosinophilia and systemic symptoms (DRESS) syndrome is an uncommon yet serious adverse cutaneous drug reaction that results from a hypersensitivity reaction. Drug reaction with eosinophilia and systemic symptoms is often misdiagnosed because of vague and confounding signs and symptoms. The most common clinical manifestations of DRESS are shared with many other diseases and include rash, lymphadenopathy, and fever. Because the syndrome can be difficult to diagnose, patients are often in the late stages of the disease process before treatment is initiated. The mainstay of treatment is stopping the culprit medication. Drug reaction with eosinophilia and systemic symptoms is associated with a high mortality rate, most often from liver failure and failure to diagnose. Emergency providers should be able to recognize the clinical manifestations of DRESS, know what diagnostic studies are indicated, and be familiar with the appropriate treatment.


Assuntos
Alopurinol/efeitos adversos , Síndrome de Hipersensibilidade a Medicamentos/etiologia , Eosinofilia/induzido quimicamente , Supressores da Gota/efeitos adversos , Idoso , Humanos , Masculino
19.
J Am Assoc Nurse Pract ; 32(5): 359-366, 2020 May.
Artigo em Inglês | MEDLINE | ID: mdl-31274679

RESUMO

BACKGROUND AND PURPOSE: Current uses of emergency care are ambiguous and lack clarity, leading to imprecise use of the term in nursing practice. An explicit definition of emergency care is necessary to build and advance the field. An empirically driven definition of emergency care is lacking in the refereed literature. The purpose of this article was to present an in-depth inquiry of emergency care that contributes to the advancement of knowledge and to articulate a defensible definition of emergency care. METHODS: This concept analysis was performed using the eight-step approach of Walker and Avant. A database search within the disciplines of nursing, medicine, education, and social sciences was conducted using the keyword emergency care. Databases of refereed literature were reviewed. Additional searches of nonrefereed literature, such as dictionaries and thesauri, were also examined. CONCLUSIONS: Based on this concept analysis, the attributes of emergency care include the immediate evaluation and treatment of an unexpected illness or injury. Emergency care is not specific to a setting or location. Antecedents to emergency care consist of a precipitating event, recognition that medical help is required, and access to emergency care. A model, borderline, related, and contrary cases of emergency care are presented. IMPLICATIONS FOR PRACTICE: The identification of emergency care attributes in this concept analysis contributes to the body of knowledge in emergency care and clarifies the ambiguity of the concept to prompt developments in practice, theory, and research with implications for emergency nurse practitioner clinical education, and scope of practice regulation.


Assuntos
Formação de Conceito , Serviços Médicos de Emergência/métodos , Serviços Médicos de Emergência/classificação , Humanos , Modelos de Enfermagem
20.
Adv Emerg Nurs J ; 41(4): 322-329, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31687996

RESUMO

Necrotizing fasciitis is a rapidly progressing soft tissue infection associated with a high rate of mortality. Vibrio vulnificus, a gram-negative bacillus found in warm seawater, is a rare but serious cause of necrotizing fasciitis. Definitive treatment is often delayed because of the vague clinical manifestations associated with the early stages of the disease. Delays in diagnosis are directly associated with increased mortality. Because infection with V. vulnificus progresses more rapidly than other causes of necrotizing fasciitis, patients presenting with soft tissue symptoms and who have been in contact with raw seafood or seawater should be considered at high risk for V. vulnificus-associated necrotizing fasciitis. Health care providers in northern and inland areas must be aware of patients who have recently traveled to regions where V. vulnificus is more common, such as warm coastal regions. Early fasciotomy, debridement, and culture-directed antimicrobial therapy are essential to improve survival. The case presented in this report highlights the importance of early diagnosis of V. vulnificus-associated necrotizing fasciitis.


Assuntos
Antibacterianos/uso terapêutico , Fasciite Necrosante/diagnóstico , Antibacterianos/administração & dosagem , Desbridamento , Quimioterapia Combinada , Fasciite Necrosante/tratamento farmacológico , Fasciite Necrosante/cirurgia , Evolução Fatal , Humanos , Masculino , Pessoa de Meia-Idade
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