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AACN Advanced Critical Care

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https://read.qxmd.com/read/31151947/management-of-select-thrombocytopenias
#1
Thomas A VanDruff
Evaluating, diagnosing, and managing patients with consumptive thrombocytopenia is challenging because of the overlapping nature of many of the diseases that reduce platelet counts. Immune thrombocytopenia (and its variations), drug-induced immune thrombocytopenia, and heparin-induced thrombocytopenia result from autoimmune antibody-mediated destruction of platelets. Thrombotic thrombocytopenia (both congenital and acquired) and the hemolytic uremic syndromes (both typical and atypical) are thrombotic microangiopathies associated with platelet aggregation and consumption along with anemia and renal dysfunction...
2019: AACN Advanced Critical Care
https://read.qxmd.com/read/31151946/hemophagocytic-lymphohistiocytosis
#2
Janice Skinner, Benedicta Yankey, Brenda K Shelton
Hemophagocytic lymphohistiocytosis is a life-threatening condition associated with hyperinflammation and multiple organ dysfunction. It has many causes, symptoms, and outcomes. Early recognition is critical for treatment. Fever, cytopenias, coagulopathy, and hepatosplenomegaly are hallmark findings. Identifying the trigger event is crucial but challenging because of the varied presentations and infrequent provider experience. Diagnostic features include anemia, thrombocytopenia, neutropenia, elevated ferritin, hypertriglyceridemia, hypofibrinogenemia, hemophagocytosis (in bone marrow, spleen, or lymph nodes), low or absent natural killer cells, and elevated soluble interleukin 2 receptor assay...
2019: AACN Advanced Critical Care
https://read.qxmd.com/read/31151945/contemporary-transfusion-science-and-challenges
#3
Heather M Passerini
Health care professionals must understand the impact of blood product transfusions and transfusion therapy procedures to ensure high-quality patient care, positive outcomes, and wise use of resources in blood management programs. Understanding transfusions of blood and blood products is also important because of the number of treatments performed, which affects individual patients and health care system resources. This article reviews research findings to acquaint health care professionals with the most successful protocols for blood, blood product, and coagulation factor transfusions...
2019: AACN Advanced Critical Care
https://read.qxmd.com/read/31151944/anticoagulant-medications-for-the-prevention-and-treatment-of-thromboembolism
#4
Lori Brien
Venous thromboembolism is a preventable medical condition associated with significant morbidity and mortality. It can lead to deep vein thrombosis, pulmonary embolism, and stroke. Thrombi develop when intravascular conditions promote activation of the coagulation system or when there is an imbalance between endogenous anticoagulants and procoagulants. Such conditions include vascular injury, inflammation, venous stasis, and hypercoagulable states. Anticoagulant medications are indicated for the prevention and treatment of venous thromboembolism...
2019: AACN Advanced Critical Care
https://read.qxmd.com/read/31151943/immunology-and-immunotherapy-in-critical-care-an-overview
#5
Nancy Munro
Until recently, immunology was not a major focus of attention in the acute and critical care setting. With the evolution of immunotherapy, however-including the development of monoclonal antibodies, checkpoint inhibitors, and adoptive cellular therapies-an in-depth understanding of the immune system has become necessary to properly care for acutely ill patients. Lymphocytes (ie, T cells and B cells) play a major role in the daily functioning of the immune response. The interaction of these cells in protecting the body against infection and foreign substances is complicated and is the basis for many of the innovations in immunology and cancer treatment...
2019: AACN Advanced Critical Care
https://read.qxmd.com/read/30842073/complex-medical-technology-strategies-for-selection-education-and-competency-assessment-and-adoption
#6
JoAnne Phillips
The prevalence of complex technology in the health care arena has increased dramatically in the 21st century. Nurses working in acute and critical care have the greatest interaction with technology, using it to manage patients and optimize clinical outcomes as well as to prevent errors and adverse events. The successful implementation of complex medical technology is, in itself, a complex process. The purpose of this article is to provide nurse leaders and clinical nurses with an overview of key steps in product selection, associated risk assessment, and establishing a business case for technology...
2019: AACN Advanced Critical Care
https://read.qxmd.com/read/30842072/implementation-of-a-data-acquisition-and-integration-device-in-the-neurologic-intensive-care-unit
#7
Amanda Szatala, Bethany Young
The neurologic intensive care unit has evolved into a data-rich, complex arena. Various neurologic monitors, collectively referred to as multimodality monitoring, provide clinicians with a plethora of real-time information about a comatose patient's condition. The time and cognitive burden required to synthesize the available data and reach meaningful clinical conclusions can be overwhelming. The Moberg Component Neuromonitoring System (Moberg Research, Inc) is a data acquisition and integration device that collects data from multiple monitors, displaying them on a single screen in a way that highlights physiological trends throughout a patient's clinical course...
2019: AACN Advanced Critical Care
https://read.qxmd.com/read/30842071/optimizing-fail-safe-use-of-complex-medical-devices
#8
Patricia Hercules, M Michael Shabot, Teresa Ryan, Susan Ratcliff
As part of its comprehensive journey toward high reliability, Memorial Hermann Health System has implemented multiple patient safety initiatives. An instance of actual patient harm due to staff unfamiliarity with a medical device triggered a project to ensure the competence of clinical staff in the operation of all approved new and updated medical devices. Medical devices are classified by level of risk to patients if caregivers are not reliably educated. Educational rigor, with tracking and accountability management, is then scaled to that risk assessment...
2019: AACN Advanced Critical Care
https://read.qxmd.com/read/30842069/burnout-in-brazilian-intensive-care-units-a-comparison-of-nurses-and-nurse-technicians
#9
Francino Azevedo Filho, Maria Cristina Soares Rodrigues, Jeannie P Cimiotti
Job-related burnout has been reported by intensive care nurses worldwide; this study was performed to examine burnout in intensive care unit bedside nurses and nurse technicians in Brazil. A cross-sectional survey that included the Practice Environment Scale and the Maslach Burnout Inventory was completed by 209 nurses and nurse technicians working in 4 Brazilian intensive care units in 3 teaching hospitals. Compared with nurse technicians, nurses reported higher levels of emotional exhaustion and depersonalization, and a lower level of personal accomplishment...
2019: AACN Advanced Critical Care
https://read.qxmd.com/read/30523014/tunneled-pleural-catheter-treatment-for-recurrent-pleural-effusion
#10
Chelsea Miller, Elizabeth Bridges, Balaji Laxmanan, Paula Cox-North, Hilaire Thompson
Recurrent pleural effusion is a symptom of several end-stage diseases and is associated with limited life expectancy. Patients with this condition have disabling symptoms resulting in reduced quality of life and often receive inconsistent treatment due to delayed recognition of pleural effusion, repeat procedures, and lengthy hospitalizations. Placement of a tunneled pleural catheter allows the patient to manage his or her symptoms at home, yet this treatment remains underused because of provider misconceptions and unfamiliarity with the intervention...
2018: AACN Advanced Critical Care
https://read.qxmd.com/read/30523013/reducing-tracheostomy-related-pressure-injuries
#11
Lois M Dixon, Susan Mascioli, Jefferson H Mixell, Tom Gillin, Camille N Upchurch, Kevin M Bradley
An interprofessional team was established to prevent tracheostomy-related acquired pressure injuries. The team performed an in-depth analysis of practice from tracheostomy insertion through postinsertion care. A literature evaluation identified best practices, and a root cause analysis for all tracheostomy-related pressure injury cases identified common causes. Lessons learned from the practice and literature reviews drove care standardization and reduced variation. Preimplementation and postimplementation data were analyzed to determine the effectiveness of improvement interventions...
2018: AACN Advanced Critical Care
https://read.qxmd.com/read/30523012/acute-respiratory-distress-syndrome-and-prone-positioning
#12
Dannette A Mitchell, Maureen A Seckel
Acute respiratory distress syndrome continues to have high morbidity and mortality despite more than 50 years of research. The Berlin definition in 2012 established risk stratification based on degree of hypoxemia and the use of positive end-expiratory pressure. The use of prone positioning as a treatment modality has been studied for more than 40 years, with recent studies showing an improvement in oxygenation and decreased mortality. The studies also provide evidence to support the methodology and length of treatment time...
2018: AACN Advanced Critical Care
https://read.qxmd.com/read/30523011/capnography-monitoring-during-procedural-sedation-and-analgesia
#13
John J Gallagher
Procedural sedation is used to alleviate pain and anxiety associated with diagnostic procedures in the acute care setting. Although commonly used, procedural sedation is not without risk. Key to reducing this risk is early identification of risk factors through presedation screening and monitoring during the procedure. Electrocardiogram, respiratory rate, blood pressure, and pulse oximetry commonly are monitored. These parameters do not reliably identify airway and ventilation compromise. Capnography measures exhaled carbon dioxide and provides early identification of airway obstruction and hypoventilation...
2018: AACN Advanced Critical Care
https://read.qxmd.com/read/30523010/alternative-modes-of-mechanical-ventilation
#14
COMPARATIVE STUDY
John J Gallagher
Modern mechanical ventilators are more complex than those first developed in the 1950s. Newer ventilation modes can be difficult to understand and implement clinically, although they provide more treatment options than traditional modes. These newer modes, which can be considered alternative or nontraditional, generally are classified as either volume controlled or pressure controlled. Dual-control modes incorporate qualities of pressure-controlled and volume-controlled modes. Some ventilation modes provide variable ventilatory support depending on patient effort and may be classified as closed-loop ventilation modes...
2018: AACN Advanced Critical Care
https://read.qxmd.com/read/30523008/boot-camp-for-caregivers-of-children-with-medically-complex-conditions
#15
Julie Van Orne, Kaylan Branson, Mary Cazzell
BACKGROUND: The safe transition of children with complex medical conditions who are dependent on technology from hospital to home requires that caregivers receive specialized training from qualified health care professionals. Inadequate caregiver training can lead to discharge delays and hospital readmissions, often resulting in caregiver distress. OBJECTIVE: To determine the effectiveness of a structured boot camp-style predischarge training program for caregivers of pediatric patients with complex medical conditions...
2018: AACN Advanced Critical Care
https://read.qxmd.com/read/30185504/wellens-syndrome
#16
Karen M Marzlin
No abstract text is available yet for this article.
2018: AACN Advanced Critical Care
https://read.qxmd.com/read/30185500/clinical-presentation-and-treatment-of-amniotic-fluid-embolism
#17
Anne-Marie McBride
Obstetric emergencies often require intensive care intervention. Amniotic fluid embolism is a rare, unpredictable, and often catastrophic complication of pregnancy that is suspected in a woman who experiences cardiac arrest after a cesarean section. The condition occurs in approximately 1 in 40‚ÄČ000 births and has an average case-fatality rate of 16%. This complication may result from activation of an inflammatory response to fetal tissue in the maternal circulation. Risk factors may include maternal age over 35 years and conditions in which fluid can exchange between the maternal and fetal circulations...
2018: AACN Advanced Critical Care
https://read.qxmd.com/read/30185499/pulmonary-edema-in-obstetrics-essential-facts-for-critical-care-nurses
#18
REVIEW
Rebecca L Cypher
Pulmonary edema is an acute pregnancy complication that, if uncorrected, can result in increased maternal and fetal morbidity and mortality. Although pulmonary edema is relatively rare in the general obstetrics population, pregnant patients are at increased risk for pulmonary edema because of the physiologic changes of pregnancy. The risk may be exacerbated by certain pregnancy-related diseases, such as preeclampsia. Prompt identification and appropriate clinical management of pulmonary complications is critical to prevent adverse outcomes in pregnant patients...
2018: AACN Advanced Critical Care
https://read.qxmd.com/read/30185498/preeclampsia-acute-complications-and-management-priorities
#19
Patricia M Witcher
Acute complications of preeclampsia contribute substantially to maternal and fetal morbidity and mortality. The considerable variation in onset, clinical presentation, and severity of this hypertensive disease that is unique to pregnancy creates challenges in identifying risk factors for clinical deterioration. Delivery of the fetus remains the only definitive treatment for preeclampsia. Surveillance of signs and symptoms and laboratory parameters consistent with progression in severity requires an appreciation of the dynamic and progressive nature of the disease...
2018: AACN Advanced Critical Care
https://read.qxmd.com/read/30185497/recognition-and-management-of-sepsis-in-the-obstetric-patient
#20
Sheryl E Parfitt, Sandra L Hering
Sepsis is one of the principal causes of maternal mortality in obstetrics. Physiologic changes that occur during pregnancy create a vulnerable environment, predisposing pregnant patients to the development of sepsis. Furthermore, these changes can mask sepsis indicators normally seen in the nonobstetric population, making it difficult to recognize and treat sepsis in a timely manner. The use of maternal-specific early warning tools for sepsis identification and knowledge of appropriate interventions and their effects on the mother and fetus can help clinicians obtain the best patient outcomes in acute care settings...
2018: AACN Advanced Critical Care
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