...0 ANCC CONTACT HOURS AFFECTING MILLIONS OF people worldwide, sepsis is a systemic response to an overwhelming inflammatory process caused by an infection. Approximately one in four people who develop sepsis will die.1 In January 2013, the international Surviving Sepsis Campaign Guidelines Committee published its 2012 surviving sepsis guidelines (SSG), an update to the 2008 guidelines for early identification and management of sepsis in adults.1 The guidelines highlight the importance of screening every potentially infected patient for sepsis and providing best-practice interventions for managing sepsis, severe sepsis, and septic shock. This article provides an overview of care for the adult patient with sepsis, focusing on sepsis identification and the first 6 hours of goal-directed treatment according to current guidelines. Defining sepsis Sepsis is the presence of infection along with systemic manifestations of infection. If sepsis isn’t recognized and treated early, it progresses rapidly to severe sepsis, defined as sepsis plus sepsis-induced organ dysfunction or tissue hypoperfusion. Sepsis-induced tissue hypoperfusion is defined as infection-induced hypotension, elevated lactate level, or oliguria.1 24 l Nursing2014 l April Copyright © 2014 Lippincott Williams & Wilkins. Unauthorized reproduction of this article is prohibited. www.Nursing2014.com D VOUGAO/iSTOCK sepsis www.Nursing2014.com April l Nursing2014 l 25 Copyright...
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...I. Introduction - Shock (Chapter 11) A. Review of anatomy and physiology B. Pathophysiology Initiation | * Decreased tissue oxygenation * Decreased intravascular volume * Decreased Myocardial contractility (cardiogenic ) * Obstruction of blood flow (obstructive) * Decreased vascular tone (distributive) * Septic (mediator release) * Neurogenic (suppression of SNS) | No observable clinical indications Decreased CO may be noted with hemodynamic monitoring | Compensatory | * Neural compensation by SNS * Increased HR and Contractiliy * Vasoconstriction * Redistribution of blood flow from nonessential to essential organs * Bronchodilation * Endocrine Compensation (RAAS, ADH, glucocorticoid release) * Renal reabsorption of sodium, chloride, and water * Vasoconstriction * Glycogenolysis | * Increased HR (EXCEPT NEUROGENIC) * Narrowed pulse pressure * Rapid, deep respirations causing respiratory alkalosis * Thirst * Cool,moist skin * Oliguria * Diminished bowel sounds * Restlessness progressing to confsion * Hyperglycemia * Increased specific gravity and decreased creatinine clearance. | Progressive | * Progressive tissue hypoperfusion * Anaerobic metabolism wih lactic acidosis * Failure of sodium potassium pump * Cellular edema | * Dysrhythmias * Decreased BP with narrowed pulse pressure * Tachypnea * Cold, clammy skin * Anuria * Absent bowel sounds * Lethargy progressing...
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...further improvements in the future. Evidence based practice is an approach that improves the impact of nursing, psychology and social work. It gives research the cause and effect that gives validity to the information. The purpose of evidence based practice is ensuring that patients receive the best quality care and keep nurses, nursing care, and knowledge up to date. The American Nurses Association (ANA) recognizes the importance of evidence based practice (EBP), and that it incorporates the registered nurse to integrate, participate in the formulation, and contribute to the knowledge of research to improve healthcare outcomes (ANA, 2010). Evidence based research results in favorable patient outcomes across various geographic locations. The impetus for evidence-based practice comes from decisions of efficacy, and healthcare facility pressures for cost containment. Evidence practice stresses changes in the education of students, more practice-relevant research, and closer working relationships between clinicians and researchers. The evidence based practice also provides opportunities for nursing care to be more individualized, more effective, and to capitalize on the effects of clinical decisions (Kenney, 2010). Evidence base practice cultivates best practices rather than to support existing practices, and the latest technological advances. The future of nursing focuses on the intent that nurses lead in improving...
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...BEATRISA SHEKHTER NRS 433-V Literature Search Wound Care is very important topic in modern medical field. Pressure ulcers are the major problem in the long term facilities. Having an understanding of the exact cause of pressure ulcers helps place the role of repositioning into context. Demographic and epidemiological data suggest that health-care demand will increase considerably in the future as a result of an ageing population and a rise in the prevalence of chronic diseases such as diabetes. This phenomenon has come to be referred to as the ‘health care time bomb’ in the popular press and political discourse. The authors seek to look beyond the headlines and political rhetoric to clarify the extent to which they reflect the likely future reality with a specific focus on wound management. The present-day burden that wounds and current wound management practices place upon the health-care system are detailed and clarified, and the potential future implications of increasing wound prevalence on the current picture are explored. Possible opportunities to enhance current wound management practice as identified in the analysis are discussed. Declaration of interest: Alistair Biel by is a contractor for Smith & Nephew. Richard Searle is and employee of Smith & Nephew. This project was supported by an unrestricted grant from Smith & Nephew. As such, a pressure ulcer is defined as localized injury to the skin and/or underlying tissue, usually over a bony prominence, as a result...
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...Comprehensive Simulation Reflection Seven seconds… The heroin coursing through his veins. Empty bottles and track marks provided an escape. A 38-year old Caucasian, male found on the bathroom floor by his nine-year-old daughter. This simulation provoked the need to prioritize nursing assessments and interventions for a patient presenting with a heroin overdose and alcohol toxicity. Genetic and genomic considerations were taken into account regarding substance addictions. By evaluating the life of another, personal strengths and weaknesses were discovered. Twelve minutes… The time spent lying on the bathroom floor. The patient was found unconscious. Cardiopulmonary Resuscitation (CPR) occurred and Narcan was administered. Pinpoint pupils,...
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...Knowledge and Conformance of Delivery Room Staff on Essential Newborn Care Protocol A Thesis Proposal Presented to the Faculty of the Graduate School of University of the Visayas Cebu City, Philippines In Partial Fulfillment of the Requirements for the Degree of Masters of Arts in Nursing Major in Maternal and Child Health Nursing by MAY PRINCES T. ABUCEJO, RN August, 2012 THE PROBLEM AND ITS SCOPE INTRODUCTION Rationale of the Study The Child Survival Strategy published by the Department of Health has emphasized the need to strengthen health services of children throughout the stages. The neonatal period has been identified as one of the most crucial phases in the survival and development of the child. The Millennium Development Goal Number four (4) of reducing under five child mortality can be achieved by the Philippines, however, if the neonatal mortality rates are not addressed from its non-moving trend of decline, MDG 4 might not be achieved (http://www.doh.gov.ph/node/2664). Based on health statistics, the Philippines is one of the 42 countries that account for 90% of under-five mortality worldwide. Eighty two thousand (82,000) Filipino children under five years old die every year. Thirty seven percent (37%) or 40,000 of them are newborn. Majority of them (3/4) die within the first two days of life, mostly from preventable causes. The high mortality and morbidity rates in newborn are directly related to inappropriate hospital and community practices...
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...deaths, increased length of stay and added medical costs. Both adult and pediatric patients who have catheters inserted into their blood vessels face increased risk of an infection developing along the invasive plastic devices which can become life-threatening as they spread into the bloodstream. According to Centers for Disease Control and Prevention (CDC), an estimated 248,000 blood stream infections are reported per year (CDC, June 2010), and mortality rate of 12%-25 %( CDC, 2011) .This dangerous lethal medical complication can be prevented by proper management of the catheter insertion and strict aseptic technique during care. Even though CDC has recommended standard catheter associated blood stream infections (CA-BSI) prevention strategies, the study shows areas of variability in the surveillance. A central line is an intravascular catheter that terminates at or close to the heart or in one of the great vessels which is used for infusion, withdrawal of blood, or hemodynamic monitoring. The Aorta, pulmonary artery, superior vena cava, inferior vena cava, brachiocephalic veins, internal jugular veins, subclavian veins, external iliac veins, common iliac veins, common femoral veins, and the umbilical artery/vein in neonates are considered to be the commonly used great vessels for the purpose of reporting the central line blood stream infection (CLBSI). Central line plays a crucial role in medical practice, especially in intensive care unit, during major surgery...
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...Assessment of Learning Style Family Centered Health Promotion Grand Canyon University, Nursing 429V Professor Holmes Julie Smith, RN Before one can decide what their VARK score is, it may be important to understand what each letter in the acronym means. The V in VARK stands for visual, A for auditory, R for reading and writing and finally the K for kinaesthetic. Each of these letters represent an individual’s preferred method of learning new information. With a total VARK score of 48, I have been placed in the Multimodal category. According to Fleming (2011) Multimodal learners "are context specific choosing the mode that best fits the need". Fleming used examples of context specific learning such as when signing a document, the Multimodal learner will use the reading/writing preference. And if Multimodal learner has to learn a physical task, they will switch to the kinaesthetic preference. For example, when learning to start an IV, the learner will learn best by practicing with real IV's and tubing even if at first they use a fake arm/vein. The Multimodal category is the largest category according to Fleming, taking up 60% of all total learners. The preferred learning strategies of this multimodal learner include aural, read/write and kinaesthetic. The intake of aural information is best learned through attending classes, discussions with others, including but not limited to teachers, using a tape recorder to hear specific information again, remembering interesting...
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...Can Adequate Nurse Staffing Improve Patient Outcomes? Nursing is more than caring for the sick and injured. It is a twenty-four hour inpatient monitoring system. It is well known that nurses spend significantly more time caring for and looking after patients than any other profession. They routinely monitor and report changing patient conditions around the clock that aid physicians in modifying and updating treatment plans to improve health and prevent complications. The level of safety of hospitalized patients and the degree of quality care that they receive has more to do than fixed nurse-to-patient ratios. It has been well established in the literature that when nursing workload increase to unmanageable levels; weather it be from the addition of patients, increases in acuity and/or care complexity, or from high levels of fluctuation in patient turnover, that nurses ability to perform patient surveillance is disordered, putting patients in undue risk (Needleman, et. al, 2011). Furthermore, excessive workloads contribute to burnout and dissatisfaction leading to nurse attrition that further compounds to the staffing problem. Hospitals need to be held accountable for providing safer nurse staffing levels. Payers and purchasers of care should demand compliance, but should also stimulate better quality and patient safety by providing financial incentives. In addition, a more comprehensive, proactive team approach to nurse staffing can help keep patients safer...
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...Journal of Neonatal-Perinatal Medicine 3 (2010) 325–331 DOI 10.3233/NPM-2010-0132 IOS Press 325 Sucrose as an analgesic in relieving procedural pain in neonates Srijana Basnet∗, Laxman Shrestha and Prakash Sundar Shrestha Department of Pediatrics, Institute of Medicine, Kathmandu, Nepal Received 1 January 2010 Revised 29 June 2010 Accepted 27 July 2010 Abstract. Objective: This study was undertaken to study physiological and behavioral pain responses of neonates and to assess the analgesic effect of orally administered sucrose as assessed by the behavioral pain rating scale [DAN (Douleur Aigu¨ du e Nouveau-n´ ) score] during venepuncture in neonates. e Method: In 50 healthy neonates requiring bilirubin estimation, blood sugar was randomly assigned to receive 2ml of 30% sucrose two minutes before the venepuncture (intervention) in comparison to a group not receiving sucrose (control). During the procedure, pain was assessed by behavioral pain rating scale [Douleur Aigu¨ Nouveau-n´ (DAN) scale]. The heart rate, oxygen e e saturation before, during and after procedure as well as crying time was noted. Results: There was significantly lower pain (DAN) score in the intervention group compared to control group. Median (interquartile) DAN score in the group receiving sucrose was 3 (1.5–5.5) compared to 7 (5–9.5) in control group. The difference in median DAN score between two groups was statistically significant (p = 0.0001). There was a significant increase in heart rate...
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...Chickenpox a Communicable Disease Cynthia Hahn Grand Canyon University: NRS-427V July 5, 2015 Chickenpox is an infection caused by the highly contagious varicella-zoster virus. A common communicable disease which can be a harmless or deadly disease depending on the community which is affected. Education and healthcare prevention will prove evident in the control of the spread of the chickenpox disease. Chickenpox is an airborne disease which is spread by coughing and sneezing of an infected person or direct contact with skin lesions. The initial symptoms of chickenpox are a fever, fatigue, loss of appetite, headache and a sore throat. A red skin rash appears a few days after the initial symptoms and forms small, itchy blisters. “After a chickenpox red spot appears, it usually takes about 1 or 2 days for the spot to go through all its stages, this includes blistering, bursting, drying and crusting over. New red spots will appear every day for up to 5 to 7 days” (Chickenpox (Varicella)-Topic Overview, n.d.). The rash initially appears on the face, back and chest to quickly cover the body including mucous membranes such as the mouth, genital area or in the ears. These symptoms will begin ten to twenty-one days after exposure to a contagious person. The virus can be spread by a person who is infected with chickenpox before symptoms even appear and until all blisters have crusted over...
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...REDUCING FALLS IN THE HOSPITAL SETTING Abstract “Falls and fall related injuries are the most commonly reported adverse event among adults admitted to inpatient setting. Up to twenty percentages of patients admitted, reported falling of at least once during an inpatient hospital stay period” (Oliver, Healey, & Haines, 2010). The author works at a city hospital located in Gilbert, Arizona and encounters a great amount of orthopedic patients along with other general surgery patients. All patients that are on that floor are at a risk of falls during the first 48 hours after surgery due to anesthesia that is still in the system and pain medication that is scheduled to help ease the patient during the post-surgical time frame. One of the side effects of anesthesia exiting the body is nausea and vomiting which can make the patient feel dizzy and lightheaded, thus making them a great risk for falls. This has been the reason that the topic was chosen; to attempt to improve this issue in the hospital setting and to provide a system in which all hospital staff collaborate to help increase the quality of patient care. The location that is being observed is the post-surgical/orthopedic floor where the author is currently working. A description of risks and concerns are provided and patient outcomes depend on implementing the proposed interventions. The two solutions that are presented are hourly rounding and the importance of an improved nurse call light button and education on proper...
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...Gowning by attendants and visitors in newborn nurseries for prevention of neonatal morbidity and mortality Webster J, Pritchard MA Background - Methods - Results - Characteristics of Included Studies - References - Data Tables and Graphs [pic] Dates Date edited: 19/05/2006 Date of last substantive update: 31/01/2003 Date of last minor update: 05/04/2006 Date next stage expected 31/05/2006 Protocol first published: Issue 2, 2002 Review first published: Issue 3, 2003 Contact reviewer Joan Webster Nursing Director, Research Teaching and Research Royal Brisbane and Royal Women's Hospital and Health Service Districts Level 6, Ned Hanlon Building Butterfield Street Herston QLD AUSTRALIA 4029 Telephone 1: +61 7 3636 8590 Telephone 2: +61 7 3636 3140 Facsimile: +61 7 3636 2123 E-mail: joan_webster@health.qld.gov.au Contribution of reviewers Internal sources of support None External sources of support Centre for Clinical Studies - Women's and Children's Health, Mater Hospital, Sth Brisbane, Queensland, AUSTRALIA Department of Health and Ageing, Commonwealth Government, Canberra ACT, AUSTRALIA What's new This review updates the existing review of "Gowning by attendants and visitors in newborn nurseries for prevention of neonatal morbidity and mortality" which was published in The Cochrane Library Issue 2, 2003 (Webster 2003). No new trials were identified as a result of this updated search. The conclusions of the review are...
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...CASE STUDY 1 Acute coronary syndrome Patrick Gallagher Case outline Peter Brown is a 58-year-old gentleman who has experienced an episode of crushing central chest pain while at work. Peter works as a taxi driver and a colleague has taken him to the Accident and Emergency Department. On admission, Peter is sweaty, clammy, nauseated and short of breath. He is complaining of chest pain radiating to his left arm. This is Peter’s first presentation to hospital and he has no relevant past medical history. Peter smokes approximately 20–30 cigarettes per day and takes alcohol at weekends only. Peter is anxious and is concerned that his wife and children are informed. He also states his father died suddenly following a heart attack a number of years ago. Peter is immediately triaged and taken to the resuscitation room. You are the receiving nurse. Observations on admission include: Respiratory rate: 18 breaths per minute Oxygen saturations: 95% Blood pressure: 150/90 mmHg Pulse: 94 beats per minute Temperature: 37ºC. On admission to hospital an electrocardiograph (ECG) has been undertaken. Peter has been diagnosed with an anterior ST segment elevation myocardial infarction (anterior STEMI). Blood samples have also been drawn for urea and electrolytes (U&E), full blood picture (FBP) and highly sensitive troponin T. 1 Discuss Peter’s immediate problems and explain these using your knowledge of pathophysiology. A On admission to Accident and Emergency...
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...University Nursing has evolved over the years to entail more than just caring for another person. The nursing profession encompasses regulatory agencies, professional organizations, theories, values, traits and a code. The following outlines some of what it means to be a nurse. A. Functional Differences The Board of Registered Nurses is an entity set up to protect the public from nurses and to regulate the practice of registered nurses. It protects the public by: setting educational standards for RN’s, approving nursing programs, evaluating license applications, issuing and renewing licenses, issuing certificates, taking disciplinary action when needed and managing intervention programs. The BRN assists me by keeping me accountable to the pledge I made as an RN to adhere to my scope of practice and maintaining my continuing education units (BRN, 2016). Professional Nursing Organizations, like the American Nursing Association, act as a voice of a nurse to the public and government. The ANA promotes the rights of nurse’s in the workplace, projects a positive view of nursing and lobbies the congress and other health care industries on behalf of nurses. My membership with the ANA personally is a resource to me for workplace issues that come up and ethical concerns I may have. The ANA offers continuing education units in the form of conferences, seminars and articles. I benefit from the ANA by having comradery with other nurses in the profession (ANA, 2015). B. Nursing Code Examples ...
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