Critical care nurse最新文献

{"title":"Pediatric Bronchiolitis Obliterans and Bronchiolitis Obliterans Syndrome: Nursing Considerations.","authors":"Jared Deffler","doi":"10.4037/ccn2025696","DOIUrl":"https://doi.org/10.4037/ccn2025696","url":null,"abstract":"<p><strong>Background: </strong>Bronchiolitis obliterans/bronchiolitis obliterans syndrome is an irreversible, obstructive lung disease characterized by the narrowing of bronchioles by lung fibrosis, inflammation, and scarring.</p><p><strong>Objective: </strong>To provide acute care, transplant, and critical care nurses a summary of the disease process, causes, and treatment options for bronchiolitis obliterans in pediatric patients to promote early recognition of signs in at-risk patients.</p><p><strong>Methods: </strong>This descriptive literature review was limited to articles published in 2013 or later. Searches of the PubMed and CINAHL databases using the terms bronchiolitis obliterans and pediatric yielded 432 articles. Of these articles, 22 were used for this review. The Johns Hopkins Nursing Evidence-Based Practice appraisal tool was used to assess levels of evidence and methodologic quality of the articles.</p><p><strong>Results: </strong>Patients in 3 main groups are at risk for bronchiolitis obliterans: those who have had respiratory infection, those who have received lung transplant, and those who have received stem cell transplant.</p><p><strong>Discussion: </strong>A diagnosis of bronchiolitis obliterans requires lung biopsy and histopathology. For patients who are unable to undergo biopsy or whose biopsy results are inconclusive, bronchiolitis obliterans syndrome can be clinically identified with spirometry (forced expiratory volume in first second of expiration and forced expiratory flow at 25% to 75% of forced vital capacity) and high-resolution computed tomography. Systemic corticosteroids are often the first-line treatment; second-line strategies are under investigation.</p><p><strong>Conclusion: </strong>Knowledge of risk factors, signs, and current treatments for bronchiolitis obliterans/bronchiolitis obliterans syndrome can help acute care and critical care nurses decelerate progression of the disease.</p>","PeriodicalId":10738,"journal":{"name":"Critical care nurse","volume":"45 4","pages":"29-37"},"PeriodicalIF":2.0,"publicationDate":"2025-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144764735","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Palliative Care Specialty Nursing in Medical Intensive Care Units.","authors":"Amy Newman, Joshua Lasseigne, Suzanne Goldhirsch, Emily Chai, Samuel Acquah, Camille Davis, Karen Stanley, Ankita Mehta","doi":"10.4037/ccn2025739","DOIUrl":"https://doi.org/10.4037/ccn2025739","url":null,"abstract":"<p><strong>Introduction: </strong>Given the serious illness burden of patients in medical intensive care units, palliative care is a key element of their care. This case discussion highlights the role of the palliative care specialty registered nurse in an embedded palliative care model in medical intensive care units.</p><p><strong>Clinical findings: </strong>A 44-year-old female patient with decompensated cirrhosis was transferred to the study hospital for liver transplant evaluation. Her hospital stay involved multiple complications.</p><p><strong>Diagnosis: </strong>The patient was determined to have palliative care needs. Multiple areas of intervention were identified.</p><p><strong>Interventions: </strong>A model including a palliative care specialty registered nurse was initiated in the medical intensive care unit.</p><p><strong>Outcomes: </strong>The palliative care specialty registered nurse had 2 roles: (1) optimizing patient care by partnering with medical intensive care unit colleagues to develop a plan of care aligned with patient and family values and preferences and (2) supporting and enhancing critical care nursing excellence by helping bedside nurses advocate for the patient's palliative care needs. Nurses were also empowered with communication skills to engage with patients, family members, and primary team colleagues.</p><p><strong>Conclusion: </strong>The palliative care specialty registered nurse model can be used in various intensive care unit settings. However, the complex care needs of critically ill patients, the unique nature and structural variations across critical care settings, and the resources required to implement this model are potential challenges.</p>","PeriodicalId":10738,"journal":{"name":"Critical care nurse","volume":"45 4","pages":"43-48"},"PeriodicalIF":2.0,"publicationDate":"2025-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144764734","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Standardization of Nursing Journal Clubs.","authors":"Shirley Visperas, Eileen Wong, Katie Azama","doi":"10.4037/ccn2025335","DOIUrl":"https://doi.org/10.4037/ccn2025335","url":null,"abstract":"","PeriodicalId":10738,"journal":{"name":"Critical care nurse","volume":"45 4","pages":"72-74"},"PeriodicalIF":2.0,"publicationDate":"2025-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144764738","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Mitigating Skin Failure in Critically Ill Patients at the End of Life: A Case Report.","authors":"Lynn Kordasiewicz, Katie Fik, Christy Petry, Janice Sturtz","doi":"10.4037/ccn2025450","DOIUrl":"https://doi.org/10.4037/ccn2025450","url":null,"abstract":"<p><strong>Introduction: </strong>Limited research on preventing and managing skin failure events such as deep tissue injuries and Kennedy terminal ulcers is available. These skin failure events often appear among patients experiencing multiple organ failure with hypoperfusion to the skin despite evidence-based nursing interventions to enhance skin integrity.</p><p><strong>Clinical findings: </strong>A 68-year-old White man presented at a trauma hospital after several recent falls at home. He immediately required hospitalization. Several medical complications, including a deep tissue pressure injury, evolved. The pressure injury remained clinically stable throughout his hospitalization.</p><p><strong>Diagnosis: </strong>The patient received a diagnosis of deep tissue pressure injury.</p><p><strong>Interventions: </strong>Aggressive medical management, implementation of a turning schedule on a low-air-loss surface, foam dressings, and offloading boots were used to prevent skin damage and preserve skin integrity.</p><p><strong>Outcomes: </strong>The patient's condition declined and he developed a deep tissue pressure injury on the sacrum that did not advance or become infected. The family agreed to comfort measures and he soon died.</p><p><strong>Conclusion: </strong>Skin failure events such as deep tissue pressure injuries and Kennedy terminal ulcers often occur among critically ill patients, older patients, those approaching end of life, and other patients with prolonged pressure upon body surfaces. The Centers for Medicare & Medicaid Services holds hospitals financially accountable for sequelae of events associated with hospital-acquired full-thickness pressure injuries. Additional research to categorize skin failure events as secondary to hypoperfusion and not medical mismanagement can optimize patient safety and positively impact the finances and credibility of medical organizations.</p>","PeriodicalId":10738,"journal":{"name":"Critical care nurse","volume":"45 4","pages":"38-42"},"PeriodicalIF":2.0,"publicationDate":"2025-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144764733","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Missed Nursing Care in Acute and Critical Care Settings: Implications and Interventions.","authors":"Debra Siela","doi":"10.4037/ccn2025560","DOIUrl":"https://doi.org/10.4037/ccn2025560","url":null,"abstract":"","PeriodicalId":10738,"journal":{"name":"Critical care nurse","volume":"45 4","pages":"8-9"},"PeriodicalIF":2.0,"publicationDate":"2025-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144764703","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Respiratory Distress Observation Scale and Medication Administration.","authors":"Erin C Hare","doi":"10.4037/ccn2025268","DOIUrl":"https://doi.org/10.4037/ccn2025268","url":null,"abstract":"","PeriodicalId":10738,"journal":{"name":"Critical care nurse","volume":"45 4","pages":"63-67"},"PeriodicalIF":2.0,"publicationDate":"2025-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144764737","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Corrections.","authors":"","doi":"10.4037/ccn2025780","DOIUrl":"https://doi.org/10.4037/ccn2025780","url":null,"abstract":"","PeriodicalId":10738,"journal":{"name":"Critical care nurse","volume":"45 4","pages":"11"},"PeriodicalIF":2.0,"publicationDate":"2025-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144764700","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Reframing the Term Missed Care to Avoid Misplaced Blame.","authors":"Annette M Bourgault","doi":"10.4037/ccn2025206","DOIUrl":"https://doi.org/10.4037/ccn2025206","url":null,"abstract":"","PeriodicalId":10738,"journal":{"name":"Critical care nurse","volume":"45 4","pages":"6-7"},"PeriodicalIF":2.0,"publicationDate":"2025-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144764736","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Reducing Postpyloric Feeding Start Times in Patients With Large Hemispheric Infarction Receiving Therapeutic Hypothermia.","authors":"Wenya Cao, Hong Chang, Miao Li, Linlin Fan, Fei Tian, Gang Liu, Yan Zhang","doi":"10.4037/ccn2025413","DOIUrl":"https://doi.org/10.4037/ccn2025413","url":null,"abstract":"<p><strong>Background: </strong>Early postpyloric feeding provides effective and safe enteral nutrition for patients with large hemispheric infarction receiving therapeutic hypothermia.</p><p><strong>Local problem: </strong>Patients with large hemispheric infarction undergoing therapeutic hypothermia often have gastrointestinal dysfunction and undergo repeated bedside attempts at blind postpyloric feeding tube placement. Confirming tube position via radiography can delay nutrient intake, increase costs, and expose patients to unnecessary radiation.</p><p><strong>Methods: </strong>In this quality improvement study, specialist nurses were trained to use ultrasonography instead of radiography to confirm postpyloric feeding tube position, reducing reliance on ancillary services. Preimplementation and postimplementation data included time from tube placement to first feeding and the frequency of radiography use. Surveys were conducted to assess the health care team's satisfaction with the new process.</p><p><strong>Results: </strong>Sixty-seven placements (30 before implementation, 37 after implementation) were evaluated. Feeding start times significantly decreased by 34.85% (mean [SD], 741.20 [192.73] minutes before implementation vs 482.86 [166.15] minutes after implementation; P < .001). The addition of ultrasound guidance for postpyloric feeding tube placement significantly decreased the number of abdominal radiographs per patient by 56.0% (mean [SD], 2.5 [0.9] before implementation vs 1.1 [0.4] after implementation; P < .001). Most health care team members indicated that this practice change reduced the time to initiation of enteral nutrition for patients with large hemispheric infarction receiving therapeutic hypothermia.</p><p><strong>Conclusions: </strong>By improving processes, we reduced feeding start times, minimized radiography use, and enhanced the health care team's satisfaction with postpyloric feeding tube placement for patients receiving therapeutic hypothermia.</p>","PeriodicalId":10738,"journal":{"name":"Critical care nurse","volume":"45 3","pages":"33-40"},"PeriodicalIF":2.0,"publicationDate":"2025-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144191601","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Interprofessional Approach to Reducing Central Line-Associated Bloodstream Infections in a Cardiac Surgical Intensive Care Unit.","authors":"Michael Mazzeffi, Marcia P White, Ashley Wade, Jacob Jordan, Akram Zaaqoq, Emily Schneiderman, Tiffany Phillips, Claire Davis, Jolian Dahl, John McNeil, Karen Singh, Joan Buckner, Costi D Sifri","doi":"10.4037/ccn2025723","DOIUrl":"10.4037/ccn2025723","url":null,"abstract":"<p><strong>Background: </strong>Central line [catheter]-associated bloodstream infection (CLABSI) is associated with longer stays and increased cost, morbidity, and mortality.</p><p><strong>Local problem: </strong>An academic cardiothoracic intensive care unit had a high CLABSI incidence (standardized infection ratio of 2.3 at baseline). The hospital's executive leadership team (chief nursing officer, chief medical officer, and chief of quality and performance improvement) directed intensive care unit leaders to reduce the standardized infection ratio.</p><p><strong>Methods: </strong>Interprofessional CLABSI reduction efforts were formulated using A3 methods based on the plan-do-check-act cycle. Unit leaders (nurses, physicians, advanced practice providers, and allied health professionals) met every 2 weeks for 2 years to formulate CLABSI reduction efforts. Efficacy of CLABSI reduction was evaluated with the standardized infection ratio.</p><p><strong>Interventions: </strong>Quality improvement activities included improved hand hygiene compliance, optimization of central venous catheter insertion, improved chlorhexidine dressing adherence, daily assessment of high-risk catheters for removal, use of an electronic intensive care unit bundle checklist to highlight central venous catheter duration for clinicians, and promotion of a blood culturing stewardship program with guidance on when to obtain blood samples for culture.</p><p><strong>Results: </strong>Interprofessional CLABSI reduction efforts reduced the standardized infection ratio from 2.3 to 0.8 over 3 years. The standardized utilization ratio, reflecting observed to expected central venous catheter days, decreased from 1.0 to 0.89.</p><p><strong>Conclusion: </strong>Interprofessional CLABSI reduction efforts can be effective in a cardiac surgical intensive care unit and improve patient safety. Keys to success include teamwork, accountability, acceptance from intensive care unit staff, and support from hospital executive leaders.</p>","PeriodicalId":10738,"journal":{"name":"Critical care nurse","volume":"45 3","pages":"11-22"},"PeriodicalIF":2.0,"publicationDate":"2025-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144191600","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}