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Abstract
ABSTRACT The rise in direct oral anticoagulant (DOAC) use means nurses must understand the reversal of these agents in case of bleeding. Depending on bleed severity, as well as other criteria, pharmacologic reversal can be considered in place of supportive care alone. Knowledge of literature surrounding DOAC reversal is crucial.
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Affiliation(s)
- Andrea Hafer
- Andrea Hafer is a critical care clinical pharmacist at Riddle Hospital in Media, Pa., and Lindsay McCann is a critical care clinical pharmacy specialist at Bryn Mawr Hospital in Bryn Mawr, Pa
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2
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Abstract
Resuscitative endovascular balloon occlusion of the aorta (REBOA) has reemerged as a treatment for noncompressible torso hemorrhage. This article discusses indications and contraindications for REBOA, describes the procedure, and reviews nursing considerations for patients undergoing REBOA.
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Affiliation(s)
- Marilynn Kyritsis Bartley
- At the time this article was written, Marilynn K. Bartley was an advanced practice nurse with the Christiana Care Health System Trauma Program in Wilmington, Del
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3
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May LA, Harrell KN, Bell CM, Basham-Saif A, Barker DE, Maxwell RA. Intraoperative Resuscitation by Specialized Trauma Nurse Clinicians Improves Adherence to Massive Transfusion Protocol. Am Surg 2020; 86:35-41. [PMID: 32077414] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
Abstract
A massive transfusion protocol (MTP) was implemented at a Level I trauma center in 2007 for patients with massive blood loss. A goal ratio of plasma to pheresed platelets to packed red blood cells (PRBCs) of 1:1:1 was established. From 2007 to 2014, trauma nurse clinicians (TNCs) administered the MTP during initial resuscitation and anesthesia personnel administered the MTP intraoperatively. In 2015, TNCs began administering the MTP intraoperatively. This study evaluates intraoperative blood product ratios and crystalloid volume administered by anesthesia personnel or TNCs. A retrospective review of trauma registry patients requiring MTP from 2007 to 2017 was performed. Patient data were stratified according to MTP administration by either anesthesia personnel (2007-2015) or TNCs (2015-2017). Ninety-seven patients were included with 54 anesthesia patients and 44 TNC patients. Patients undergoing resuscitation by MTP administered by TNCs received less median crystalloid (3000 mL vs 1500 mL, P < 0.001). The ratio of plasma:PRBC (0.75 vs 0.93, P = 0.027) and platelets:PRBC (0.75 vs 1.04, P = 0.003) was found to be significantly closer to 1:1 for TNC patients. MTP intraoperative blood product administration by TNCs reduced the amount of infused crystalloid and improved adherence to MTP in achieving a 1:1:1 ratio of blood products.
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Affiliation(s)
- L Andrew May
- From the *University of Tennessee College of Medicine Chattanooga, Chattanooga, Tennessee
| | - Kevin N Harrell
- From the *University of Tennessee College of Medicine Chattanooga, Chattanooga, Tennessee
| | | | | | - Donald E Barker
- From the *University of Tennessee College of Medicine Chattanooga, Chattanooga, Tennessee
| | - Robert A Maxwell
- From the *University of Tennessee College of Medicine Chattanooga, Chattanooga, Tennessee
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4
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Steinberg MC. Using Scorecard Feedback to Improve Quantitative Blood Loss Measurement at Birth. Nurs Womens Health 2019; 23:390-403. [PMID: 31590724 DOI: 10.1016/j.nwh.2019.07.008] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2019] [Revised: 06/23/2019] [Accepted: 07/01/2019] [Indexed: 06/10/2023]
Abstract
OBJECTIVE To increase the percentage of cases in which quantitative blood loss (QBL) was documented by labor and delivery nurses for women giving birth. DESIGN Quality improvement project. SETTING/LOCAL PROBLEM Labor and delivery unit of a community hospital in which a previous implementation of QBL measurement was not sustained. PARTICIPANTS Labor and delivery nurses were the focus of the intervention, but the entire multidisciplinary team became involved. INTERVENTION/MEASUREMENTS Based on literature supporting the use of scorecard feedback to stimulate performance improvement, weekly blinded individual scorecards showing the percentage of births attended by each labor and delivery nurse with QBL documented and a run chart showing the percentage of all births with QBL documented were posted on the unit and discussed during huddles for 12 weeks. Data on blood product administration were collected, and charts comparing QBL and estimated blood loss (EBL) volumes documented were shared with nurses and physicians. RESULTS Over 12 weeks, the percentage of births with QBL documented increased from 22.7% to 80.0%. Consistent with previous reports comparing QBL and EBL volumes at birth, there was a significant difference between the mean QBL volume (mean = 482.20 ml, standard deviation = 358.03) and the mean EBL volume (mean = 313.15 ml, standard deviation = 211.91; p < .001) for total births. The mean QBL volume was also greater than the mean EBL volume for vaginal and cesarean births, but those differences were not statistically significant. There was no increase in blood product administration associated with the increase in QBL documentation. CONCLUSION Discussing weekly scorecards and a run chart of QBL measurement was associated with an increase in documentation of QBL by labor and delivery nurses. Planning this project and discussing the results engaged the entire multidisciplinary team in more consistent measurement of QBL. The increased level of QBL documentation has been sustained for longer than 1 year.
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Gurney D. Hemorrhage in the Pregnant Trauma Patient. J Emerg Nurs 2018; 44:532-534. [PMID: 30055767 DOI: 10.1016/j.jen.2018.06.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
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6
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Li J, Meng L, Zhang H, Wang X. Efficacy and drug resistance of antibacterials in patients' with acute pancreatitis and stress ulcer bleeding. Pak J Pharm Sci 2017; 30:1905-1909. [PMID: 29084665] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
Abstract
This study was designed to discuss key points regarding the clinical observations and nursing of patients with acute pancreatitis and stress ulcer bleeding. Retrospective analysis of 280 cases admitted to our hospital between January 2010 and January 2015 with acute pancreatitis and stress ulcer bleeding. At the same time, we treated patients with antimicrobial agents based on the epidemiology of sever acute pancreatitis (SAP) infection. According to the results of bacterial culture and drug sensitivity, we analyzed the sequence of pathogenic bacteria and the rate of bacterial resistance. During hospitalization, patients were given omeprazole and other intravenous drip line. Within this group, there was one death. The rest were all cured and discharged. Cases of acute pancreatitis, especially cases combined with biliary stone obstruction, pancreatic abscess, or pancreatic pseudo cyst are likely to show stress ulcer hemorrhage. There is a high risk of bleeding within 7 weeks of onset. The key is good nursing assessment and dynamic observation. Timely and effective anti-shock treatment is crucial to nursing when cooperating in rescues.
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Affiliation(s)
- Jun Li
- The First Affiliated Hospital of Hainan Medical University, Haikou, China
| | - Liping Meng
- The First Affiliated Hospital of Hainan Medical University, Haikou, China
| | - Hua Zhang
- Hainan Medical University, Haikou, China
| | - Xuejiao Wang
- The First Affiliated Hospital of Hainan Medical University, Haikou, China
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7
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Affiliation(s)
- Isabelle Klein
- Brigade de sapeurs-pompiers de Paris, 1, place Jules-Renard, 75017 Paris, France
| | - Jordan Fradin
- Brigade de sapeurs-pompiers de Paris, 1, place Jules-Renard, 75017 Paris, France
| | - Claire Valentin
- Brigade de sapeurs-pompiers de Paris, 1, place Jules-Renard, 75017 Paris, France
| | - Hugues Lefort
- Brigade de sapeurs-pompiers de Paris, 1, place Jules-Renard, 75017 Paris, France.
| | - Jean-Pierre Tourtier
- Brigade de sapeurs-pompiers de Paris, 1, place Jules-Renard, 75017 Paris, France
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Learning lessons from war to treat people with trauma. Nurs Stand 2016; 31:66. [PMID: 27848415 DOI: 10.7748/ns.31.11.66.s49] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/06/2023]
Abstract
Trauma is a leading cause of death and disability in civilian environments, and on the battlefield, and trauma-induced haemorrhage is the main cause of potentially preventable death.
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Wolschon EM, Köpke S. [1: Oral anticoagulants]. Pflege Z 2016; 69:236-238. [PMID: 27214954] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/05/2023]
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10
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Davis LL. Preventing stroke in patients with atrial fibrillation. Nurse Pract 2013; 38:24-32. [PMID: 24096550 DOI: 10.1097/01.npr.0000435781.73316.9c] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/02/2023]
Abstract
Adults with atrial fibrillation are at an increased risk for stroke. New oral antithrombotic agents are now available to help prevent stroke and other thromboembolic events. This article provides an update on factors to consider when determining various treatment options for these high-risk patients in hopes of improving outcomes.
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Affiliation(s)
- Leslie L Davis
- Leslie L. Davis is an Assistant Professor of Nursing at University of North Carolina, Greensboro School of Nursing, Greensboro, N.C
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11
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Danzer S. [Avoiding any unnecessary manipulation of the wound. Tumor wounds and wound management in palliative care]. Pflege Z 2013; 66:26-29. [PMID: 23394052] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/01/2023]
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12
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Maurice GDS. [The treatment of combat casualties today]. Rev Infirm 2012:16-18. [PMID: 23316578] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/01/2023]
Abstract
Most soldiers are wounded by an explosion and haemorrhaging is the main cause of death. From the first aid provided on the field of combat to repatriation to France, every stage in the treatment of injured soldiers is meticulously organised in order to save as many lives as possible.
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Vernooij JWP, Kaasjager HAH, van der Graaf Y, Wierdsma J, Grandjean HMH, Hovens MMC, de Wit GA, Visseren FLJ. Internet based vascular risk factor management for patients with clinically manifest vascular disease: randomised controlled trial. BMJ 2012; 344:e3750. [PMID: 22692651 PMCID: PMC3374126 DOI: 10.1136/bmj.e3750] [Citation(s) in RCA: 48] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 04/20/2012] [Indexed: 12/17/2022]
Abstract
OBJECTIVE To investigate whether an internet based, nurse led vascular risk factor management programme promoting self management on top of usual care is more effective than usual care alone in reducing vascular risk factors in patients with clinically manifest vascular disease. DESIGN Prospective randomised controlled trial. SETTING Multicentre trial in secondary and tertiary healthcare setting. PARTICIPANTS 330 patients with a recent clinical manifestation of atherosclerosis in the coronary, cerebral, or peripheral arteries and with at least two treatable risk factors not at goal. INTERVENTION Personalised website with an overview and actual status of patients' risk factors and mail communication via the website with a nurse practitioner for 12 months; the intervention combined self management support, monitoring of disease control, and drug treatment. MAIN OUTCOME MEASURES The primary endpoint was the relative change in Framingham heart risk score after 1 year. Secondary endpoints were absolute changes in the levels of risk factors and the differences between groups in the change in proportion of patients reaching treatment goals for each risk factor. RESULTS Participants' mean age was 59.9 (SD 8.4) years, and most patients (n=246; 75%) were male. After 1 year, the relative change in Framingham heart risk score of the intervention group compared with the usual care group was -14% (95% confidence interval -25% to -2%). At baseline, the Framingham heart risk score was higher in the intervention group than in the usual care group (16.1 (SD 10.6) v 14.0 (10.5)), so the outcome was adjusted for the separate variables of the Framingham heart risk score and for the baseline Framingham heart risk score. This produced a relative change of -12% (-22% to -3%) in Framingham heart risk score for the intervention group compared with the usual care group adjusted for the separate variables of the score and -8% (-18% to 2%) adjusted for the baseline score. Of the individual risk factors, a difference between groups was observed in low density lipoprotein cholesterol (-0.3, -0.5 to -0.1, mmol/L) and smoking (-7.7%, -14.9% to -0.4%). Some other risk factors tended to improve (body mass index, triglycerides, systolic blood pressure, renal function) or tended to worsen (glucose concentration, albuminuria). CONCLUSION An internet based, nurse led treatment programme on top of usual care for vascular risk factors had a small effect on lowering vascular risk and on lowering of some vascular risk factors in patients with vascular disease. TRIAL REGISTRATION Clinical trials NCT00785031.
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Affiliation(s)
- J W P Vernooij
- Department of Vascular Medicine, University Medical Center Utrecht, PO Box 85500, 3508 GA Utrecht, Netherlands
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Hunt RL. Evaluation of the prothrombin time, aPTT, and platelet count in the bleeding infant. Neonatal Netw 2011; 30:253-256. [PMID: 21729857 DOI: 10.1891/0730-0832.30.4.253] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/31/2023]
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Pautas E, Mitha N, Gouronnec A, Siguret V, Gouin-Thibault I. [Management of complications with antivitamin K in elderly people]. Soins Gerontol 2011:12-16. [PMID: 21698957] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/31/2023]
Abstract
latrogenic complications with antivitamin K (AVK) largely entail haemorrhages, apparently more frequent in the elderly. Recent French and North American recommendations are available and must be widely circulated, in community practices as well as hospitals, in order to improve the treatment of overdoses and/or haemorrhagic accidents under AVK.
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Affiliation(s)
- Eric Pautas
- Unité de gériatrie aiguë, hôpital Charles Foix (AP-HP), Ivry-sur-Seine, faculté de médecine Pierre et Marie Curie, Paris.
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16
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Leclerc J, Devos L, Penaud JS. [Multiple trauma in the child]. Soins Pediatr Pueric 2011:45-46. [PMID: 21520582] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/30/2023]
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17
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Bouix J. [Management of hemorrhage]. Rev Infirm 2010:43-44. [PMID: 20432855] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/29/2023]
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18
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Becze E. Put evidence into practice to prevent and manage bleeding. ONS Connect 2009; 24:12-13. [PMID: 19947076] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/28/2023]
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19
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Doherty D. The latest in trauma nursing. Nurs Manag (Harrow) 2008; 34 Suppl Critical:19. [PMID: 12891082] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/04/2023]
Affiliation(s)
- Daniel Doherty
- Emergency Departmentat Christiana Care Health System, Christiana Hospital, in Newark, Del, USA
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21
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Abstract
PURPOSE/OBJECTIVES To update information concerning the antiangiogenic agent bevacizumab, discuss side effects, and provide information on nursing management of the side effects. DATA SOURCES Published articles, abstracts, and research data. DATA SYNTHESIS In clinical trials, the addition of bevacizumab to standard chemotherapy increased survival in patients with metastatic colorectal cancer and advanced non-small cell lung cancer and increased progression-free survival in patients with metastatic breast cancer. Bevacizumab also is being evaluated in combination with other targeted agents in various tumor types. Commonly reported side effects associated with bevacizumab include hypertension, proteinuria, and minor bleeding. CONCLUSIONS The value of bevacizumab in treating metastatic colorectal cancer has long been established. Clinical trial data have demonstrated the benefit of using bevacizumab in combination with standard chemotherapy in the treatment of non-small cell lung cancer and metastatic breast cancer. Because of bevacizumab's expanding role in cancer treatment, nurses need to know how to use it, be aware of possible side effects, and anticipate interventions. IMPLICATIONS FOR NURSING Nurses play an important role in the identification and management of adverse events associated with bevacizumab.
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22
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Sukprasert M, Choktanasiri W, Ayudhya NIN, Promsonthi P, O-Prasertsawat P. Increase accuracy of visual estimation of blood loss from education programme. J Med Assoc Thai 2006; 89 Suppl 4:S54-9. [PMID: 17726810] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/17/2023]
Abstract
OBJECTIVE To study the increase accuracy of visual estimation of blood loss after an education program. MATERIAL AND METHOD Seven simulated scenarios with known measured amount of blood were created by using expired packed red cell from blood bank and common surgical materials. Ninety nurses were randomized into two groups. The experimental group attended blood loss estimation course while the control group did not. The percentage of errors in blood loss estimation were calculated and compared between both groups. The main outcome of this study was percentage of nurses who had accurate estimation. We assumed that if the estimated blood volume is within twenty percentage of actual volume it is accurate. RESULTS There were no difference in age group (p = 0.08), clinical experiences (p = 0.95) and type of work (p = 0.47) between both groups. Educational program significantly increase accuracy in blood loss estimation (p < 0.05) in all seven scenarios. CONCLUSION Educational program increased the accuracy of visual estimation of blood loss.
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Affiliation(s)
- Matchuporn Sukprasert
- Department of Obstetrics and Gynaecology, Faculty of Medicine Ramathibodi Hospital, Mahidol University, 270, Rama 6, Rachatavee, Bangkok 10400, Thailand
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24
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Abstract
The role of the professional nurse in the perioperative care of the patient undergoing open heart surgery is beneficial for obtaining a positive outcome for the patient. This article focuses on the preoperative and postoperative nursing care of patients undergoing coronary artery bypass graft surgery. Risk assessment, preoperative preparation, current operative techniques, application of the nursing process immediately after surgery, and common postoperative complications will be explored.
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Affiliation(s)
- Caron G Martin
- School of Nursing and Health Professions, Northern Kentucky University, Highland Heights, Ky, USA.
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26
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Galli A, Palatnik A. What is the proper activated clotting time (ACT) at which to remove a femoral sheath after PCI? What are the best "protocols" for sheath removal? Crit Care Nurse 2005; 25:88-92, 94-5. [PMID: 15871538] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/02/2023]
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Abstract
Fingating wounds always present a management challenge. Not only is it often difficult to manage the physical aspects of the wound - pain, bleeding, exudate and odour - but also the psychological impact of a fungating wound on the patient and their family or carers is often considerable. This review examines current practice in relation to fungating wounds, and emphasizes the central important of assessment, communication and sensitivity in nursing management.
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Affiliation(s)
- Vicky Wilson
- School of Nursing, Midwifery and Health, University of Paisley, Renfrewshire.
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Abstract
Os pacientes que fazem uso de anticoagulante orais apresentam necessidades especificas, para as quais, o atendimento de enfermagem tem um importante papel, principalmente, no sentido de prevenir complicações. A presente revisão foi realizada visando discutir os diagnósticos de enfermagem para esses pacientes, utilizando-se do sistema North American Nursing Diagnoses Association - NANDA. Os diagnósticos para esses pacientes retratam o risco de sangramento e retrombose quase sempre devido ao controle ineficaz do regime terapêutico e o déficit de volume de líquidos quando ocorre perda ativa de sangue. Propõem-se ainda as intervenções de enfermagem e os critérios de avaliações para tais condições. Os autores consideram relevante, no sucesso da assistência o preparo da equipe para lidar com essa terapia.
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Allen L. It's in the blood. Nurs Stand 2004; 18:26. [PMID: 15318648] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/30/2023]
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Affiliation(s)
- Ruth Ann Kirschman
- Mountain States Regional Hemophilia and Thrombosis Center, University of Colorado Health Sciences Center, Aurora, USA
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Frakes MA, Evans T. Major pelvic fractures. Crit Care Nurse 2004; 24:18-30; quiz 31-2. [PMID: 15098308] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/29/2023]
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Abstract
This article examines the available literature surrounding the procedure of clean intermittent self-catheterization (CISC) and its impact on patients' quality of life. Many articles have been written about, and much research has been carried out into, the practicalities of performing CISC regarding dexterity, disability, etc, and its advantages and disadvantages related to infection rates and complications. However, there appear to be very few articles addressing the day-to-day problems that having to perform CISC presents to patients. While many articles do acknowledge that CISC improved patients' quality of life, very few go on to identify and discuss the daily life activities that are impacted upon by having to perform the procedure. There is a need for further research from patients' perspectives: to identify the issues that they have in living with this inconvenience and in order for carers to understand fully the implications of CISC on a patient's quality of life. With this insight, carers will be better armed to help patients overcome their fears and be more supportive in the ongoing care of the patient. Non-compliance is the main reason for patients' inability to perform CISC and with a better understanding of the problems, carers will be able to give practical help and support.
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Affiliation(s)
- Sue Woodward
- Florence Nightingale School of Nursing and Midwifery, King's College London, London, UK
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Andritschke K. [Hemophilia--as a chronic and emergency illness]. Kinderkrankenschwester 2003; 22:392-3. [PMID: 16130559] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/04/2023]
Affiliation(s)
- Karin Andritschke
- Gerinnungsambulanz für Kinder, Johann-Wolfgang-Goethe Universitätsklinikum, Deutschland
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Abstract
Peripherally inserted central catheters (PICCs) are frequently placed in neonates to optimize nutrition and provide stable infusions of critical medications into the central vascular system. PICCs have been associated with a number of device-specific complications that can manifest during insertion, while the line is indwelling, and/or after the removal of the line. The first article of this series in Focus on the Physical, titled "Assessment of Infants With Peripherally Inserted Central Catheters: Part I. Detecting the Most Frequently Occurring Complications," presented assessment strategies to detect common complications such as catheter occlusions and catheter-related bloodstream infections. Part 2 of this series emphasizes the importance of ongoing systematic assessment of PICCs for device-specific complications such as catheter migration, dislodgement, breakage, phlebitis, and thrombosis, as well as the life-threatening complications of pleural and pericardial effusion and tamponade. Each complication is described, along with a review of the etiology, a description of presenting signs and symptoms, and key clinical interventions.
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Affiliation(s)
- Janet Pettit
- Neonatal Intensive Care Unit, Doctors Medical Center, 1441 Florida Ave, Modesto, CA 95350, USA.
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Sadler GR, Stoudt A, Fullerton JT, Oberle-Edwards LK, Nguyen Q, Epstein JB. Managing the oral sequelae of cancer therapy. Medsurg Nurs 2003; 12:28-36. [PMID: 12619597] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Subscribe] [Scholar Register] [Indexed: 03/01/2023]
Abstract
Patients undergoing systemic chemotherapy and/or head and neck radiotherapy frequently experience treatment side effects. Oral complications are among the most common problems associated with these therapies. These sequelae include mucositis, oral hemorrhage, infection, and xerostomia (dry mouth). Occasionally, oral complications are so severe that the cancer treatment must be reduced or even terminated. By providing comprehensive care, nurses work to help prevent, identify, and manage these oral sequelae, and thus maximize quality of life. Limiting the effects of oral sequelae increases patient adherence to treatment protocols, improves the quality of life, and increases the odds of long-term survival.
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38
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Torres M, Rodrigues E. [Care of severe burns at the emergency service]. Servir 2002; 50:75-83. [PMID: 12068663] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/25/2023]
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39
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Reiss G, Reiss M. [Otorhinolaryngology--V. Hemorrhage of the ENT area requires rapid management]. Pflege Z 2002; 55:167-70. [PMID: 11924318] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/24/2023]
Affiliation(s)
- Gilfe Reiss
- Klinik und Poliklinik für Neurochirurgie an der TU Dresden
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Abstract
PURPOSE To provide nurse practitioners (NPs) with a practical approach for the management of postmenopausal bleeding in office settings. DATA SOURCES Selected scientific literature and the author's own experience. CONCLUSIONS Postmenopausal bleeding should be considered cancer until proven otherwise, despite the fact that abnormal pathology is found in only 15% of endometrial biopsies. IMPLICATIONS FOR PRACTICE Post menopausal bleeding can be safely evaluated and managed by NPs using aspiration endometrial biopsies and/or transvaginal ultrasound. Hospitalization for dilation and curettage under anaesthesia can often be avoided.
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Affiliation(s)
- H F McGregor
- Regional Breast Cancer Program, Madigan Army Medical Center, Tacoma, WA, USA.
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Vernon T. Managing haemorrhagic skin lesions. Nurs Times 2001; 97:IX. [PMID: 12014329] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 04/18/2023]
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Abstract
A case report is presented that describes the initial care of a severely injured patient who was hemodynamically unstable. The discussion highlights the process used to recognize life-threatening injuries, to differentiate internal sources of hemorrhage, to provide damage-control surgery, and to stop further bleeding with an interventional radiologic examination. The emergency nursing care of a patient with unstable pelvic trauma is included.
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Affiliation(s)
- A Koestner
- Bronson Methodist Hospital, 252 E Lovell, Kalamazoo, MI 49001, USA
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Abstract
Percutaneous coronary intervention in patients with coronary artery disease can lead to thrombotic occlusion of the artery and to subsequent ischemic complications. Patients undergoing these procedures have been treated with aspirin, heparin, or both as a means of preventing thrombosis. The arsenal of antithrombotic agents has recently been augmented by the addition of a new class of drugs the platelet receptor glycoprotein (GP) IIb-IIIa inhibitors, which include abciximab, eptifibatide, and tirofiban. Unlike aspirin or heparin, which inhibit some but not all pathways leading to thrombosis, GP IIb-IIIa inhibitors block the final common pathway of platelet aggregation. When used in conjunction with aspirin and heparin, GP IIb-IIIa inhibitors have yielded favorable clinical outcomes, reducing the incidence of death, myocardial infarction, and urgent intervention. However, GP IIb-IIIa inhibitors also have been associated with an increased risk of bleeding complications, especially at the femoral access site. This presents new challenges for nurses charged with the care of patients treated with these agents. The goal of nursing care for this population is to ensure the optimal benefits of GP IIb-IIIa inhibitor therapy while simultaneously preventing or minimizing groin bleeding in patients undergoing percutaneous coronary procedures.
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Affiliation(s)
- N B Juran
- The Cleveland Clinic Foundation, OH 44195, USA
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Juran NB, Rouse CL, Smith DD, O'Brien MA, DeLuca SA, Sigmon K. Nursing interventions to decrease bleeding at the femoral access site after percutaneous coronary intervention. SANDBAG Nursing Coordinators. Standards of Angioplasty Nursing Techniques to Diminish Bleeding Around the Groin. Am J Crit Care 1999; 8:303-13. [PMID: 10467467] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/13/2023]
Abstract
BACKGROUND This trial is the first prospective, multicenter clinical nursing trial conducted to measure the effect of nursing interventions on bleeding at the femoral access site after percutaneous coronary intervention with or without a potent antiplatelet agent given along with heparin and aspirin. OBJECTIVE To measure the relationship between nursing interventions and complications at the arterial access site in patients undergoing percutaneous coronary interventions and to recommend a standard of care to minimize bleeding complications. METHODS In a descriptive, correlational 4010-patient study, nursing care interventions after coronary procedures were measured. Observed standards of care were assessed, and regression techniques were used to evaluate nursing interventions and the effect of the interventions on bleeding at the access site after percutaneous coronary procedures. RESULTS Several significant correlations between nursing interventions and the occurrences of moderate to severe bleeding at the access site were found; however, most interventions had little effect. The most significant factors in decreasing complications at the access site were early removal of the arterial sheath, the type of pressure mechanism used to achieve arterial hemostasis, staffing allocation, and the person and method used to remove the sheath. CONCLUSION Many nursing interventions after percutaneous coronary intervention have become routine in the absence of clinical outcome data. Most nursing interventions aimed at decreasing bleeding at the vascular access site increase nursing workload but do not significantly affect bleeding in the groin. These results underscore the importance of continued clinical research studies to validate nursing practice on the basis of patients' outcomes.
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Affiliation(s)
- N B Juran
- Cleveland Clinic Foundation, Ohio, USA
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45
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First aid series. Bleeding. Nurs Times 1999; 95:53. [PMID: 10568998] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/14/2023]
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46
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Affiliation(s)
- B A Gallauresi
- Center for Devices and Radiological Health, Food and Drug Administration, Rockville, Md., USA
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47
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Field D. Assessment of haemostasis. Nurs Times 1998; 94:54-6. [PMID: 9749031] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Abstract
Major surgery and some therapies carry with them the chance of severe bleeding. Recognising who is at risk and knowing what to do if it happens are important parts of the nurse's job. Debbie Field explains.
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48
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Grocott P. Controlling bleeding in fragile fungating tumours. J Wound Care 1998; 7:342. [PMID: 9791362] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/09/2023]
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50
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Nanlon M, Loehner D. Patient with jejunostomy, caput medusae, and bleeding peristomal varices. J Wound Ostomy Continence Nurs 1997; 24:123-5. [PMID: 9204861] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Affiliation(s)
- M Nanlon
- Scott and White Hospital, Temple, Texas, USA
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