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Assessing the abdomen

Mehta, Marjaana

Nursing Critical Care. 5(1):47-48, January 2010.

Use sight, sound, and touch to assess your patient's abdomen for abnormalities. This article provides step-by-step photos to help you improve your technique.

A guide to critical appraisal of evidence

Fineout-Overholt, Ellen

Nursing Critical Care. 14(3):24-30, May 2019.

How do nurses assess the quality of clinical research? This article outlines a stepwise approach to critical appraisal of research studies' worth to clinical practice: rapid critical appraisal, evaluation, synthesis, and recommendation. When critical care nurses apply a body of valid, reliable, and applicable evidence to daily practice, patient outcomes are improved.

Caring for hospitalized patients with alcohol withdrawal syndrome

Elliott, Dolores Y.

Nursing Critical Care. 14(5):18-30, September 2019.

Alcohol use disorder can lead to the potentially life-threatening alcohol withdrawal syndrome (AWS). Assessing for AWS is an important skill for frontline nurses in all hospital units. This article includes screening tools and tips to individualize patient treatment.

Tracheostomy Care

Parker, Laura C.

Nursing Critical Care. 9(6):38-41, November 2014.

The longer a patient requires mechanical ventilation, the more likely it is that the patient will have a tracheostomy. Read about indications, benefits, potential complications, and nursing care associated with tracheostomies.

Six steps to ABG analysis

Woodruff, David W.

Nursing Critical Care. 2(2):48-52, March 2007.

The arterial blood gas (ABG) analysis is a lab test that measures the acid-base balance and oxygenation of an arterial blood sample, usually obtained by direct arterial puncture. Nurses can learn valuable information about their patients by analyzing the ABG results.

Determining the level of evidence: Experimental research appraisal

Glasofer, Amy; Townsend, Ann B.

Nursing Critical Care. 14(6):22-25, November 2019.

The first installment in this series provides a basic understanding of research design to appraise the level of evidence of a source. This article reviews appraisal of randomized controlled trials and quasi-experimental research.

Third-spacing: When body fluid shifts

Holcomb, Susan Simmons

Nursing Critical Care. 4(2):9-12, March 2009.

Third-spacing of fluid into nonfunctional areas between cells can cause potentially serious problems such as reduced cardiac output and hypotension. Here's what you need to know to restore balance.

Nurse-driven protocols

Barto, Donna

Nursing Critical Care. 14(4):18-24, July 2019.

Without nurse-driven protocols, nurses must contact a physician or NP for intervention orders. The sense of autonomy nurses derive from nurse-driven protocols can contribute to increased nursing job satisfaction and retention rates. This article outlines the step-by-step process of designing and implementing a new protocol in the hospital setting.

Using pain to assess neurologic response

Lower, Judith "Ski"

Nursing Critical Care. 5(4):11-12, July 2010.

This illustrated guide explains various techniques for assessing a patient's neurologic response through painful stimuli, which are used when a patient doesn't respond to verbal stimuli or gentle shaking.

Managing PICCs

Argame, Jerome

Nursing Critical Care. 9(2):48, March 2014.

Learn about using, maintaining and removing peripherally inserted central catheters or PICCs and who benefits most from using them and who should avoid them.

Understanding ventilator waveforms—and how to use them in patient care

Lian, Jin Xiong

Nursing Critical Care. 4(1):43-55, January 2009.

Ventilator waveforms provide real-time information about patient ventilator interaction and ventilator function. Learn the basics of ventilator waveforms, how they're interpreted, and how you can use this information when caring for your patient.

Performing a respiratory assessment

Mehta, Marjaana

Nursing Critical Care. 5(3):45-47, May 2010.

Follow the steps in this illustrated guide to performing a thorough respiratory assessment through inspection, palpation, percussion, auscultation, and taking a complete patient history.

Keeping pace: Understanding temporary transvenous cardiac pacing

Gibson, Jennifer A.

Nursing Critical Care. 9(5):20-27, September 2014.

A temporary, ventricular transvenous pacemaker (TVPM) is an invasive intervention option to manage unstable cardiac dysrhythmias. TVPMs can also be associated with serious risks.

Measuring serum lactate

Antinone, Richard; Kress, Terri

Nursing Critical Care. 4(5):56, September 2009.

A serum lactate level, which measures the level of lactic acid in the blood, is a fairly reliable and accurate indication of tissue hypoperfusion and hypoxia. Learn about this test, how to interpret results, and what your patient needs to know.

Extracorporeal membrane oxygenation: The nurse's role in patient care

Bergeron, Amanda; Holifield, Linda

Nursing Critical Care. 15(3):6-14, May 2020.

Extracorporeal membrane oxygenation (ECMO) is increasingly being used with adult patients in respiratory failure or cardiac failure. ECMO is a complex treatment that requires diligent nursing care. Critical care nurses with the knowledge and ability to identify complications of ECMO can potentially reduce morbidity and mortality in these high-acuity patients.

Caring for patients with burn injuries

Culleiton, Alicia L.; Simko, Lynn M.

Nursing Critical Care. 8(1):14-22, January 2013.

Caring for a patient with severe burn injuries offers many challenges for critical care nurses. Find out about various types of burns and providing initial resuscitative care for a patient if treatment in a designated burn center facility or burn ICU isn't possible.

How to recognize and respond to refeeding syndrome

Yantis, Mary Ann; Velander, Robyn

Nursing Critical Care. 4(3):14-20, May 2009.

Restarting nutrition in malnourished patients can pose lethal consequences. Here's what you need to know about assessing your patient and avoiding problems.

Tegmen tympani defect: A hidden danger

Vacca, Vincent M. Jr.

Nursing Critical Care. 10(4):43-47, July 2015.

A tegmen tympani defect is a tear in either the right or left side of the tegmen tympani, or the roof of the middle ear, which disrupts communication between the intracranial and extracranial sections. Any delay in diagnosis increases the risk of seizures, meningitis, encephalitis, or cerebral abscess.

Addressing workplace incivility

Kisner, Tamela

Nursing Critical Care. 13(6):24-29, November 2018.

Incivility on the unit can have dangerous consequences for team professionalism, staff retention, and even patient outcomes. It comes in many forms, including bullying, lateral violence, and passive aggression. Healthcare facilities should work to adopt a zero-tolerance policy and educate nurses on how to prevent and manage workplace incivility.

Caring for a patient after coronary artery bypass graft surgery

Mullen-Fortino, Margaret; O'Brien, Noreen

Nursing Critical Care. 4(1):22-27, January 2009.

Every year, some 427,000 patients in the United States have coronary artery bypass graft (CABG) surgery. A patient undergoing CABG has complex healthcare needs. We'll outline your role in patient care by body system.

Acute respiratory failure and COPD: Recognition and care

Siela, Debra

Nursing Critical Care. 13(1):28-37, January 2018.

First, review the pathophysiology of COPD, signs and symptoms, and diagnosis. Then, learn how COPD exacerbations can lead to acute respiratory failure and hospitalization in these patients. A case study illustrates one patient's treatment plan.

Assessing the anion gap

Campana, Theresa

Nursing Critical Care. 4(2):15-17, March 2009.

Arterial blood gas results and serum electrolyte values let you assess the anion gap so you can diagnose and treat acid-base imbalances in critically ill patients.

Determining the level of evidence: Nonexperimental research designs

Glasofer, Amy; Townsend, Ann B.

Nursing Critical Care. 15(1):24-27, January 2020.

The next installment in this series provides critical care nurses with guidance to identify key features of the most-common nonexperimental research designs.

Deceased donor organ donation: The critical care nurse's role

O'Leary, Geraldine M.

Nursing Critical Care. 13(4):27-32, July 2018.

Critical care nurses are instrumental in the process of identifying potential organ donors. As such, nurses must be familiar with the criteria used to determine brain death and best practices when communicating with the families of potential donors.

Bispectral index monitoring in critical care: What's the science?

Olson, DaiWai M.; Gurram, Ananda R.; Zomorodi, Meg G.

Nursing Critical Care. 4(4):19-21, July 2009.

Initially developed as an adjunct to sedation monitoring for general anesthesia during surgery, bispectral index monitoring is increasingly being used in critical care. Find out how it can be used to reduce sedative use and decrease oversedation.

Getting involved in policy and politics

Oestberg, Fredrik

Nursing Critical Care. 8(3):48, May 2013.

By knowing how the political system works and which strategies can effectively influence policy, any nurse can become an advocate at the local, state, or federal level.

Acute ischemic stroke: The golden hour

Anderson, Jane A.

Nursing Critical Care. 11(3):28-36, May 2016.

Acute ischemic stroke is a medical emergency resulting from an embolic or thrombotic occlusion of an intracranial artery. This article provides acute care nurses with a summary of recent updates on the rapid evaluation and workup for patient selection and treatment with I.V. fibrinolysis.

Monitoring liver function

Schoch, Lisa; Whiteman, Kim

Nursing Critical Care. 3(5):5-6, September 2008.

Liver function tests are used to monitor liver function or to investigate specific signs and symptoms. Testing may be ordered before a patient starts therapy with a drug that's metabolized by the liver.

Improve your professional etiquette

Pagana, Kathleen D.

Nursing Critical Care. 5(6):48, November 2010.

Professional etiquette is critical for presenting yourself as a polished, confident, and professional nurse. These seven tips can help you stand out and improve your chances for career success.

Preventing postoperative pneumonia

Pusey-Reid, Eleonor

Nursing Critical Care. 9(4):42-47, July 2014.

While all patients are at risk for postoperative pulmonary complications after anesthesia and surgery, a patient's lifestyle, for example being a smoker, increases their odds of developing infections including bronchitis, COPD, and pneumonia.

Supporting your patient through holiday heart syndrome

Dirks, Joni

Nursing Critical Care. 4(1):29-30, January 2009.

Holiday heart syndrome is the term for an acute dysrhythmia, typically supraventricular tachycardia. Find out the causes for it and what treatment a patient should receive.

Palliative care in a critical setting: A case study

Burdette-Taylor, Shelly R.

Nursing Critical Care. 2(5):64, September 2007.

Nurses are using more discretion when suggesting curtailing aggressive care for cure and instead are focusing on promoting aggressive care for comfort.

Pneumocephalus assessment and management

Vacca, Vincent M. Jr.

Nursing Critical Care. 12(4):24-29, July 2017.

Pneumocephalus is a pathologic collection of air contained within the intracranial space. Although traumatic head injury accounts for 75% of all cases, pneumocephalus is also common following neurosurgery. Simple, asymptomatic pneumocephalus can often be managed conservatively; however, tension pneumocephalus is a neurosurgical emergency.

Critical care of a patient after CABG surgery

Mullen-Fortino, Margaret; O'Brien, Noreen; Jones, Maryann

Nursing Critical Care. 4(4):46-53, July 2009.

Your patient's just had coronary artery bypass grafting surgery. Learn more about your role in hemodynamic monitoring and mechanical ventilation in the crucial early postoperative hours.

Effective handoff communication

Wheeler, Kim K.

Nursing Critical Care. 10(6):13-15, November 2015.

The frequency of patient handoffs increases the chance of losing critical information during care transition. The challenge is to develop and implement effective strategies for standardized handoffs across various healthcare settings.

Music therapy: Nursing interventions with a beat

Crowley, Jessica

Nursing Critical Care. 8(2):15-17, March 2013.

Research has shown that older adults can benefit from music therapy and that this therapy doesn't need to be formal to be effective. This article focuses on interventions you can use to help patients.

Pediatric nasogastric tube placement

Wathen, Beth; Peyton, Christine

Nursing Critical Care. 9(3):14-18, May 2014.

The lifesaving, blind procedures of nasogastric or orogastric tube placement performed at bedside on children aren't without risks.

Electrolyte series: Sodium and chloride

Rowe, Amy

Nursing Critical Care. 13(3):20-27, May 2018.

The latest installment in our Electrolyte Series explores sodium and chloride. Learn the causes, signs and symptoms, and available treatments for the following imbalances: hypernatremia, hyponatremia, hyperchloremia, and hypochloremia.

Inhaled epoprostenol for acute respiratory distress syndrome

Schroeder, Nicole M.; Castiello, Danielle R.; Siemianowski, Laura A.

Nursing Critical Care. 13(4):6-13, July 2018.

This article describes the safe and effective use of inhaled epoprostenol in patients with acute respiratory distress syndrome (ARDS) by examining the current literature published on this topic.

Pulmonary arterial hypertension

Leeper, Barbara; Powell, Brook

Nursing Critical Care. 14(3):14-22, May 2019.

Pulmonary arterial hypertension is a rare and progressive disease that leads to right ventricular failure and death. This article examines the pathophysiology, risk factors, management guidelines, pharmacologic therapies, and nursing considerations associated with this disease.

Music helps heal mind, body, and spirit

Thomas, Linda S.

Nursing Critical Care. 9(6):28-31, November 2014.

Heart rate, blood pressure, and oxygen consumption decease when the right type of music is played. This auditory stimulus positively affects the patient physiologically and psychologically.

ACTH stimulation: Testing the adrenals

Whiteman, Kim

Nursing Critical Care. 4(1):56, January 2009.

Adrenal insufficiency is a state of inadequate cortisol production. An adrenocorticotropic hormone stimulation blood test can be used to evaluate whether the adrenal glands are producing sufficient amounts of cortisol.

Caring for the patient with a left ventricular assist device

Chmielinski, April; Koons, Brittany

Nursing Critical Care. 12(2):24-31, March 2017.

Mechanical circulatory support devices such as left ventricular assist devices provide an alternative to heart transplantation for patients with advanced heart failure, and critical care nurses need to understand how to care for these patients.

Calming patient agitation with dexmedetomidine

Boyer, Jeanne

Nursing Critical Care. 5(1):30-34, January 2010.

An ICU stay can make patients agitated, delirious, and anxious. This drug may help calm patients without causing respiratory depression, and has a fast onset and analgesic action.

Sedation Vacation: Worth The Trip

Hogue, Michael D.; Mamula, Staci

Nursing Critical Care. 8(1):35-37, January 2013.

Daily sedation interruption (DSI, also called a sedation vacation) can be beneficial for mechanically ventilated patients. Here's what you need to know about DSI so that evidence-based guidelines are followed when sedatives and analgesics are stopped temporarily.

Interpreting and using the arterial blood gas analysis

Lian, Jin Xiong

Nursing Critical Care. 5(3):26-36, May 2010.

This article reviews the physiology behind ABGs and describes a 5-step approach to ABG interpretation. The 5-step approach is then applied to case studies that illustrate how to use ABGs to manage patients, particularly those on mechanical ventilation.

Uncontrolled atrial fibrillation in adults

Wietbrock, Mary Ann

Nursing Critical Care. 10(4):6-11, July 2015.

Atrial fibrillation (AF) is a chaotic, rapid, irregular heartbeat that often causes poor perfusion. The atria can beat above 400 times/minute. Currently, 33.5 million people worldwide suffer from AF.

Dysrhythmia self-quiz: A dangerous slowing

Nursing Critical Care. 7(5):5-6, September 2012.

Test your rhythm strip interpretation using a five-step analysis method. Identify the mystery dysrhythmia and learn about its causes and management.

Evidence-based practice knowledge, attitudes, practices, and barriers: A nurse survey

Crable, Jane; Highfield, Martha E. Farrar; Patmon, Frances

Nursing Critical Care. 15(5):24-32, September 2020.

This study assessed nurses' knowledge, attitudes, practices, and perceived barriers related to evidence-based practice (EBP). Nurses reported highly positive attitudes toward EBP, and relatively strong EBP knowledge and practices, but they also identified several barriers. Removing barriers and building on strengths may close this knowledge-practice gap.

Recognizing and preventing drug diversion

Pfrimmer, Dale M.

Nursing Critical Care. 10(6):5-9, November 2015.

The OR, ED, and ICUs use a significant amount of controlled substances, making them susceptible to drug diversion by nurses. Unfortunately, access increases risk.

Mechanical ventilation weaning: An evidence-based review

Hetland, Breanna; Heusinkvelt, Jennifer; Krabbenhoft, Lisa; More

Nursing Critical Care. 13(6):5-16, November 2018.

Mechanical ventilation weaning is an ongoing challenge in critical care nursing. This article reviews evidence-based guidelines on common ventilator modes and settings, the weaning process, complications, and symptom management.

Reducing compassion fatigue with self-care and mindfulness

Abernathy, Staci; Martin, Rebecca

Nursing Critical Care. 14(5):38-44, September 2019.

This article outlines a nonrandomized pre-post intervention study on the impact of mindfulness and meditation on reducing compassion fatigue. Study participants saw statistically significant improvement in levels of compassion satisfaction.

Preventing hospital-acquired pressure ulcers

Cherry, Cecile; Moss, Jacqueline; Maloney, Martin; More

Nursing Critical Care. 7(5):28-34, September 2012.

Learn how one hospital used a collaborative approach to create a quality improvement program that reduced the incidence of hospital-acquired pressure adults in adult cardiac surgery patients to under 2%.

Assessing cardiovascular status

Mehta, Marjaana

Nursing Critical Care. 5(2):37-39, March 2010.

Perfect your cardiac assessment with this illustrated guide to assessing your patient's cardiovascular status through sight, sound, and touch.

Determining the level of evidence: Nonresearch evidence

Glasofer, Amy; Townsend, Ann B.

Nursing Critical Care. 15(2):22-26, March 2020.

The final installment in this series reviews different types of nonresearch evidence useful in clinical decision-making.

Interpreting 12-Lead ECGs, part I

Goldich, Guy

Nursing Critical Care. 5(1):16-22, January 2010.

Take an in-depth look at how the ECG translates the heart's electrical activity into a waveform, and what that waveform tells you about your patient's condition. Part II, appearing in a future issue, will focus on recognizing myocardial infarction and dysrhythmias.

Long QT syndrome: Dangerous delay

Foran, Catherine K.

Nursing Critical Care. 4(1):5-7, January 2009.

By understanding what causes long QT syndrome and how to manage it, you may be able to help your patient avoid the potentially lethal complications of this condition.

Caring for the patient with schizophrenia

Iannaco, Dodi

Nursing Critical Care. 6(5):20-22, September 2011.

Caring for a patient with schizophrenia includes ensuring that prescribed medications are administered as directed. You'll also monitor for adverse drug reactions, in addition to addressing the medical problem that brought the patient to the ICU.

7 LEGAL Tips for SAFE NURSING PRACTICE

Austin, Sally

Nursing Critical Care. 5(2):15-20, March 2010.

Keep your nursing practice safe and legally sound by following these tips on medication administration, monitoring for patient deterioration, communicating effectively, delegating responsibly, documenting accurately and promptly, knowing and following facility policies and procedures, and using equipment properly.
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