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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.

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.

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.

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.

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.

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.

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.

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.

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.

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.

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.

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.

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.

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.

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.

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.

The importance of patient advocacy

Maine, Jillian

Nursing Critical Care. 10(4):48, July 2015.

As a student nurse, the author learned two powerful lessons: addressing concerns gets results, and you always need to be a voice for your patients, whether it's for their physical health or getting their meal requests right!

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.

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.

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.

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.

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.

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.

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.

Recognizing pulmonary hypertension on the ECG

Barto, Donna

Nursing Critical Care. 6(2):11-13, March 2011.

Clues on your patient's ECG can alert you to the presence of pulmonary hypertension, which increases right ventricular workload.

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.

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.

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.

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.

Minimizing self-extubation

Smilow, Rachelle

Nursing Critical Care. 8(5):44-47, September 2013.

Nearly a quarter of ICU patient prematurely remove their endotracheal tubes. Find out how to use sedation and restraints wisely to prevent self-extubation.

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.

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.

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%.

Rhythm self-quiz: Fast and deadly

Craig, Karen Jean

Nursing Critical Care. 8(1):5-6, January 2013.

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

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.

What is urine specific gravity?

Flasar, Cathy

Nursing Critical Care. 3(6):9, November 2008.

Measuring urine specific gravity is an easy and convenient way to gauge a patient's hydration status, as well as the functional ability of the kidneys.

Sepsis-3: The new definitions

Seckel, Maureen A.

Nursing Critical Care. 12(2):37-43, March 2017.

Sepsis definitions were recently revised by the Third International Consensus Definitions for Sepsis and Septic Shock (Sepsis-3) to better align with current understanding of the research, physiology, and management of patients with sepsis. This article reviews the new definitions and other recent changes in sepsis management.

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.

Noise in the ICU: sound levels can be harmful

Maidl-Putz, Carolyn; McAndrew, Natalie S.; Leske, Jane S.

Nursing Critical Care. 9(5):29-35, September 2014.

The noise from alarms, staff conversations, and equipment seem normal to experienced ICU nurses and healthcare providers. However, noise levels are associated with negative effects on patients' sleep and may contribute to hospital-acquired delirium.

Prone positioning: Improving oxygenation in patients with ARDS

Kennison, Monica; Yost, Wilbert III

Nursing Critical Care. 4(3):42-46, May 2009.

Although not standard therapy, prone positioning can help recruit collapsed alveoli and improve oxygenation in patients with ARDS when mechanical ventilation doesn't help. Whether accomplished manually or mechanically, proning could turn things around for your patient.

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.

Recognizing the red flags of low back pain

McDevitt, Louise; Davis, Matthew A.

Nursing Critical Care. 6(1):24-29, January 2011.

Low back pain usually is benign, but can also signal a serious underlying problem. The authors describe "red flags" that can help nurses recognize patients who need a more in-depth clinical evaluation.

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.

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.

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.

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.

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.

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.

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.

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.

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.

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.

Recognizing amiodarone-induced hypothyroidism

Mosher, Mary C.

Nursing Critical Care. 7(3):27-32, May 2012.

Amiodarone is often prescribed for ventricular and atrial dysrhythmias. The signs and symptoms of amiodarone-induced hypothyroidism (AIH) can be missed or misdiagnosed in a patient with a complex clinical condition. Here's what you need to know.

Advantages of personal health records

George, Tracy P.; Hopla, Deborah L.

Nursing Critical Care. 10(6):10-12, November 2015.

A personal health record is an electronic application developed and maintained by patients to store and manage their health information in a private and secure environment. It differs from patient portals that are connected to patients' electronic health records and are usually associated with a healthcare institution or an insurance company.

Reducing your liability risk

Nursing Critical Care. 7(4):4, July 2012.

Are you doing everything you can to reduce your liability risk? A recent report sheds light on areas where you must stay vigilant to keep yourself and your patients safe.

Managing a patient with Acute Respiratory Distress Syndrome PART 2: ARDS

Lian, Jin Xiong

Nursing Critical Care. 6(1):31-40, January 2011.

In the second and final part of this series, the author describes how to handle refractory hypoxemia and how to use information gleaned from ventilator waveforms to optimize ventilation for patients with ARDS.

Postoperative pulmonary complications

Thanavaro, Joanne L.; Foner, Barbara J.

Nursing Critical Care. 11(1):38-47, January 2016.

Postoperative pulmonary complications are a major contributor to the overall risk of noncardiac surgery. They can cause deleterious clinical outcomes after surgery, may lead to serious health issues, and contribute to long-term mortality.

Patient readiness for PACU discharge

Pusey-Reid, Eleonor

Nursing Critical Care. 13(5):31-34, September 2018.

Prematurely discharging patients from the postanesthesia care unit (PACU) can lead to poor patient outcomes. To achieve optimal patient outcomes, nurses need to be familiar with evidence-based practices surrounding safe patient discharge from the PACU.

Start with a PICOT question to make your case

Echevarria, Ilia M.; Walker, Susan

Nursing Critical Care. 10(3):14-16, May 2015.

PICOT is an acronym for five key components that help nurses ask clinical or researchable questions with an evidence-based practice framework.

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.

What is Brown-Séquard syndrome?

Franges, Ellie

Nursing Critical Care. 4(3):36-41, May 2009.

Also know as lateral cord syndrome, this type of spinal cord injury results from an incomplete transection of the cord. Find out about this uncommon condition and how to care for your patient.

Know the facts of mechanical ventilation

Lian, Jin Xiong

Nursing Critical Care. 3(5):43-49, September 2008.

Mechanical ventilation (MV) is one of the core components of supportive therapies for critically ill patients, but its application may lead to ventilator-induced lung injury. A sound knowledge of MV and a patient's condition enables clinicians to maximize the benefits of ventilatory support.

Recognizing vascular bleeding after cardiac catheterization

Sedlacek, Mary Ann; Newsome, Joseph

Nursing Critical Care. 6(5):7-12, September 2011.

After a patient died from unrecognized retroperitoneal bleeding, the authors' facility developed a tool to help identify patients at risk for vascular bleeding complications after cardiac catheterization.

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.

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