Barbara S. Turner

EFFECT OF SHORT-DURATION HYPERVENTILATION DURING ENDOTRACHEAL SUCTIONING ON INTRACRANIAL PRESSURE IN SEVERE HEAD-INJURED ADULTS

A repeated measures randomized within-group design was used to determine the effectiveness of controlled short-duration hyperventilation (HV) in blunting the increase of intracranial pressure (ICP) during endotracheal suctioning (ETS). A multimodal continuous real-time computerized data acquisition procedure was used to compare the effects of two HV ETS protocols on ICP, arterial pressure, cerebral perfusion pressure (CPP), heart rate, and arterial oxygen saturation in severe head-injured adult patients. The results indicated that short-duration HV for 1 minute, which decreases the PaCO2, reduced ETS-induced elevations in ICP while maintaining CPP. However, it is not clear whether short-duration HV is neuroprotective, particularly in ischemic regions of the brain. Therefore, before a change in practice is implemented on the use of short-duration HV as a prophylactic treatment against ETS-induced elevations in ICP, additional questions on cerebral oxygen delivery and uptake need to be answered.

Tracheobronchial Trauma Associated With Airway Management in Neonates

Airway management procedures are an integral part of caring for the newborn infant with respiratory compromise. Concomitant with these interventions are latrogenic consequences that result in varying degrees of trauma to the tracheobronchial tree. Common interventions such as intubation, mechanical ventilation, use of heated and humidified gases, and endotracheal suctioning are discussed using research-based literature that evaluates the injury to the trachea and the mucociliary transport system.

A review of cardiovascular risk factors in US military personnel.

As the civilian population exhibits increasing trends in major cardiovascular (CV) risk factors in younger age groups, the US military is observing similar trends. These worrisome developments are seen even in young adulthood. Despite the need for a fit, combat-ready force, increases in CV risk are increasingly evident in the military population. This review provides an overview of coronary artery disease in the young and the prevalence of risk factors in the military population. With increases in current military operations in an acutely stressful environment, the role of stress and the manifestation of CV disease are also examined.

Blood Pressure Screenings Through Community Nursing Health Fairs: Motivating Individuals to Seek Health Care Follow-Up

Purpose: To evaluate the effectiveness of blood pressure [BP] screenings through community-based health fairs. Effectiveness was measured by those with high BP readings who either made an appointment with or actually followed up with their primary care provider [PCP] in person following post-screening referral. Data sources: Anonymized data were provided for 958 individuals who obtained BP screening through a three-day health fair provided by the Ceres Police Department Nurse Program. Conclusions: Of 958 screened, 170 (17.8%) were identified with high BP readings and provided with PCP referral. Data were analyzed on 124 individuals with high BP recordings. Of the 124 PCP referrals, 116 (93%) either made an appointment with or followed up in person with their PCP following BP screening. Of the 98 who visited with their PCP, 29 (30%) were either placed on BP medication, had their current BP medication dose increased, or were changed to another BP medication by their PCP. Implications for Practice: Hypertension remains a leading cause of morbidity and mortality. Nurse-operated health fairs, crafted to identify those with high BP readings, are promising as a simple and effective means in motivating individuals to seek follow-up care.

Central line "attention" is their best prevention.

Central line associated blood stream infections (CLABIs) are associated with an increase in length of stay, morbidity, hospital costs, and mortality. In 2009, CLABIs were on the increase at Covenant Healthcares 55 bed Level III neonatal intensive care unit (NICU). Prior to this practice initiative, there were no standardized central line management practices in the NICU. We retrospectively reviewed the incidence CLABIs for the six months prior to the initiation of the standardization of central line management and then 3 months following the implementation of the new practice policy. Specific outcomes measured were the number of CLABIs, length of stay related to CLABIs, and adherence to the policies and procedures. The project was implemented in four phases: 1) hand hygiene, 2) “scrub the hub”, 3) central line tubing changes, 4) central line insertion, removal, and dressing changes. Although there were no statistically significant changes in the outcome measures, there were clinically significant differences between length of stay and risk for central line infection, incidence of CLABIs, and an increase in adherence to the central line practice change policies. The study showed for every week that is added to the patient stay, the patient was 7 times more likely to have a CLABIs. The rate of central line infection was decreased from 15.6 percent per 1000 line days to zero in 2010.

Efficacy of saline vs heparin in maintaining 24-gauge intermittent intravenous catheters in a rabbit model.

Purpose: The purpose of this study was to compare saline and heparin flushes in 24-gauge IV catheters. Design: A double-blind experiment in four recorded trials was conducted using a rabbit model. Twenty-four-gauge catheters were placed in both auricle veins, and all catheters were secured in the same manner. Ampicillin was infused into each ear at the same interval, with each ear randomized to receive either the heparin solution or the saline solution. Sample: The subjects were ten white New Zealand rabbits. Data were collected on 76 catheter sites. Main Outcome Variable: Patency for each catheter was measured in hours and evaluated based on presence of warmth, erythema, induration, leakage, or occlusion. Results: There was no significant difference in the duration of patency of the catheters between the two groups.

Neonatal lung remodeling: structural, inflammatory, and ventilator-induced injury.

The developing lung is subject to events, both prenatal and postnatal, that alter the normal developmental process. The degree of insult or injury affects how the lung functions at birth and then responds to the insult throughout childhood. In this article, only 3 of the influences are examined: structural, inflammatory, and mechanical. It is recognized that there is a plethora of other factors that influence lung remodeling.

How to Make Research Happen: Working with Staff

Implementing a research project in a clinical nursing unit requires the researcher to gain cooperation and support from administration, physicians, and the nursing staff. In this article the site coordinators from the Transition of the Preterm Infant to an Open Crib research-utilization project share their strategies for generating support, energizing the staff nurses, assuring compliance with the study, resolving problems, and bringing the project to closure. Many of the strategies used can be applied to other research projects by nurse researchers interested in using clinical nursing units as research sites.Implementing a research project in a clinical nursing unit requires the researcher to gain cooperation and support from administration, physicians, and the nursing staff. In this article the site coordinators from the Transition of the Preterm Infant to an Open Crib research-utilization project share their strategies for generating support, energizing the staff nurses, assuring compliance with the study, resolving problems, and bringing the project to closure. Many of the strategies used can be applied to other research projects by nurse researchers interested in using clinical nursing units as research sites.

Effectiveness of an Advanced Practice Nurse-Led Preoperative Telephone Assessment.

The purpose of this project was to determine the effectiveness of an advanced practice nurse–led preoperative telephone assessment in reducing day-of-surgery cancellations of patients at an ambulatory surgery center. We concluded that a good history obtained by a trained and experienced advanced practice nurse or registered nurse can reduce day-of-surgery cancellations. Patients who were identified at high risk for preoperative complications during the telephone assessment were referred to the preoperative evaluation clinic for further evaluation.

Creating a Culture of Safety Around Bar-Code Medication Administration: An Evidence-Based Evaluation Framework.

Bar-code medication administration (BCMA) effectiveness is contingent upon compliance with best-practice protocols. We developed a 4-phased BCMA evaluation program to evaluate the degree of integration of current evidence into BCMA policies, procedures, and practices; identify barriers to best-practice BCMA use; and modify BCMA practice in concert with changes to the practice environment. This program provides an infrastructure for frontline nurses to partner with hospital leaders to continually evaluate and improve BCMA using a systematic process.