Stephen D. Krau

Heat-Related Illness: A Hot Topic in Critical Care

With current predictions of climate change, the incidence of heat-related illnesses is projected to increase. Heat-related illnesses occur on a continuum from mild symptoms to fatalities. To prevent heat-related illnesses, nurses should have comprehension of persons at risk. Primary treatment of heat-related illness centers on cooling, but not overcooling, the patient. Heatstroke involves coagulopathies and cytokines, and can result in systemic inflammatory response syndrome and multiple organ dysfunction. Critical care nursing intervention requires more than effective cooling to support bodily processes that have been damaged or destroyed by the pathophysiology of heatstroke.

Cytochrome p450 Part 3: Drug Interactions : Essential Concepts and Considerations

The most important considerations related to understanding cytochrome p450 enzymes is the appreciation that all drug effects vary among individuals and, although there are multiple causes of these variations, drug effects are strongly influenced by genes. Nurses who administer and monitor, or prescribe, these medications can only be safe if there is understanding of these processes. The same enzyme may display a variety of functions and alterations, which can range from ultrarapid activity to no activity. Foods given with medications also can affect the metabolism of the medication. Each cytochrome p450 subfamily is instrumental in the metabolism of numerous drugs.

Cytochrome p450, Part 1: What Nurses Really Need to Know

Although knowledge about the impact of cytochrome p450 on individual variations in drug response has been known for decades, the transition to clinical practice has not evolved. Nurses who administer and prescribe medications have a responsibility to their patients to understand the responses to medications that are mediated by this family of enzymes. An overview of the variations seen in drug responses based on genetics is presented with discussion focusing on the current prescriptive practices and limitations in clinical drug trials.

Cytochrome p450 Part 2: What Nurses Need to Know About the Cytochrome p450 Family Systems

To provide the best patient care related to medication administration and prescription, an understanding of the specific enzymes is essential. Enzymes affect the metabolizing of most medications that nurses administer and that nurse practitioners and physicians prescribe on a regular basis. More specifically, the most important p450 enzymes in drug metabolism are cytochrome p450 (CYP) 1A2, the CYP2C family, CYP2D6, and CYP3A4. In addition, the enzymes are instrumental in the bodys reaction to environmental factors, some of which are carcinogens.

Creating Educational Objectives for Patient Education Using the New Bloom’s Taxonomy

Whenever the nurse encounters a patient or a patients family, there is a transfer of information that is expected to be incorporated into the patients overall outcome. Objectives help guide the transfer of knowledge and provide a basis by which to evaluate the extent of the patients understanding. Blooms Taxonomy has been a cornerstone for the development of objectives in academe for over half of a century. The Revised Blooms Taxonomy is a tool that can be used by nurses who educate patients to ensure the education session is focused, clear, has standards for evaluation, and is well documented.

Allergy Skin Testing: What Nurses Need to Know

Skin testing is a common procedure in any clinical setting. Critical care nurses will encounter skin testing in the inpatient and outpatient settings primarily to test for patient allergies to environmental factors, or allergies to certain medications. As there is a great deal of controversy about standard practices surrounding the different tests, information about various allergy tests and testing protocols is vital. Quality assurance standards should be met to ensure adequacy of the skin testing technique. Persons performing skin tests should undergo evaluation of their technique. To improve the predictive values of skin testing, and to ameliorate the incidence or severity of adverse affects, it is important for the critical care nurse to understand the dynamics of the test and the possible risks, along with variables that can confound the results. By doing this, nurses will improve not only patient outcomes related to the testing itself but also the value and reliability of the most effective diagnostic tool available for allergic disease.

Creating a tool to evaluate patient performance.

Patient education is a nursing responsibility that is often impromptu, spontaneous, and poorly documented. In many cases the patients ability to perform a skill or task in the management of an illness or disease process affects the patients outcome. A tool designed to evaluate patient performance guides the teaching process, promotes communication between the patient and nurse, and promotes communication among health care providers as it relates to patient performance. Nurses are in key positions to develop patient performance tools to ensure that the patient, or a patients family member, can manage the health care requisites.

Avian Influenza: Are We Ready?

The threat of an H5N1 influenza virus (avian flu) pandemic is substantial, and an effective response is contingent upon effective coordination among state and local public health authorities and individual health care providers. It is imperative that critical care nurses take an active role in the plans to meet the demands that will be placed on the health care system. This can be accomplished by developing an understanding of the etiology and manifestations of the virus, and becoming familiar with recent advances in research that address the demands of a pandemic. Equally important are the ethical considerations our state of preparedness will pose on the health care system, the community, and health care workers, both professionally and personally.

The influence of technology in nursing education.

The complexity of the relationship between nursing and technology is not new. The complexity has increased with the advent of new technology and technological devices. For faculty who are in the clinical area on a limited basis, and for nurses who are not involved in decisions related to the adoption of technology, terms and concepts related to technology can be misconstrued or misunderstood. An overview of some major terms used in reference to technology and technological approaches can only enhance the intricate relationship between nursing and technology.

Technology in Nursing: The Mandate for New Implementation and Adoption Approaches

The advances of technology in health care and nursing remain one of the fastest growing aspects of our profession. As technology explodes on the health care scene, the technological rift between nursing skills, knowledge, and terminology increases. Use of technology in so many aspects of our profession is unavoidable and is well supported by the Institute of Medicine. In their report in 2011, The Future of Nursing: Leading Change, Advancing Health, there is an explicit recommendation that health care organizations, in addition to “private and public funders [to] collaborate to advance research on innovative solutions, including technology that will enable nurses to contribute to improved health care.” The report recommends that health care organizations employ “frontline staff in design, development, purchase, implementation, and evaluation of ‘devices and technology products’.” The focus of technological advances in health care is to directly improve the delivery of patient care in health care facilities. Technology is used to diagnose patients, monitor patients, treat patients, record information about patients, as well as to facilitate earlier discharges for patients. Implications for utilization go far beyond the beside, as they impact budget and have important ramifications for traditional nursing education as well as staff development. The continual infusion of technology into all venues of health care requires thoughtful consideration, as there is limited understanding of how health care facilities make decisions about, procure, embrace, and ultimately, implement technology. As identified by Schoville and Titler from the University of Michigan, there are two main spheres of models and theories that are related to the use of technology. These include technology adoption and the sciences of implementation. Technology