Practice Question and Search Strategy
Within the intensive care population, the use of prophylactic treatment is used to prevent the risk of venous thrombosis. These patients in particular are at a greater risk for developing thromboembolism due to heightened immobility. The increased risk of venous thrombosis occurs in this population due to the use of mechanical ventilation, sedation and paralytics (Cook & Crowther, 2010). Venous thrombosis can significantly increase the risk of a patient developing a pulmonary embolism. Additionally, it can create long term impacts such as post-thrombotic syndrome. This syndrome occurs twenty to fifty percent after the development of the thrombosis. This can have momentous impacts on individual’s ability
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The process of how the articles were selected to answer the above question will be discussed. The two search databases which were used included MEDLINE and CINAHL. The MEDLINE search engine was used first as demonstrated in appendix A. At the beginning of the search, a broad search with no limits were indicated to assess the literature in its entirety and to determine how many articles were associated with the research question posed. First the keywords used were “venous thrombosis” and “thrombosis or thromboembolism or anticoagulation” and “prophylaxis” to determine the results. This yielded 3401 results, however it was discovered that by using “or” as a Boolean operator rather than “and” lead the discovery of articles which were not appropriately related. The articles did not have all the criteria required to answer the proposed PICO question. Therefore, the Boolean operators were changed to meet the criteria of the question. This included using the keywords “venous thrombosis” and “anticoagulation” and “prophylaxis” together, this yielded 2119 results. Then critical care was added to the search to ensure its applicability to this population group. When combining the search terms “venous thrombosis” “anticoagulation” “prophylaxis” and “critical care” were selected together which had 22 results. When the articles were assessed they were not correlated with research question as they tended to discuss children, venovenous hemofiltration and major traumas. Therefore “venous thrombosis” “prophylaxis” “anticoagulation” and “intensive care units” to determine if the results would differ, 37 results were found, yet they still did not appropriately correlate therefore the use of the term “pulmonary embolism” was also combined and 13 results were discovered. Since venous thrombosis is a common occurrence associated with pulmonary embolism, this was deemed to be more inclusive for the search strategy. The
In septic patients, increased levels of PAI-1 inhibit plasminogen activator (t-PA), which converts plasminogen to plasmin. Release of fibrin inhibits fibrinolysis by activation of thrombin-activatable fibrinolysis inhibitor (TAFI). In addition, the release of PAF causes platelet aggregation. This combination of inhibition of fibrinolysis, fibrin strand production and platelet aggregation contribute to a state of coagulopathy. This can lead to microcirculatory dysfunction with isolated or multiple organ dysfunction and cell death. Mr Hertz’s coagulation profile showed a fibrinogen level of 5.6 g/L, indicating that coagulopathies were underway in his system.
The Beginning Stages of the Writing and Publication Process: Matching the Topic to the Journal
“Patient Navigators are trained, culturally sensitive health care workers who provide support and guidance throughout the cancer care continuum” (What are patient navigators? 2009). The healthcare system, which includes hospitals, clinics and insurance claims, can be hard to navigate for many patients. This is where patient navigators come in and help direct patients so that their experience in the hospital is made easier. According to the Center to Reduce Cancer Health Disparities, the activities conducted by patient navigators include:
In the United States alone 600,000 new cases are diagnosed each year. It has been referred to as "Economy Class Syndrome" due to the occurrence on long flights. One in every 100 patients who develop DVT die from pulmonary embolism (PE). If PE can be diagnosed and treatment started the mortality rate can be reduced from 30% to less than 10%.
Cochrane and CINHAL were also used in their search. Three trial registry web sites (clinicaltrials.gov, ISRCTN registry, and WHO) were also used. The searches were screened by two reviewers. Methodology was maintained by using Cochran’s risk of bias tool. Each trial used was rated as either, low risk, unclear or high risk for bias based on sequence generation, blinding, concealment sequence, selective reporting of outcomes, and data completeness. Relative risk (pooled) for all outcomes was calculated using a 95% confidence interval. I2 was used to measure heterogeneity. Event rates of 2% and 5% were used to identify the need for prophylaxis for bleeding and also overt bleeding with H2 blockers,
The nursing staff can answer the call immediately. The system provides up to 24 hours of PCA dosing history with corresponding time-based values from capnography and/or pulse oximetry monitoring. For proper implementation Physicians, nurses, pharmacists, and respiratory therapists worked together to develop policies and procedures, standardized PCA dosing forms, physician notification parameters, routine order sets for SpO2 and EtCO2monitoring, criteria for discontinuing monitoring and a reversal agent protocol. Patient and hospital staff knowledge about the process also played an key role in success of the therapy. It was ensured that Medical staff Education took place during staff orientation, annual competency assessments, and at the bedside. Well educated patients regarding the procedure are more likely to accept wearing the filter line and do very well with postoperative
Medication errors are among the biggest issues in health care settings today. The effect of managed care is one of the causative factors. The need to contain costs has invariably doubled the nurses' workload making them less efficient as caregivers. Example of problem is the high incidence of medication errors. Nurses' workload has increased tremendously regardless of the fact that most of these patients are of great acuity, thereby predisposing them to a greater risk of medication errors.
Mr J is sedated for comfort while intubated but it is proven that reducing sedation and extubating a patient as soon as appropriate will help avoid VAP (DeBakey 2010). The ETT can hinder natural mechanisms that normally protect the airways including muccocillary flow, hair, saliva, sneeze, and cough reflex, and this may lead to the result of bacteria moving into the lung and lower lobes easily (DeBakey 2010). Mr J had a MAAS score of 1 on admission (Responsive only to noxious stimuli) with one factor being heavy sedation, but later on his MAAS score improved to 3 (Calm and cooperative) which can enable the extubation assessment process (DeBakey 2010).
This case scenario also helped me appreciate evidence-based practice and the use of current published literature in informing healthcare decisions. It is essential during critical care the signs and symptoms of VAP must be assessed periodically and try to avoid it. I should be aware of the first line of intervention, If faced with a similar situation in the future, I will still follow the same interventions we employed in caring for patients with VAP for my continuing professional development, I will learn more about complications and how we can avoid
We have not yet completed clinical hours for primary care so I am using a compilation of examples from work. I currently work in the emergency department in Minot, ND and we often care for ischemic stroke patients. Determining when the stroke symptoms began is one of the most important and most challenging questions to answer. Some patients wake up with stroke symptoms, some have a witnessed incident, and some are found after an unknown amount of time. Depending on the timetable, and whether or not patients meet criteria determines whether the patient will be treated with intravenous tPA or mechanical removal of the clot or tPA placed specifically on the clot via intra-arterial access. I decided to compare mechanical removal with
Guidet et al(2) conducted a study in sepsis patients to find haemodynamic efficacy and safety between 6%HES 130/0.4 vs 0.9% NaCl. He found that volume requirement was less with HES than NaCl in inial phase of fluid resuscitation and also the time required to reach haemodynamic stability was less with HES. There was no difference between AKIN and RIFLE criteria between two groups. There was also no difference in mortality upto 90days after resuscitation.
If early interventions are conducted, the mortality rate and ICU duration are highly decreased. In Hui el (2016) reviewed a journal regarding the application of protocols and procedures to reduce VAP, with his major goal being to evaluate the importance of early intervention of VAP in the ER. He found out that there is a need of initiating early intervention in the ER, including oral care with about 0.13% chlorhexidine, 30 to 40 degrees of elevation of the head in bed, administration blockers, prophylaxis of vein thrombosis, vacation of daily sedation, sub glottal suction, and prophylaxis of ulcers. He also gave the evidence that supports his argument about how ER creates a direct impact on the mortality of VAP patient. However, there are no studies that give the rational evidence whether such early interventions in the ER decrease the VAP incidences (Sole el.
bed rest increases the risk of a DVT progressing to a PE and that ambulation is
The heart and lungs grind closely and thoroughly to meet our tissues oxygen demands. If the equilibrium between oxygen demand and supply becomes troubled and distressed in critical illness, tissue hypoxia and cell death can promptly transpire. An indispensable and vital portion of critical care is to preserve and conserve cardiopulmonary function with the assistance of pharmacotherapy, fluid administration, and respiratory
When a nurse is taking care of a patient with a pulmonary embolism or pulmonary edema, there is a very good chance that they are assisting an elderly patient. It is difficult however to determine the severity of these problems in some cases. If a patient is experiencing a pulmonary embolism, and are elderly, then they may not present with common symptoms (Sen et al., 2010). Elderly patients will tend to present with an increased heart rate, while chest pain may not be present (Sen et al., 2010). There may also be a case where in an elderly patient, they may present with delusions or confusion (Soysal & Isik, 2014). This type of presentation may not appear in a younger patient. Depending on the situation, there is the potential for thrombolytic