scholarly journals Multisystem Inflammatory Syndrome in Children in the Critical Care Setting

2021 ◽  
pp. e1-e10
Author(s):  
Kristin Atlas ◽  
Jessica Strohm Farber ◽  
Kerry Shields ◽  
Ruth Lebet
Keyword(s):  
Critical Care ◽  
Treatment Options ◽  
Signs And Symptoms ◽  
Medication Administration ◽  
Critical Care Nurses ◽  
Data Synthesis ◽  
Cardiovascular Failure ◽  
Literature Searches ◽  
Gastrointestinal Distress ◽  
Inflammatory Syndrome

Background Multisystem inflammatory syndrome in children is a new syndrome that has been hypothesized to be connected with the COVID-19 pandemic. Children are presenting—likely after SARS-CoV-2 infection or exposure—with vague symptoms including fever, gastrointestinal distress, and/or rash. Objective To review what is currently known about multisystem inflammatory syndrome in children, including physiology, signs and symptoms, laboratory and imaging findings, treatment options, and nursing considerations in critical care settings. Methods This integrative review was conducted using the keywords multisystem inflammatory syndrome in children, Kawasaki-like syndrome, COVID, COVID-19, and SARS-CoV-2. Initially, 324 articles were found. All were screened, and 34 were included. Eight articles were added after hand-searching and weekly literature searches were conducted. Data Synthesis Multisystem inflammatory syndrome in children is a newly identified syndrome, thus information on diagnosis, treatment, and outcomes is available but evolving. Many aspects of nursing care are important to consider with regard to this illness, including COVID precautions, physical assessments, medication administration, and timing of blood sampling for laboratory testing as well as other standard intensive care unit considerations. Providing anticipatory guidance and support to patients and their families is also important. Conclusion Critical care nurses must remain informed about advances in the care of patients with multisystem inflammatory syndrome in children, as these patients are often seen in critical care environments because of their high risk of cardiovascular failure.

A survey of pediatric critical care nurses' knowledge of pain management

1997 ◽  
Vol 6 (4) ◽  
pp. 289-295 ◽  
Author(s):  
C Pederson ◽  
D Matthies ◽  
S McDonald
Keyword(s):  
Critical Care ◽  
Pain Management ◽  
Signs And Symptoms ◽  
Educational Interventions ◽  
Critical Care Nurses ◽  
Toxic Metabolite ◽  
Pediatric Critical Care ◽  
Related Information ◽  
Item Scale ◽  
Nurses Knowledge

BACKGROUND: Although nurses are accountable for pain management, it cannot be assumed that they are well informed about pain. Nurses' knowledge base underlies their pain management; therefore, it is important to measure their knowledge. OBJECTIVE: To measure pediatric critical care nurses' knowledge of pain management. METHOD: A descriptive, exploratory study was done. After a pilot study, an investigator-developed Pain Management Knowledge Test was distributed to 50 pediatric ICU nurses. Test responses were collected anonymously and coded by number. Item analysis was done, and descriptive statistics were calculated. Modified content analysis was used on requests for pain-related information. RESULTS: The test return rate was 38%. The overall mean score was 63%. Mean scores within test subsections varied from 50% to 92%. Other mean scores were 85% on a nine-item scale of drug-action items and 92% on a two-item scale of intervention items. However, no nurse recognized that cognitive-behavioral techniques can inhibit transmission of pain impulses; only 32% indicated that meperidine converts to a toxic metabolite, only 47% recognized nalbuphine as a drug that may cause signs and symptoms of withdrawal if given to a patient who has been receiving an opioid; and only 63% indicated that when a child states that the child has pain, pain exists. Thirteen nurses requested pain-related information, and all requests focused on analgesic medications. CONCLUSIONS: Testing nurses' knowledge of pain indicated gaps that can be addressed through educational interventions. Research is needed in which the test developed for this study is used as both pretest and posttest in an intervention study with pediatric critical care nurses or is modified for use with nurses in other clinical areas.

Continuing to Challenge Practice to Be Evidence Based

2015 ◽  
Vol 35 (2) ◽  
pp. 39-50 ◽  
Author(s):  
Mary Beth Flynn Makic ◽  
Carol Rauen ◽  
Kimmith Jones ◽  
Anna C. Fisk
Keyword(s):  
Critical Care ◽  
Daily Practice ◽  
Medication Administration ◽  
Chest Physiotherapy ◽  
Critical Care Nurses ◽  
Current Evidence ◽  
Care Practice ◽  
Evidence Based ◽  
Actual Weight ◽  
Daily Interruption

Practice habits continue in clinical practice despite the availability of research and other forms of evidence that should be used to guide critical care practice interventions. This article is based on a presentation at the 2014 National Teaching Institute of the American Association of Critical-Care Nurses. The article is part of a series of articles that challenge critical care nurses to examine the evidence guiding nursing practice interventions. Four common practice interventions are reviewed: (1) weight-based medication administration, (2) chest tube patency maintenance, (3) daily interruption of sedation, and (4) use of chest physiotherapy in children. For weight-based administration of medication, the patient’s actual weight should be measured, rather than using an estimate. The therapeutic effectiveness and dosages of medications used in obese patients must be critically evaluated. Maintaining patency of chest tubes does not require stripping and milking, which probably do more harm than good. Daily interruption of sedation and judicious use of sedatives are appropriate in most patients receiving mechanical ventilation. Traditional chest physiotherapy does not help children with pneumonia, bronchiolitis, or asthma and does not prevent atelectasis after extubation. Critical care nurses are challenged to evaluate their individual practice and to adopt current evidence-based practice interventions into their daily practice.

Discharge planning for the patient with a new tracheostomy

1990 ◽  
Vol 10 (7) ◽  
pp. 73-79 ◽  
Author(s):  
EB Wilson ◽  
N Malley
Keyword(s):  
Critical Care ◽  
Planning Process ◽  
Discharge Planning ◽  
Signs And Symptoms ◽  
Critical Care Nurses ◽  
Care Plan ◽  
Discharge Care ◽  
Increased Risk ◽  
Hospital To Home ◽  
Discharge From Hospital

A patient with a new tracheostomy will face threatening changes upon discharge from hospital support. Nurses, particularly in the critical care unit, frequently and closely support a patient and family through new and often difficult situations during hospitalization. The patient leaving the hospital with a new tracheostomy will face problems with secretion management, increased risk of infections, alterations in body image, and impaired vocalization. To ensure a safe transition from the hospital to home, the patient and family must demonstrate competence in all aspects of tracheostomy care, must be able to recognize signs and symptoms that should be reported to the physician, and must have adequate support at home (such as homecare nurses, properly functioning equipment, and access to necessary supplies). These "musts" form the basis of the discharge care plan. Nurses can help a patient successfully manage these problems through comprehensive discharge planning. Although the critical care nurses who initiate the multidisciplinary discharge planning process may not remain involved in that process throughout the patient's hospitalization, their early efforts can provide an orderly, comprehensive discharge plan optimally suited to ensure that the patient and family acquire the necessary skills, confidence, supplies, and support for the eventual transition home. The information, encouragement, skills demonstrations, and referrals to other resources that critical care nurses provide help the patient adjust to a new tracheostomy.

Hereditary Hemorrhagic Telangiectasia: A Primer for Critical Care Nurses

2016 ◽  
Vol 36 (3) ◽  
pp. 36-48 ◽  
Author(s):  
Kathleen M. Sacco ◽  
Thomas W. Barkley
Keyword(s):  
Critical Care ◽  
Health Care Providers ◽  
Genetic Disease ◽  
Hereditary Hemorrhagic Telangiectasia ◽  
Arteriovenous Malformations ◽  
Early Death ◽  
Signs And Symptoms ◽  
Critical Care Nurses ◽  
Care Providers ◽  
Abnormal Growth

Hereditary hemorrhagic telangiectasia is a rare, autosomal dominant genetic disease that causes abnormal growth of blood vessels and, subsequently, life-threatening arteriovenous malformations in vital organs. Epistaxis may be one of the initial clues that a patient has more serious, generalized arteriovenous malformations. Recommended treatment involves careful evaluation to determine the severity and risk of spontaneous rupture of the malformations and the management of various signs and symptoms. The disease remains undiagnosed in many patients, and health care providers may miss the diagnosis until catastrophic events happen in multiple family members. Prompt recognition of hereditary hemorrhagic telangiectasia and early intervention can halt the dangerous course of the disease. Critical care nurses can assist with early diagnosis within families with this genetic disease, thus preventing early death and disability.

Recognition and Management of Sepsis in the Obstetric Patient

2018 ◽  
Vol 29 (3) ◽  
pp. 303-315 ◽  
Author(s):  
Sheryl E. Parfitt ◽  
Sandra L. Hering
Keyword(s):  
Critical Care ◽  
Maternal Mortality ◽  
Acute Care ◽  
Patient Outcomes ◽  
Early Warning ◽  
Treatment Options ◽  
Signs And Symptoms ◽  
Timely Manner ◽  
Obstetric Patient ◽  
Acute Care Settings

Sepsis is one of the principal causes of maternal mortality in obstetrics. Physiologic changes that occur during pregnancy create a vulnerable environment, predisposing pregnant patients to the development of sepsis. Furthermore, these changes can mask sepsis indicators normally seen in the nonobstetric population, making it difficult to recognize and treat sepsis in a timely manner. The use of maternal-specific early warning tools for sepsis identification and knowledge of appropriate interventions and their effects on the mother and fetus can help clinicians obtain the best patient outcomes in acute care settings. This article outlines the signs and symptoms of sepsis in obstetric patients and discusses treatment options used in critical care settings.

Pulmonary Hypertension: Overview and Case Study

2020 ◽  
Vol 31 (1) ◽  
pp. 57-66
Author(s):  
Brook Powell ◽  
Barbara Leeper
Keyword(s):  
Risk Factors ◽  
Pulmonary Hypertension ◽  
Critical Care ◽  
Critical Care Unit ◽  
Treatment Options ◽  
Signs And Symptoms ◽  
Diagnosis And Treatment ◽  
Broad Overview

This article provides a broad overview of pulmonary hypertension, including classifications, risk factors, signs and symptoms, diagnosis, and treatment options. Nursing considerations and optimization of hemodynamic values in patients with pulmonary hypertension in a critical care unit are reviewed through the lens of a case study. Preventing decompensation is essential in the successful care of these patients.

scholarly journals Critical Care Nurses Competency Level on the Administration of Microinfusion Medication at Critical Care Unit Kenyatta National Hospital

2020 ◽  
Vol 8 (04) ◽  
pp. 312-329
Author(s):  
Isaac Nyabuto Onwongá ◽  
Hannah Inyama ◽  
Eve Risper Rajula
Keyword(s):  
Critical Care ◽  
Medication Errors ◽  
Drug Administration ◽  
Statistical Significance ◽  
Medication Administration ◽  
Critical Care Nurses ◽  
Local Data ◽  
Cross Sectional ◽  
Medication Administration Errors ◽  
Competency Level

Background of the study: Most drugs given as Microinfusion require infusion pumps to administer. They are very potent with very narrow therapeutic index and any small changes on the process results in enormous effects to patients. The nursing profession has a duty to advocate for patients rights as well as do no harm. One of the core goals of nurses is medication administration; this puts nurses in the last line of defence against medication administration errors (MAEs). This study aimed to look into the roles played by nurse that hamper the efforts to reduce the Microinfusion MAEs on which minimal studies have been done. Objective: This study determined the competency level influencing the administration of Microinfusion medication by critical care nurses at Kenyatta National Hospital’s (KNH) Intensive Care Unit (ICU). Significance of study: Local data in the area of Microinfusion MAEs is not available, specifically KNH’s ICU. This study therefore sought to breech this gap and hopes to influence policy on management of critical patients, patient safety, environment, and curriculum development so as to reduce Microinfusion MAEs. Methodology: This study used a descriptive cross-sectional study design, simple random sampling was used to pick 64 participants. Quantitative data was analyzed by both descriptive and inferential statistics, which included regression analysis. Descriptive statistics were presented by use of the mean, percentages and standard deviation. Chi-square was used to determine statistical significance of the differences in proportions and logistic regression was used to identify factors that lead to Medication administration errors. Necessary ethical approval was sought. Results: The prevalence of MAEs was at 64.1% in the last six months, 65.6% 0f the respondents reported lack of supportive supervision, 37.5% of the respondents reported not to know mechanisms in place for reporting Microinfusion medication errors. This prevalence was of statistical significance when cross tabulated with critical care nurses competency level (p<0.05) on aspects such as; having prescription checks [95%CI= 0.000-17.9; p=0.008], working experience, type of medication error, checking weight of patients [p=0.019], reporting of the errors [95%CI = 0.1-0.8; p=0.019], documenting drug errors and monitoring patients after drug administration. Conclusion and recommendation: The prevalence of Microinfusion administration errors in KNH-ICU is high. There is need to ensure that nurses are always equipped with adequate knowledge and experience in drug administration through trainings and mentorship programs as this will reduce  medication errors and increase  safety of patient  in health facilities.

Adverse Events Reporting System as Experienced by Critical-Care Nurses in KwaZulu-Natal, South Africa

2018 ◽  
Vol 20 (1) ◽  
Author(s):  
Thusile Mabel Gqaleni ◽  
Busisiwe Rosemary Bhengu
Keyword(s):  
South Africa ◽  
Critical Care ◽  
Adverse Events ◽  
Patient Care ◽  
Family Involvement ◽  
Reporting System ◽  
Legal Framework ◽  
Critical Care Nurses ◽  
Kwazulu Natal ◽  
Life Threatening

Critically ill patients admitted to critical-care units (CCUs) might have life-threatening or potentially life-threatening problems. Adverse events (AEs) occur frequently in CCUs, resulting in compromised quality of patient care. This study explores the experiences of critical-care nurses (CCNs) in relation to how the reported AEs were analysed and handled in CCUs. The study was conducted in the CCUs of five purposively selected hospitals in KwaZulu-Natal, South Africa. A descriptive qualitative design was used to obtain data through in-depth interviews from a purposive sample of five unit managers working in the CCUs to provide a deeper meaning of their experiences. This study was a part of a bigger study using a mixed-methods approach. The recorded qualitative data were analysed using Tesch’s content analysis. The main categories of information that emerged during the data analysis were (i) the existence of an AE reporting system, (ii) the occurrence of AEs, (iii) the promotion of and barriers to AE reporting, and (iv) the handling of AEs. The findings demonstrated that there were major gaps that affected the maximum utilisation of the reporting system. In addition, even though the system existed in other institutions, it was not utilised at all, hence affecting quality patient care. The following are recommended: (1) a non-punitive and non-confrontational system should be promoted, and (2) an organisational culture should be encouraged where support structures are formed within institutions, which consist of a legal framework, patient and family involvement, effective AE feedback, and education and training of staff.

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