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Vasopressin as a Catecholamine-Sparing Mechanism
Get PDFPersistent hypotension, or refractory hypotension, is frequently observed as an adverse event intraoperatively. Various conditions, including chronic hypertension, metabolic acidosis, and/or methamphetamine misuse, may lead to catecholamine desensitization. As consequence of catecholamine resistance, hypotension is often unresolved by administration of commonly used vasopressors like phenylephrine, ephedrine, epinephrine, and/or norepinephrine. It is essential that persistent hypotension is treated promptly in effort to avoid end-organ ischemia and subsequent mortality risks. Vasopressin use may spare progressive catecholamine depletion through a separate mechanism of action that increase blood pressure and perfusion to vital organs. During an observed case, a 43-year-old male patient with a history of chronic hypertension, generalized anxiety, and methamphetamine misuse underwent a shoulder arthroscopy. Following placement in a sitting position, the patient experienced hypotension that was not responsive to phenylephrine, ephedrine, and fluid boluses. In effort to optimize cerebral perfusion, the patient received 2 consecutive boluses of vasopressin, resulting in stabilization of blood pressure back to the patient’s baseline. This case scenario elucidates the benefits of early use of vasopressin in the incident of unresolved hypotension
Preoperative Sedation for the Pediatric Patient with Autism
Get PDFAn individualized plan for preoperative sedation is generally recommended for patients with autism spectrum disorder (ASD). Patients with ASD can display impairment with social interaction and adversity with processing new sensory information. About 1.5% of the United States population is estimated to have ASD; with males being 4:1 more likely than females.1 Diagnosis of ASD usually occurs by age 3.1 Patients with ASD may have difficulty tolerating changes in a normal routine. Because of this, preoperative sedation, such as midazolam and ketamine, is often necessary for the patient to increase cooperation, reduce stress, and improve the overall experience
Dexmedetomidine as an Adjunct Therapy for Labor Analgesia
Get PDFAnalgesia during labor is important; pain and pressure that is reported during labor are often characterized as some of the most intense pain that a parturient will ever experience, both mentally and physically. Analgesia during labor is vital in reducing stress levels and catecholamine release, as well as increasing the chance for positive outcomes for both the fetus and the mother. Often this type of analgesia is provided through neuraxial administration of local anesthetic, sometimes in conjunction with opioids including fentanyl, sufentanil, or morphine. While there are benefits to the use of opioids, such as reduced amounts of LA with decreased motor blockade, there are also adverse effects including urinary retention, nausea and vomiting, and respiratory depression. Utilizing dexmedetomidine as an alternative adjunct can minimize these negative side effects while reaching the desired levels of analgesia
Exploring LGBTQ+ Health: Insights from Ireland
Get PDFThis webinar explores key issues in LGBTQ+ health in Ireland, highlighting challenges, progress, and opportunities for inclusive healthcare. Dr. John Gilmore will share research insights, policy developments, and best practices to improve health outcomes for LGBTQ+ communities. Ideal for healthcare professionals, researchers, and advocates committed to equitable care
Parental Education on Childhood Injury Prevention: Insights from Nurse Family Partnership
No full textThis BSN Honors student project, with the oversight of a research mentor, will examine the lived experiences of Nurse Family Partnership (NFP) nurse home visitors and their unique approach in delivering parental education to reduce unintentional childhood injuries among marginalized populations. Nurses play an essential role in empowering patients on health promotion, illnesses prevention, and disease management. However, sufficient time is rarely allotted to address anticipatory guidance regarding injury prevention strategies during in-office pediatric visits. Community nurses have the potential to bridge this gap by assessing the health needs of their communities and meeting families where they are, thus promoting global health equity in the provision of healthcare. The NFP program addresses this need by supporting low-income families, where social disparities such as language barriers and lack of education are most prevalent, often impeding pediatric health outcomes. By serving marginalized populations, NFP provides an equitable, innovative, and inclusive delivery to patient care and health promotion, targeting underserved communities. This qualitative study investigates the lived experiences of NFP nurse home visitors and their strategic approaches to delivering parental education aimed at minimizing unintentional childhood injuries. Focus groups transcripts were coded to identify major themes in the discussion. Major themes identified from the series of focus groups will be presented and discussed during the Sigma conference
Effectiveness of a Health Management App on Quality of Life in Patients With Chronic Heart Failure
No full textBackground: Advances in medical care have extended the life expectancy of patients with chronic heart failure (CHF); however, their health-related quality of life (HRQoL) remains low. A user-friendly, home-based self-health management app has the potential to significantly improve patients’ self-care behaviors, disease knowledge, and overall quality of life.
Objective: To assess the demographic characteristics, readiness to change behaviors (C-URICA), self-care behaviors, disease knowledge, and quality of life among patients with CHF. It also evaluated the impact of a health management app intervention on these factors.
Results:Analysis of primary study variables revealed an inverse relationship between self-care behavior scores and actual self-care practices, with lower scores indicating better self-care. The experimental group demonstrated significantly improved self-care behaviors compared to the control group (P = .008). Additionally, the intervention group showed markedly better quality of life scores than the control group (P = .046), with lower scores correlating with better perceived quality of life (P = .000). Readiness to change behaviors (C-URICA) analysis indicated significant improvements in self-care behaviors during early motivational stages. Patients in the early motivation and preparation stages also showed notable increases in disease knowledge, with minimal variation in quality of life.
Nursing Application: Health education plays a pivotal role in enhancing the self-care behaviors, disease knowledge, and HRQoL of CHF patients. Traditional paper-based health education often falls short of meeting patient needs. With the widespread use of smartphones, patients can now easily upload daily metrics such as weight, blood pressure, and pulse to a platform integrated with a case management system, enabling case managers to monitor patients’ home-based self-care activities. The app’s educational materials are accessible for repeated review at home, allowing patients or primary caregivers to gain knowledge at their convenience. The health management app’s simplicity and accessibility facilitate communication between healthcare providers and patients, improving the patient\u27s knowledge, medication adherence, and compliance. Case managers also benefit by reducing health education time, enhancing patient awareness, and extending care to more CHF patients
Shared Decision-Making, Health Literacy, and Self-Care Knowledge on Hemodialysis Self-Care Behaviors
No full textPatients undergoing hemodialysis experience various complications and physical and emotional difficulties, leading to decreased quality of life. Self-care behaviors(SCB) are essential for preventing complications and reducing mortality rates. Effective SCB significantly depend on shared decision-making(SDM), health literacy(HL), and self-care knowledge(SCK), each critical in patient self-care performance and disease management. This study aimed to determine the importance and relevance of SDM, HL, and SCK. In particular, it enhances SCB among hemodialysis patients. Further, it sought to propose practical nursing interventions based on these findings. Participants were 108 adult hemodialysis patients from the nephrology departments of three general hospitals in Region C. Moreover, the study utilized a descriptive survey research design. SCB was measured using a self-care behavior assessment tool. SDM was evaluated using the SDM-Q-9, HL using the HLS-SF12, and SCK using a self-care knowledge assessment tool. Data were analyzed using descriptive statistics, independent t-tests, one-way ANOVA, Pearson\u27s correlation coefficients, and multiple linear regression analyses. The average score for SCB was 125.28 out of 175 points, with high scores for medication and vascular management. Furthermore, there were low scores for social activities and dietary management. Analysis of SCB based on demographic characteristics showed significant sex differences (t = -2.39, p = .019), age (F = 6.53, p = .002), and economic status (F = 11.92, p \u3c .001). Correlation analysis indicated significant positive correlations between SCB and SDM (r = .28, p = .003), health literacy (r = .42, p \u3c .001), and SCK (r = .29, p = .003). Regression analysis revealed that sex (β = -.26, p = .001), age (β = .36, p \u3c .001), economic status (β = .25, p = .006), HL (β = .41, p \u3c .001), and SCK (β = .17, p \u3c .001) significantly influenced SCB. Thus, it explains 45.2% of the variance in SCB (F = 13.59, p \u3c .001). This study confirmed that HL and SCK significantly impacted hemodialysis patients\u27 SCB. These findings support the need for tailored educational programs, enhanced explanatory nursing roles, and SDM promotion. Further, comprehensive interventions, including economic support, should be emphasized to provide foundational data for devising strategies to enhance SCB
Nationwide Cohort Study on Anticoagulant Adherence Post-Heart Valve Surgery in Older Adults
No full textBackground: Valvular heart disease (VHD) with calcification-induced aortic stenosis being the most common, followed by aortic regurgitation and mitral insufficiency. The 2020 ACC/AHA guidelines recommend vitamin K antagonists (VKAs), mainly warfarin, for patients with mechanical heart valves. Although VKAs are advised for anticoagulation after bioprosthetic valve replacement, literature from Germany, USA, and Japan reveals inconsistencies regarding direct oral anticoagulants (DOACs) in patients undergoing aortic or mitral valve replacement.
Purpose: This study evaluates anticoagulant adherence and adverse event rates in post-valve surgery patients using population-representative national data.
Study Design: We conducted a retrospective cohort study using the Taiwan National Health Insurance Research Database (NHIRD) from 2009 to 2020. The cohort of VHD, including aortic stenosis, aortic regurgitation, and mitral insufficiency, who underwent valve replacement, and a diagnosis age of 65 years or older. The Cox proportional hazards model was used to compare risks associated with anticoagulant adherence.
Results: Of the 4,872 patients, 190 received DOACs, 2,805 were treated with warfarin, and 1,877 had no anticoagulation therapy. DOAC users were primarily in northern Taiwan, with higher comorbidity rates like hypertension and atrial fibrillation (AF). Patients with AF and in the northern region had higher medication adherence; diabetes and coronary artery disease showed no significant adherence impact (p\u3e0.05). Mortality analysis indicated reduced risk in the DOAC group (Adjusted HR = 0.59, 95% CI 0.37-0.94, p=0.024). Age, particularly ≥85, significantly increased readmission (Adjusted HR = 1.98, 95% CI 1.58-2.48, p\u3c0.001) and mortality (Adjusted HR = 3.86, 95% CI 2.97-5.02, p\u3c0.001). Additionally, type 2 diabetes correlated with readmission risk (Adjusted HR = 1.37, 95% CI 1.22-1.53, p\u3c0.001).
Conclusion: These findings provide valuable insights into anticoagulant adherence in post-valve replacement patients, highlighting the need for strategies to reduce adverse event rates and readmissions
Evaluating the Impact of Telehealth Prenatal Care: A Innovation to Provide Care to Latinx Clients
No full textBackground: Mary’s Center, a federally qualified health center, built an innovative telehealth group prenatal care (T-GPNC) program during the coronavirus pandemic to ensure equitable and safe healthcare access. T-GPNC sessions include individual assessment, group education and social support led by a culturally congruent community health worker, and connection to community resources. This presentation will describe the T-GPNC program, assess the adequacy of T-GPNC compared with individual prenatal care (IPC), and describe client satisfaction.
Methods: We used a mixed methods design. We conducted a retrospective chart review of Spanish speaking midwifery care clients from July 1, 2021 to August 31, 2023. We assessed adequacy using the Adequacy of Prenatal Care Index and timely lab completion. We used inductive coding to analyze T-GPNC satisfaction surveys.
Results: The final sample included 334 client charts (141 T-GPNC and 193 IPC). The majority were Latinx, and used public insurance or were uninsured. T-GPNC clients were significantly more likely to receive adequate or adequate plus care at 67.9% versus 39.1% for IPC clients. T-GPNC clients liked receiving T-GPNC (95.7%) with an average rating (4.85 out of 5, SD = 0.63). Qualitative themes included: gaining knowledge, shared experiences, and systems level support.
Conclusions: T-GPNC provided critical support to a marginalized community during COVID-19, resulting in higher rates of adequate prenatal care for T-GPNC clients versus IPC. T-GPNC clients were highly satisfied with their care. Clinical practices should implement this model with technology and equipment resources that ensure equitable access to telehealth care
Traditional and Technologically Reliant Studying Methods of BSN Students: A Comparative Study
No full textIncorporating technology has emerged as a significant and influential factor in education that alters conventional approaches to teaching and learning. (Kulshreshtha, M. et al, 2023). Though technology has significantly influenced the global educational system, contributing to the advancement of education, traditional learning methods still exist. This study compares the preferences, advantages, and disadvantages between traditional and technology-reliant studying methods among Gen Z nursing students at Centro Escolar University.
A descriptive comparative research design was used to elicit the preferences, advantages, and disadvantages between traditional and technologically reliant study methods. Questionnaires were randomly given to 310 nursing students from level 1 to level 4. The study underwent approval by the Internal Ethics Review Board.
Results show the overall mean of the preferences for the traditional study method was 3.212 (SD = 0.419), indicating a general agreement for the traditional method is much higher compared to technologically reliant, the overall mean was lower (M = 2.854, SD = 0.472). In terms of advantages, it shows that traditional and technologically reliant methods reveal a statistically significant difference favoring the technologically reliant approach. The result for the perception of the advantages of using technologically reliant methods (M =3.396, SD = 0.527) was higher than that for traditional methods (M = 3.22, SD =0.523). The respondents\u27 perceptions of the disadvantages associated with traditional and technologically reliant methods reveal statistically significant differences, with technologically reliant methods perceived as having slightly more disadvantages. The mean score for perceived disadvantages in technologically reliant methods (M = 3.027, SD = 0.555) was higher than that for traditional methods (M = 2.859, SD = 0.648). The respondents\u27 preferences for traditional and technologically reliant studying methods when grouped by age, sex, and year level, show no statistically significant differences across these demographic profiles.
The study concludes that being technologically reliant has a great advantage accompanied by some challenges over traditional methods. However, since students\u27 preferences were traditional methods, the researchers recommend that the two methods of studying can always be combined