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Amniotic Fluid Embolism Diagnosis & Treatment Pathway
Get PDFAccess to care in rural areas can prove difficult for any patient, but especially for the expecting mother. Healthcare providers in these rural settings often lack the staffing and experience to effectively recognize and treat rare obstetric emergencies. Amniotic fluid embolism (AFE) is a rare medical emergency that requires healthcare providers to rapidly diagnose, monitor, and treat the sequela of resulting symptoms in the obstetric patient. After a literature review, a teaching session was developed and implemented as part of the annual training for 20 nursing staff at a small 50-bed rural hospital in central California. An 8-question pre-test was given to assess knowledge of AFE, and a PowerPoint presentation highlighting the key presenting symptoms, monitoring, and treatment pathway. After completing the PowerPoint presentation, a post-test was administered following the same format to all 20 nurses to assess key symptoms of AFE, ability to recognize treatment pathways and monitoring recommendations. This project is sustainable by the annual use of the PowerPoint for training and continued review outcomes of suspected AFE cases
Improving Traumatic Brain Injury Outcomes: Early Identification and Management of Paroxysmal Sympathetic Hyperactivity
Get PDFAbstract
Background: Paroxysmal sympathetic hyperactivity (PSH) can occur in patients with acutely acquired brain injury and is associated with mortality, poor clinical outcomes, prolonged hospitalizations, physical disability, and increased healthcare costs. The most common cause of PSH syndrome is traumatic brain injury (TBI). Symptoms consist of hyperthermia, diaphoresis, arterial hypertension, tachycardia, tachypnea, and extremity motor dystonic posturing, often in response to evoked stimuli and occurs in 8% to 33% of TBI patients. Critical care nurses are at the forefront of providing direct patient care to TBI patients and are often the first to identify PSH.
Purpose: The objective of this quality improvement project (QI) was to comprehensively evaluate the literature and provide evidence-based information regarding PSH to nurses, advanced practice providers, residents, and trauma/surgical critical care attendings who deliver care to TBI patients in a surgical trauma intensive care unit (ICU).
Methods: An integrative literature review was performed, PowerPoint was created to conduct seminars, and pre-and post-test analyses were obtained to evaluate knowledge attainment of the management of PSH. The overall goal of the educational seminars was to increase scores by \u3e20% for adequate knowledge attainment, which was obtained. Limitations: high acuity patients, staffing schedules, seminar timing, and lack of perceived educational need by providers.
Conclusion: This QI project identified a gap in clinical knowledge and practice surrounding PSH in TBIs. Continuous education on PSH is imperative to promote early identification and timely management for prevention of secondary brain injury and worsening healthcare outcomes in this complex patient population.
Author Contact Information
Randi Rockwell
[email protected]
[Dataset] Comparison of Intermittent Fasting and Voluntary Wheel Running on Physical and Cognitive Abilities in High-Fat Diet-induced Obese Rats
Get PDFRegular physical activity is a proven routine for weight management in addressing obesity. Another method that has gained attention for its health benefits is intermittent fasting (IF). Physical and cognitive abilities while on these routines are poorly understood in the obese population. Sixty-five male Sprague Dawley rats at 7 weeks of age were subjected to diet-induced obesity by feeding a high-fat diet (HFD) or a standard diet (SD) for 8 weeks, after which behavioral testing was performed to detect any changes in physical and cognitive abilities. Rats from the HFD-fed (now considered obese) and SD-fed groups were then subjected to IF (18-hour fast and 6-hour feeding daily), voluntary wheel running (VWR), or control conditions for 3 weeks before repeating the same behavioral testing protocol. [...
Active Learning Techniques to Improve Emotional Intelligence Among Student Registered Nurse Anesthetists
Get PDFStudents enrolled in nurse anesthesia programs are challenged to meet rigorous and lengthy clinical and didactic requirements throughout doctoral-level curriculums. Historically, admission into nurse anesthesia programs has been based on categories such as academic performance, intensive care nursing experience, and the curriculum vitae. However, emerging research has exhibited emotional intelligence as an essential skill for varying situations that may be encountered. Additionally, training can be utilized to increase emotional intelligence levels (Lolaty et al., 2012).
The goal of this doctoral project was to provide emotional intelligence training for first-year student registered nurse anesthetists (SRNAs) at a mid-size University in the Midwestern United States. Project implementation involved a presentation given by an expert in the field of emotional intelligence, followed by two active learning sessions directed by a second-year SRNA, to reiterate concepts from the presentation. Pre- and post-emotional intelligence evaluation scores were obtained via the Mayer-Salovey-Caruso Emotional Intelligence Test (MSCEIT) along with subjective data about the training program via a post-implementation survey. Overall, total post- MSCEIT scores showed improvement compared to pre-scores, and survey results revealed positive student feedback.
Keywords: emotional intelligence, training, active learning, nurse anesthesia, graduate student
Establishing a Diabetes Self-Management Resource for the Self-Pay Client in a Rural Clinic
Get PDFSelf-management of type 2 diabetes mellitus remains a prominent health concern across the United States. Adherence to treatment plans, medication, and glucose monitoring are often limited by out-of-pocket costs for the client. Diabetes Self-Management Education (DSME) is a set of domains that includes: medication adherence, glucose monitoring, nutrition, exercise, and effective coping mechanisms. DSME programs are provided across the United States helping those with Type 2 diabetes mellitus on their daily habits and management of the condition. DSME programs are largely unavailable to rural communities due to cost and distance barriers, resulting in diabetes education not being readily available in these communities. The greatest disparities are among individuals with Medicare, Medicaid, and without insurance. This project utilized DSME domains, alongside local resources, to formulate a DSME brochure conducive to a designated rural community in south central Florida. The brochure included information regarding affordable glucose monitoring supplies, free medication programs, and resources for: diet, exercise, and coping mechanisms. Brochures were initially designed for self-pay clients, but limitations and unexpected occurrences resulted in difficulty reaching clients without insurance; therefore, the final implementation included distributing brochures to all patients with type 2 diabetes mellitus. Over the implementation period, 220 DSME brochures were given to clients in the rural clinic over a 3-month period
Understanding COVID-19 Vaccine Hesitancy in Underserved Populations
Get PDFVaccination remains one of the most effective ways to limit the spread of infectious diseases and reduce mortality and morbidity in the United States, especially in underserved populations. African Americans and Latinos are eight times more likely to die than White Non-Hispanic populations of COVID-19-related complications. Although vaccines are currently offered and approved to anyone over 5 years old in the United States, there continues to be vaccine hesitancy in the underserved population. The purpose of this project was to understand vaccine hesitancy in underserved populations to promote vaccine confidence and build trust in patients to the point where they will seek to be vaccinated. The setting for this project was a local health department in an underserved community of East St. Louis, IL that provides both COVID-19 vaccinations and testing free of charge. With the demands of COVID-19, education is important. Providing patients with proper education helps patients understand the disease process and avoid misinformation from unreliable sources. Questionnaires were provided to patients during COVID-19 testing to understand vaccination status, reasons for not being vaccinated, and offered vaccine if applicable.
Keywords: COVID-19, vaccine hesitancy, underserved populations, disparities, Racial/Ethnic minoritie
Standardization of Perioperative Management of the Breastfeeding Women
Get PDFMother\u27s milk is the optimal nutrition for the term and preterm neonates. The psychological and physiological stressors in the perioperative setting can impede a lactating mother\u27s ability to breastfeed in the postoperative setting successfully. A best-practice guideline incorporating a stoplight color-coding chart and categories such as safe, caution, and consider avoidance was used to group medications according to their safety for anesthesia providers in a large urban academic medical center in Pennsylvania. The evidence-based guideline also provided links to the hospital policy, LactMed, and Hale database to streamline resources and aid in the rapid decision-making of anesthesia providers in identifying the safety profiles of common medications administered in the perioperative setting. The best practice guidelines were published on the anesthesia department website for improved accessibility. The post-implementation survey results demonstrated that anesthesia providers would use this best-practice guideline during their clinical decision-making to support lactating mothers to continue breastfeeding after surgery. There were no guidelines directed to the care of this patient population at the host facility prior to the implementation of this project. The long-term effectiveness of this guideline can be evaluated through repeated assessments of staff knowledge and improvement in patient satisfaction. Standard perioperative practice for breastfeeding patients by encouraging resuming breastfeeding as soon as the mother can safely hold the baby can optimize outcomes for the mother and the baby.
Keywords: breastfeeding, perioperative, lactation, pharmacokinetics, bioavailabilit
Prophylactic Tranexamic Acid Administration to Prevent Postpartum Hemorrhage After Cesarean Delivery in Patients at High Risk of Severe Postpartum Bleeding
Get PDFPostpartum hemorrhage (PPH) is the leading cause of maternal death worldwide. Cases of PPH are increasing in the United States, and despite current treatment recommendations, mortality remains high. This project included a review of the research on the use of prophylactic tranexamic acid (TXA) administration to prevent or reduce blood loss after cesarean delivery. Statistics regarding the impact of PPH and the pharmacology of TXA were reviewed in detail. Evidence shows that TXA is safe for parturients and nursing infants. Further evidence shows prophylactic TXA administration is associated with a modest reduction in blood loss, the need for blood transfusion, and post-delivery drop in hemoglobin and hematocrit after cesarean delivery. This information was shared with obstetric and anesthesia staff at a level III perinatal center in central Illinois as an informative PowerPoint presentation. Thirteen pre and post-test surveys were collected from staff which showed an improvement in knowledge regarding the use of TXA as a prophylactic measure in the management of PPH. The goal of this project was to ensure that the individuals providing direct patient care are aware of up-to-date research findings on this therapy which may clinically benefit their patients
Implementation of a GlideScope Educational Program for Novice Student Registered Nurse Anesthesiologists
Get PDFGlideScope Video laryngoscopy carries a higher risk of injury to the pharyngeal cavity than direct laryngoscopy. Verathon is aware of this risk and has developed a proprietary “Four-step method” to mitigate it. This project aimed to reduce injuries related to GlideScope video laryngoscopy by providing first-year nurse anesthesiologists at Southern Illinois University Edwardsville with didactic and simulation education related to GlideScope video laryngoscopy and injury prevention. Didactic education was provided via a pre-recorded PowerPoint presentation. Simulation education was provided with the GlideScope and airway trainer manikins. The participants completed an identical 8-question pre-test and post-test to assess for knowledge gain and operator confidence after the educational intervention. Our results indicate increased knowledge gain and operator confidence
Weight Loss Communication and Treatment in Primary Care
Get PDFObesity is undertreated in the primary care setting as a single medical condition. Obese patients are higher risk for comorbid conditions including heart disease, hypertension, diabetes mellitus and stroke. There is no universal screening tool implemented in the primary care setting for obesity management. An extensive literature review was completed to identify barriers in the primary care settings for providers to treat obesity as a disease state, assess current practices for weight management in these settings, and to identify health behaviors of adult patients with obesity. This project implemented the Five A’s Communication Tool to identify patients willing to discuss weight management during their wellness exams and to guide providers’ conversations based on patient health behaviors. A sample size of 30 patients were surveyed, of which 86% of patients answered ‘yes’ to discuss weight management during their exam, regardless of BMI, and 56% of patients answered \u27yes’ to receiving additional resources regarding weight management for their specific medical comorbidities. Providers preferred patients complete the survey prior to starting the exam to avoid discussing weight management with those patients who did not want their weight addressed. Identified limitations included a lack of patient population diversity, small sample size, and timing of project implementation. This project was trialed to improve the provider-patient conversation surrounding weight management and improving patient overall health in the primary care setting. The Five A’s Communication Tool was proven beneficial by providers to help discuss weight management during annual exams in the primary care setting