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Pneumonia is a lung infection caused by bacteria, virus, or fungus. The most direct endogenous sources of any of these microorganisms include infected nasal carriers, sinusitis, oropharynx, gastric, or tracheal colonization, and hematogenous spread (Alcon Fabregas & Torres, 2005). Although much is known about pneumonia, it remains the leading infectious cause of hospitalization and death in the United States ("Pneumonia," n.d.). One of the reasons why pneumonia is common is that the lungs are exposed to some ten thousand liters of air each day, as well as small amounts of saliva and even occasionally aspirated regurgitation, all of which can contain bacteria, viral and fungal agents, and other pathogens ("Pneumonia," n.d.).
Although pneumonia is contagious via airborne particles shared by infected persons, self-infection is far more common. This is why oral hygiene, nutrition, and other lifestyle issues are central to reducing disease prevalence. When the immune system has been compromised…
Alcon A1, Fabregas N, Torres A. (2005). Pathophysiology of pneumonia. Clin Chest Med. 2005 Mar; 26(1):39-46.
Mayo Clinic Staff (2014). Pneumonia. Retrieved online: http://www.mayoclinic.org/diseases-conditions/pneumonia/basics/causes/con-20020032
"Pneumonia." Chapter 15. Retrieved online: http://www.thoracic.org/education/breathing-in-america/resources/chapter-15-pneumonia.pdf
"Pneumonia - Pathophysiology Of Pneumonia," (n.d.). Retrieved online: http://science.jrank.org/pages/5358/Pneumonia-Pathophysiology-pneumonia.html
Pneumonia and Timely Antibiotic Therapy
The purpose of this project to educate hospital staff concerning the fact that research supports a best practice protocol that pneumonia patients should be provided with antibiotics within 4 hours of being admitted to the hospital. Pneumonia is defined by Evans and Tippins (2007) as being "an acute inflammation of the lower respiratory tract most commonly due to viral and bacterial infection. Areas or lobes of the lungs become consolidated resulting in an impairment of gas exchange" (p. 224). The environment of the project is a tertiary hospital facility that provides surgical, medical and rehabilitation services. The question is whether pneumonia patients should be given antibiotics within a certain time frame, such as 4 hours after being admitted to the hospital. At present, pneumonia remains the leading cause of death attributable to infection in patients aged 65 years and older and accounts for 13% to…
Evans, C. & Tippins, E. (2007). The foundations of emergency care. Maidenhead, England:
Four hours to start treatment of pneumonia? (2006). Clinical Infectious Diseases, 43(11), v-vi.
Houck PM, Bratzler DW, & Nsa W, Ma A, etc. (March 22, 2007). Timing of antibiotic administration and outcomes for Medicare patients hospitalized with community-
acquired pneumonia. Retrieved from www.ncbi.nlm.nih.gov/pubmed/15037492.
Pneumonia Case Study
The general statistics and facts about the patient are as follows. The patient is a Caucasian whit e email that is 52 years old. She was admitted to St. Mary's hospital on 12/12/2012. She stood a bit over five feet tall and weighed around 128 pounds. She was married with two grown children and lives in a small camping trailer as opposed to a conventional home or apartment/room.
Both the patient herself and the spouse of the patient are of disabled status. Advanced directives for the patient were in force as of the date of admission of the patient, again that being 12/12/2012. The purpose of the admission on 12/12/2012 was for a pneumonectomy. The patient was prior-diagnosed with necrotizing pneumonia in August 2012 and she hoad a lobectomy in Sepbemter. However, the necrotizing pneumonia destroyed the rest of the patient's lung.
The patient in question had…
The best nursing practice in the specific case would be not only the direct care of the young patient, but also the inclusion of the family in the in house hospital care as to provide an example of what is to be done at home in order to prevent relapse. Many family members might mistakenly believe that their own form of care will be sufficient in the case of a child's illness. However, it is the nurse's duty in such cases to prove to those family members that they need to follow specific and professionally proven methodologies in order to succeed in the recovery process, "Proponents of professionally-centered models view professionals as experts who determine child and family needs from their own as opposed to a family's perspective," (Trivette, Carl J.; Dunst, Carl; Boyd, Kimberly; Hamby, Debra W., 1995). By involving the family in the necessary care practices in house,…
Trivette, Carol M.; Dunst, Carl J.; Boyd, Kimberly; Hamby, Deborah W. (1995). Family-orientated program models, helpgiving practices and parental control appraisals. Exceptional Children. Vol. 62.
These factors were examined in the work of Tolentino-DelosReyes, et al. (2007) who report themselves having conducted a study and in the form of the administration of a test containing ten items which was developed for the purpose of scoring the nurse on knowledge related to VAP. These questions were comprised by a Powerpoint presentation utilized by the project director in the education sessions in the CCU and SICU. The test specifically were related to "best-practice guidelines, microorganisms that cause VAP, hand washing, supine positioning, enteral feeding, factors related to VAP, definition of VAP, and diagnosis of pneumonia." (Tolentino-DelosReyes, et al., 2007) Stated as participants in the reported study were 14 nurses on day shift and another 14 night shift nurses along with 15 day shift and 18 night shift nurses from the CCU comprising a stated "65% to 70% of all the nurses in each unit." (Tolentino-DelosReyes, et al.,…
Topic: Pneumonia readmissions among nursing home residents 65 years and older in the United States of America.
Backdrop of the dilemma
Pneumonia remains an extreme health condition in America. It accounts for roughly 1 million medical-center admissions and over 50,000 fatalities yearly. Roughly ten to twenty percent of pneumonia occurrences need admittance to the Intensive Care Unit or ICU. Moreover, pneumonia accounts for near to 140,000 medical-center readmissions each year, pricing in excess of 10 billion dollars in medical expenses. Unsurprisingly, in the age of reputation and expense awareness, pneumonia re-admission levels for older people over Sixty-five years have grown to be a topic of greater attention and quality enhancement endeavors. Together with the Affordable Care Federal act enactment, the Centers for Medicare And Medicaid Solutions (CMS) keeps medical-centers responsible for extra re-hospitalizations by connecting readmission levels to compensation. In 2013, CMS recognized 2,225 medical-centers for compensation decrease in keeping…
Calvillo, L., Arnold, D., Eubank, K. J., Lo, M., Yunyongying, P., Stieglitz, H., & Halm, E. A. (2013). Impact of social factors on risk of readmission or mortality in pneumonia and heart failure: systematic review. Journal of general internal medicine, 28(2), 269-282.
De Alba, I., & Amin, A. (2014). Pneumonia readmissions: risk factors and implications. The Ochsner Journal, 14(4), 649-654.
Donzé, J., Lipsitz, S., Bates, D. W., & Schnipper, J. L. (2013). Causes and patterns of readmissions in patients with common comorbidities: retrospective cohort study. Bmj, 347, f7171.
Hansen, L. O., Greenwald, J. L., Budnitz, T., Howell, E., Halasyamani, L., Maynard, G., ... & Williams, M. V. (2013). Project BOOST: effectiveness of a multihospital effort to reduce rehospitalization. Journal of hospital medicine, 8(8), 421-427.
McHugh, M. D., & Ma, C. (2013). Hospital Nursing and 30-Day Readmissions among Medicare Patients with Heart Failure, Acute Myocardial Infarction, and Pneumonia. Medical Care, 51(1), 52–59. http://doi.org/10.1097/MLR.0b013e3182763284
Shorr, A. F., Zilberberg, M. D., Reichley, R., Kan, J., Hoban, A., Hoffman, J., ... & Kollef, M. H. (2013). Readmission following hospitalization for pneumonia: the impact of pneumonia type and its implication for hospitals. Clinical infectious diseases, 57(3), 362-367.
Weinreich, M., Nguyen, O. K., Wang, D., Mayo, H., Mortensen, E. M., Halm, E. A., & Makam, A. N. (2016). Predicting the risk of readmission in pneumonia. a systematic review of model performance. Annals of the American Thoracic Society, 13(9), 1607-1614.
Yelena, M. S., Pratt, L. A., Kramarow, E. A., & Elgaddal, N. (2015). Hospitalization, Readmission, and Death Experience of Noninstitutionalized Medicare Fee-for-service Beneficiaries Aged 65 and Over.
Ventilator Associated Pneumonia reflects the most common healthcare related infection in the process of providing intensive care within the context of the hospital. The condition enhances the morbidity, mortality, length of stay, and costs increments. Ventilator Associated Pneumonia possesses significant threat to the development of human beings because of the costs and complexion of the condition. The condition occurs under the watch of the nurses who have the responsibility of providing extensive care to patients. Since the condition is complex, it is essential to focus on its prevention rather than treatment thus reduction in the total costs and adverse effects in association with Ventilator Associate Pneumonia (Zilberberg et al., 2011). This calls for the development of the implementation plan (K-1) to enable the prevention and reduction of the Ventilator Associated Pneumonia.
The population in which the solution is intended, the staff that will participate, and the key contributors that must…
Zilberberg, M., & Shorr, A. (2011). Ventilator-associated pneumonia as a model for approaching cost-effectiveness and infection prevention in the ICU. Current Opinion In Infectious
Diseases, 24(4), 385-389. doi:10.1097/QCO.0b013e3283474914
Uneja et al. (2011). Prevention and management of ventilator-associated pneumonia: A survey on current practices by intensivists practicing in the Indian subcontinent. Indian Journal
Of Anaesthesia, 55(2), 122-128. doi:10.4103/0019-5049.79889
Ventilator Associated Pneumonia: eview and Critique of a Quantitative esearch Article
Ventilator associated pneumonia is a significant problem affecting many patients that are intubated during hospital stays (NIH, 2012). Understanding and addressing this problem requires careful attention to the latest research, and this research must be approached from a critical perspective. Quantitative research, or research that directly and concretely measures certain phenomenon and describes relationships in numerical terms, has yielded no small amount of useful information on this topic, and critically examining a current article that outlines the knowledge regarding ventilator associated pneumonia is an excellent way to determine if there are any knowledge gaps or inconsistencies that require attention (Burns & Grove, 2011). The following paragraphs present just such an examination.
A substantial portion of patients intubated for ventilator-assisted breathing during hospital stays develop pneumonia as a result of infection spread or allowed to flourish at…
Burns, N., & Grove, S. (2011). Understanding Nursing Research (5th ed.). New York: Elsevier.
Chastre, J. & Fogan, J. (2002). Ventilator-associated pneumonia. American Journal of Respiratory Critical Care Medicine 165(7): 867-903.
NIH. (2012). Hospital-acquired pneumonia. Accessed 18 July 2012. http://www.ncbi.nlm.nih.gov/pubmedhealth/PMH0001201/
A study conducted by Ledgerwood et al. (2013) on the effects of tracheotomy tubes that have suction above the cuff established that the tubes have the capability to reduce VAP incidents. The amount of time spent in ICU and on the ventilator was also reduced. This does demonstrate that the patient was accorded the best treatment available to drain pleural effusion. The development of haemothorax/pneumothorax is anticipated in most patients who are intubated, but the risk is normally reduced. According to the different studies conducted, the likelihood of a patient suffering from VAP is decreased slightly when using SSD. The patient would still have contracted VAP if they were not intubated with the endotracheal tube. Therefore, the patient ended up incurring higher medical costs as they had to pay for the tube, and haemothorax/pneumothorax treatment. If they had not been intubated the patient would have only paid for the sickness.…
BOUZA, E., PEREZ, A., MUNOZ, P., PEREZ, M.J., RINC "N, C., SANCHEZ, C., MARTON-RABADAN, P., RIESGO, M. & GROUP, C.I.S. 2003. Ventilator-associated pneumonia after heart surgery: A prospective analysis and the value of surveillance*. Critical care medicine, 31, 1964-1970.
BOUZA, E., PEREZ, M.J., MUNOZ, P., RINC "N, C., BARRIO, J.M. & HORTAL, J. 2008. Continuous aspiration of subglottic secretions in the prevention of ventilator-associated pneumonia in the postoperative period of major heart surgery. CHEST Journal, 134, 938-946.
DEZFULIAN, C., SHOJANIA, K., COLLARD, H.R., KIM, H.M., MATTHAY, M.A. & SAINT, S. 2005. Subglottic secretion drainage for preventing ventilator-associated pneumonia: a meta-analysis. The American journal of medicine, 118, 11-18.
DODEK, P., KEENAN, S., COOK, D., HEYLAND, D., JACKA, M., HAND, L., MUSCEDERE, J., FOSTER, D., MEHTA, N. & HALL, R. 2004. Evidence-based clinical practice guideline for the prevention of ventilator-associated pneumonia. Annals of Internal Medicine, 141, 305-313.
Ventilator associated pneumonia (VAP) accounts for the majority of nosocomial pneumonia which may lead to more extensive hospital stay and increased intensive care. Endrotachael tubes that provide continuous subglotic suctioning (abbreviated: C-ETT) may reduce VAP, but they are more expensive than the standard endrotacheal tubes (abbreviated: -ETT) that do not have the characteristic of continuous suctioning. The objective of this study (peronni et al., 2011), therefore, was to measure the comparative costs of C-ETT against -ETT among intubated people and see whether indeed the more costly C_ETT do show a difference that makes their expense worthwhile.
The issue that was discussed were the comparative merits of C-ETT compared with -ETT and to assess whether the merits of one are more significant than the merits of another and significant to the point that their added cost is worth the hospital's investment in the resource.
2/2: Correct critique of sampling design. Cite…
Speronni, KG., Lucas, J. & Dugan, L (2011)Comparative Effectiveness of Standard Endotracheal Tubes vs. Endotracheal Tubes With Continuous Subglottic Suctioning On Ventilator-Associated Pneumonia Rates Nursing Economics, 29
Stillwell, S. et al. 92010). Evidence-Based Practice, Step-by-Step: Searching for the Evidence American Journal of Nursing, 10 (5), 41-47
Tuckett, A.G. (2004). Qualitative research sampling: The very real complexities. Nurse Researcher, 12(1), 47 -- 61.
A 65-year-old female with pneumonia
CHIEF COMPLAINT: A 3-day long fever accompanied by a persistent cough
HISTORY: The patient's name is Mrs. Alcot, a sixty-five-year-old woman with a complaint of persistent fever and cough. The patient stated that the illness started three days ago after waking up. A feverish feeling and the ejection of yellowish-green phlegm from the mouth during coughing fits were the symptoms reported at the onset of illness. The symptoms of the illness have since worsened as time passed. A notification was also given a recurring pain in the right chest whenever a deep breath is taken. The patient's husband was reported by the patient to have been ill with similar but milder symptoms a week ago.
Vital Signs: BP 128/86, HR 101 (regular), RR 18, T 37.4°C
GEN: Slight increase in breathing speed; no discomfort is expressed
Community-acquired pneumonia (CAP)
Kaysin, A., & Viera, A. J. (2016). Community-acquired pneumonia in adults: diagnosis and management. American Family Physician, 94(9), 698-706.
Llinares, P., Menéndez, R., Mujal, A., Navas, E., & Barberán, J. (2014). Guidelines for the management of community-acquired pneumonia in the elderly patient. Rev Esp Quimioter, 27(1), 69-86.
Cacciatore, F., Gaudiosi, C., Mazzella, F., Scognamiglio, A., Mattucci, I., Carone, M., ... & Abete, P. (2017). Pneumonia and hospitalizations in the elderly. Geriatric Care, 3(1).
Eekholm, S., Ahlström, G., Kristensson, J., & Lindhardt, T. (2020). Gaps between current clinical practice and evidence-based guidelines for treating older patients with Community-Acquired Pneumonia: a descriptive cross-sectional study. BMC infectious diseases, 20(1), 73.
Thanavaro J. L. (n.d) Chapter 3: Common respiratory diseases disorders in primary care. Joanes & bartlett Learning, LLC.
Chlorhexidine Gluconate Use in Ventilator Assisted Patients Prevent Ventilator Associated Pneumonia
Ventilator associated pneumonia is a common and fatal complicated issue for patients in ventilator care within the intensive care unit. Ventilated and incubated patients are a challenging threat for registered nurses to deliver high quality of care. It has been observed that incubation impedes the natural defense of the body against respiratory infections. The placement of an endotracheal tube enforces negative effect on the cough reflexes, which aims to protect the airway from invasive pathogens. The endotracheal tube prevents mucocoliary clearance of secretions and depresses epiglottic reflexes (ello, Lode, Cornaglia, & Masterton, 2010; Labeau, Vyver, Brusselaers, Vogelaers, & Blot, 2009). It causes the virulent bacteria to enter and it leaks around the inflated cuff of the endotracheal tube. Consequently, the lungs of patient infiltrate due to which pneumonia is caused. The ventilator associated pneumonia possibly occurs early…
Abad, C., McKinley, L., & Safdar, N. (2008). Measures to Prevent Ventilator-Associated Pneumonia: Which Are Efficacious? Clinical Review, 71-85.
Chan, E., Ruest, A., Meade, M., & Cook, D. (2007). Oral decontamination for prevention of pneumonia in mechanically ventilated adults: systematic review and meta-analysis. BMJ, 889-899.
Chastre, J., & Fagon, J.Y. (2002). Ventilator-associated pneumonia. Am J. Respir Crit Care Med, 867-903.
Elward, A.M., Warren, D.K., & Fraser, V.J. (2002). Ventilator-associated pneumonia in pediatric intensive care unit patients: risk factors and outcomes. Pediatrics, 758-764.
In critically ill adults (p), how does the daily use of chlorohexidine (I) compared to sterile water reduce VAP (ventilator-associated pneumonia) (O) during hospitalized stay (T).
Part 2 Identifying a Problem
Of the infections acquired by patients who've used mechanical ventilation in hospitals, ventilator-associated pneumonia is the most common. It causes several deaths, prolongs hospital stay and adds to the cost of medical care. Ventilator-associated pneumonia is commonly developed when pathogenic bacteria colonize the aero digestive tract. Given this reality, prevention of the infection has always involved preventing bacteria colonization and the following aspiration of the contaminated secretions to the lower airways. (Babcock et al., 2004).
It is necessary that a reappraisal be carried out because of the limitations that the evidence base has. First, the current meta analyses are influenced heavily by three significant studies in patients undergoing cardiac surgery and they accounted for between forty to sixty…
Klompas, M., Speck, K., Howell, M. D., Greene, L. R., & Berenholtz, S. M. (2014). Reappraisal of routine oral care with chlorhexidine gluconate for patients receiving mechanical ventilation: systematic review and meta-analysis. JAMA internal medicine, 174(5), 751-761.
Zhang, T., Tang, S., & Fu, L. (2014). The effectiveness of different concentrations of chlorhexidine for prevention of ventilator-associated pneumonia: a meta-analysis. Journal Of Clinical Nursing, 23(11/12), 1461-1475. doi:10.1111/jocn.12312
Tablan OC, Anderson LJ, Besser R, Bridges C & Hajjeh R (2004) Guidelines for preventing healthcare-associated pneumonia, 2003. Morbidity and Mortality Weekly Report 53, 1-36.
Pruitt, B., & Jacobs, M. (2006). BEST-PRACTICE INTERVENTIONS: How can you prevent Ventilator-Associated Pneumonia? (Cover story). Nursing, 36(2), 36-42.
Pneumonia, as Calkins and Palamountain (2017) point out in their article, Fighting Childhood Pneumonia in Uganda, remains one of the leading causes of death for children under the age of five across the world. As a matter of fact, more children have died from pneumonia related complications in recent times than from measles, malaria and HIV combined. This, in essence, is an indication to the seriousness of the issue – particularly in developing countries. In Uganda, for instance, “approximately 20,000 children under five died from the illness” in 2012; with the said figure being representative of “15 percent of under-five deaths in Uganda” (Calkins and Palamountain, 2017, p. 10). Various initiatives have been undertaken by both the government and INGOs in an attempt to arrest the situation. However, no single approach has yielded significant benefits. Therefore, taking the context of this discussion into consideration, the all-important question remains: what would…
Calkins, T, & Palamountain, K. (2017). Fighting Childhood Pneumonia in Uganda. Retrieved from https://services.hbsp.harvard.edu/services/proxy/content/72006155/72006157/5014d36c8a70f53dec5cb0411a30b81d
Nkrumah, Y. & Mensah, J. (Eds.). (2014). Accelerating Health Reforms through Collective Action: Experiences from East Africa. Washington, DC: World Bank Publications.
United Nations Human Rights (2017). Human Rights Council Holds Panel Discussion on Access to Medicines. Retrieved from http://www.ohchr.org/EN/NewsEvents/Pages/DisplayNews.aspx?NewsID=21325&LangID=E
suffered from its quasi-experimental approach, as several participants left the study since they left the facility or otherwise were not permitted to participate -- for example, those patients who recovered sufficiently to conduct their own oral care no longer engaged in the experimental protocol and condition. The results were positive and significant, however, the severity of the patients' conditions and the small sample size challenged the researchers, as discussed below.
The title of the article, Oral Intensity: educing Non-Ventilator-Associated Hospital-Acquired Pneumonia In Care-Dependent, Neurologically Impaired Patients, is absolutely clear, unambiguous, and accurate. The abstract offers a clear overview of the study, particularly as it is divided into sections that enable readers to quickly learn about the methodology, results, discussion, and implications of the study. The purpose of the research study is clearly defined: The purpose of the study is to determine if an enhanced oral care protocol would decrease the…
Robertson, T. & Carter, D. (2013). Oral intensity: Reducing non-ventilator-associated hospital-acquired pneumonia in care-dependent, neurologically impaired patients. Canadian Journal of Neuroscience Nursing, 35(2), 10-17.
Ryan, F., Coughlan, M. & Cronin, P. (2007). Critiquing Nursing Research. Guidelines for Critiquing a Quantitative Research Study. (also Nieswiedomy, page 297).
Nurses Knowledge on Ventilated Associated Pneumonia Prevention
Synthesizing & Describing: Differences & Similarities of Various esearch Components
The study provides the similarities and differences of the three studies (Al-Sayaghi, 2014, Bagheri-Nesami, & Amiri, 2014, Labeau, Vandijck, Claes, B. et al. 2007) by comparing their statement of problems and significant of the studies.
The three studies identify the VAP (Ventilator-associated pneumonia) as the most common HAIs (hospital-acquired infections) among patients in the intensive care unit. (Al-Sayaghi, 2014, Bagheri-Nesami, & Amiri, 2014, Labeau, Vandijck, Claes, B. et al. 2007). All the studies believe that the VAP can lead to high rates of mortality, and morbidity leading to an increase duration of hospitalization. (Al-Sayaghi, 2014, Bagheri-Nesami, & Amiri, 2014, Labeau, Vandijck, Claes, B. et al. 2007). They identify associated problems of VAP as longer stay in hospitals, and increased use of resources. However, Al-Sayaghi, (2014) provide detailed statistics related to VAP problems by…
Al-Sayaghi, K.M. (2014). Prevention of ventilator-associated pneumonia a knowledge survey among intensive care nurses in Yemen. Saudi Med J. 35 (3): 269-276.
Bagheri-Nesami, M. & Amiri, M. (2014). Nurses' knowledge of evidence- based guidelines for preventing ventilator-associated pneumonia in intensive care units. Journal of Nursing and Midwifery Sciences. 2014: 1(1): 44-48.
Labeau, S. Vandijck, D.M. Claes, B. et al. (2007). Critical Care Nurses' Knowledge of Evidence-Based Guidelines for Preventing Ventilator-Associated Pneumonia: An Evaluation Questionnaire. Nurses Am J Crit Care: 16:371-377.
Perez-Granda, M.J. Munoz, P. Heras, C.et al. (2013). Prevention of Ventilator-Associated Pneumonia: Can Knowledge and Clinical Practice Be Simply Assessed in a Large Institution? Respiratory Care. 58 ( 7): 1213-1219.
Aspiration Pneumonia Prevention through in-Service Training for Nurses
N451 N Capstone Course
Design for Change Proposal: Aspiration Pneumonia Prevention through in-Service Training for Nurses
This is a position paper recommending the implementation of an in-service training among nurses in the hospital and skills nursing facilities on the prevention of aspiration pneumonia, of which a large segment of the sufferers are elderly patients. Especially in the case of elderly patients with nasogastric or under peg tube feeding, the need for nurses taking care of these patients is essential to ensure correct and proper care and safety for the patient. In this paper, the proponent of this paper will discuss relevant literature on the effectiveness of in-service nurse training in preventing aspiration pneumonia. Further, after this review of relevant literature, the proponent will present an action plan that the hospital management can review and take into consideration.
Change Model Overview
Ebihara, S. And T. Ebihara. (2011). "Cough in the elderly: a novel strategy for preventing aspiration pneumonia." Pulmonary Pharmacology & Therapeutics, Vol. 24.
Liantonio, J., B. Salzman, and D. Snyderman. (2014). "Preventing aspiration pneumonia by addressing three key risk factors: dysphagia, poor oral hygiene, and medication use." Annals of Long-Term Care, Vol. 22, Issue 10.
Newhouse, R., S. Dearholt, S. Poe, L. Pugh and K. White. (2007). Johns Hopkins Nursing Evidence-Based Practice: Model and Guidelines. IN: Sigma Theta Tau International.
Quagliarello, V., M. Juthani-Mehta, S. Ginter, V. Towle, H. Allore, and M. Tinetti. (2009). "Pilot testing of intervention protocols to prevent pneumonia among nursing home residents." Journal of American Geriatric Society, Vol. 57, No. 7.
Preventing Ventilator Associated Pneumonia
One of the most commonly occurring infections among patients hospitalized in intensive care units is ventilator-associated pneumonia, which is associated with several negative outcomes. This infection has generated considerable concerns among healthcare providers because it leads to protracted hospital stay, increased costs of healthcare services, and high mortality rate of between 15 and 45%. The infection also generates numerous complications for these patients, particularly those undergoing a major heart surgery that needs mechanical ventilation in the treatment process. Given these negative outcomes and increased concerns, prevention of ventilator-associated pneumonia is increasingly important in intensive care units. While several methods have been suggested to help prevent this infection, the use of endotracheal tube with subglottic suction line would help prevent VAP.
Using Endotracheal Tube with Subglottic Suction Line to Prevent VAP
As previously indicated, the use of endotracheal tube with subglottic suction line seems to be the…
Amato, C.W. (2011, May). Effectiveness of Subglottic Suctioning in the Prevention of Ventilator Associated Pneumonia. Retrieved from The University of Central Florida website: http://etd.fcla.edu/CF/CFH0003810/Amato_Cody_W_201105_BSN.pdf
Granda, M.J.P, Barrio, J.M., Hortal, J., Munoz, P., Rincon, C. & Bouza, E. (2013). Routine Aspiration of Subglottic Secretions After Major Heart Surgery: Impact on the Incidence of Ventilator-associated Pneumonia. Journal of Hospital Infection, 85, 312-315.
Compliance to Ventilator Care Bundles on educing Ventilator-Associated Pneumonia
Ventilator-Associated Pneumonia (VAP) is a common infection that is acquired by patients who have used mechanical ventilation in health care facilities. This infection has generated numerous concerns in public health because of its negative impacts on health care. Some of these negative health effects include extended hospital stays, increased costs of health care services, and deaths. Consequently, there have been numerous initiatives in healthcare to address this problem including ventilator care bundles. Existing literature on evidence-based practice for dealing with VAP has shown that compliance with ventilator care bundles is the most suitable clinical intervention (Al-Thaqafy, 2014). For this study, the John Hopkins Nursing Evidence Practice Process will be utilized to facilitate compliance to these bundles in order to reduce VAP. John Hopkins developed an equation that helps administrators quantify probable savings through lessening hospital-acquired infections like VAP (Guterl, 2013). This…
Al-Thaqafy, M. S., El-Saed, A., Arabi, Y. M., & Balkhy, H. H. (2014). Association of Compliance of Ventilator Bundle with Incidence of Ventilator-associated Pneumonia and Ventilator Utilization among Critical Patients Over 4 Years. Annals of Thoracic Medicine, 9(4), 221-226. doi:10.4103/1817-1737.140132
Guterl, G. (2013). Cost Implications of VAP. Retrieved from: http://respiratory-care-sleep-medicine.advanceweb.com/Features/Articles/Cost-Implications-of-VAP.aspx
Lawrence, P., & Fulbrook, P. (2011). The Ventilator Care Bundle and its Impact on Ventilator-associated Pneumonia: A Review of the Evidence. Nursing In Critical Care, 16(5), 222-234. doi:10.1111/j.1478-5153.2010.00430.x
Mukhtar, A., Zaghlol, A., Mansour, R., Hasanin, A., El-Adawy, A., Mohamed, H., & Ali, M. (2014). Reduced Incidence of Methicillin-resistant Staphylococcus Aureus Ventilator-associated Pneumonia in Trauma Patients: A New Insight into the Efficacy of the Ventilator Care Bundle. Trauma, 16(3), 202-206. doi:10.1177/1460408614532622
Elevating heads of beds for patients on mechanical ventilation
Along with the recommendations for removal of plaque, there is also a guideline made by CDC that for proper treatment to "elevate at an angle of 30 to 45 degrees the head of the bed of a patient at high risk for aspiration." The benefits elevation of the head of the bed is on the theory that then gravity will reduce the possibilities of regurgitation that exists in an overly distended stomach. The recommendation by CDC also clearly states that the patients should not be lying flat unless there is some clinical need for that. At the same time, some medical authorities feel that this is likely to make the patients uncomfortable, though the recommendation is from CDC. This makes them reduce the angle of laying the patients bed at a lower angle than the angle specified by CDC.…
Afessa, Bekele. (May, 2004) "From pro and con debate to evidence-based practice: ventilator- associated pneumonia" CHEST. Retrieved at http://www.findarticles.com/p/articles/mi_m0984/is_5_125/ai_n6094553 . Accessed on 20 July, 2005
Caffery, Lisa. "Preventing Ventilator associated Pneumonia" Retrieved from www.genesisheart.com/clinical_staff/ventilator_pneumonia.pdf+elevating+patient's+beds+for+ventilator+acquired+pneumonia&hl=en" http://www.genesisheart.com/clinical_staff/ventilator_pneumonia.pdf . Accessed on 20 July, 2005
Chulay, Marianne. (1 March, 2005) "VAP Prevention: The latest guidelines" Retrieved at http://rnweb.com/rnweb/article/articleDetail.jsp?id=149672Accessed on 20 July, 2005
Geyer, Sherree. "Breathing easy" Retrieved from www.matmanmag.com/matmanmag/jsp/articledisplay.jsp?dcrpath=AHA/PubsNewsArticleGen/data/0407MMH_FEA_Cover_Story&domain=MATMANMAG
Some of the symptoms of ventilator assisted pneumonia may be the onset of fever, a higher white blood cell count, and a new or changing lung infiltrate that may be visible on a normal chest x-ray. Cultures taken as samples from the patient's airways may show the presence of microorganisms or bacteria and fungi that would eventually cause the dreaded ventilator assisted pneumonia in the patient. JAMA states that these risk factors may be eliminated to a large extent if the nurses and medical practitioners were to follow certain simple but essential steps in preventing the onset of the symptoms of pneumonia. First and foremost, the nurse must maintain a high degree of hygiene; he must wash his hands both before and after coming into contact with any patient, and second, he must try to keep the bed elevated to a 30 degree head up position, so that…
Druding, Mary. C. (1997, Aug) "Re-examining the practice of normal saline installation prior to suctioning" Medical Surgery Nursing, Retrieved 8 October, 2007 at http://findarticles.com/p/articles/mi_m0FSS/is_n4_v6/ai_n18607505
Medscape. (2007) "Should Normal Saline be Used When Suctioning the Endotracheal Tube of the Neonate?" Retrieved 8 October, 2007 at http://www.medscape.com/viewarticle/552862
Schwenker, Ferrin, M; Gift, a.G. (1998) "A survey of endotracheal suctioning with installation of normal saline" American Journal of Critical Care, vol. 7, no. 4, pp: 255-260.
Torpy, Janet M. (2007, Apr) "Ventilator assisted pneumonia" the Journal of the American
Furthermore, one of the pillars of collaborative care that will need to be firmly established is the fostering of clear dialogue and a means for strong communication within the care management planning. For instance, there needs to be a clear decision and communication of all tests ordered and when the test results will be available. One of the most important aspects of this collaborative care will be the nursing interventions which can have significant impact on the patient's health and stabilization (Allen, 2010). In fact, strategic nursing care can even minimize readmission rates of Margaret and other patients with comparable conditions (Chen et al., 2012).
Prioritize the Nursing Care Needs of Margaret
The prioritization of nursing interventions is essential, and the way in which a nurse determines this priority is going to be something unique and distinct. "Trials reviewed demonstrated a beneficial impact of nursing interventions for secondary prevention in…
Adler, H.M. (n.d.). Toward a biopsychosocial understanding of the patient -- physician relationship: An emerging dialogue. (2007). J Gen Intern Med,22(2), 280 -- 285.
Afilala, J. (n.d.). Frailty in patients with cardiovascular disease: Why, when, and how to measure. (2011). Curr Cardiovasc Risk Rep, 5(5), 467 -- 472.
Allen, J.K. (2010). Randomized trials of nursing interventions for secondary prevention in patients with coronary artery disease and heart failure: Systematic review.
Journal of Cardiovascular Nursing,25(3), 207-220.
Baker, 2000).The measurement of project effectiveness, an element of project impact evaluation, is crucial for the success of every proposed project. In this section, we present the method/mechanism for evaluating the effectiveness of the proposed solution. The process starts with the identification of the project users (Ventilation associated pneumonia patients), gathering data to be used in determining if the user received output, identification of process of transmission and ends up with the change process. This is indicated in the flowchart model (see figure 1.) which provides for an elaborate systematic way of examining the process within the proposed project and the outcome of the proposed project. The evaluation of the outcomes is the major purpose of the framework even though the outcomes can never be seen in total isolation of the proposed project "mechanics" (including transmission, project reception as well as use).At certain points in the project evaluation framework, it…
Apisarnthanarak A, Thongphubeth K, Sirinvaravong S, et al.(2007) Effectiveness of multifaceted hospitalwide quality improvement programs featuring an intervention to remove unnecessary urinary catheters at a tertiary care center in Thailand. Infect Control Hosp Epidemiol 2007; 28(7):791 -- 798
Baker, JL (2000). Evaluating the Impact of Development Projects on Poverty: A Handbook for Practitioners. A Handbook for Practitioners. http://siteresources.worldbank.org/INTISPMA/Resources/handbook.pdf
Gawlinski A. (2007)Evidence-based practice changes: measuring the outcome. AACN Adv Crit Care. Jul-Sep;18(3):320-2. Review. PubMed PMID: 180195
Hugonnet, S., S. Harbarth, H. Sax, R.A. Duncan and D. Pittet. (2004). "Nursing Resources: A Major Determinant of Nosocomial Infection?" Current Opinions in Infectious Diseases 17: 329 -- 33.
patients undergoing mechanical ventilation contract Ventilator Associated Pneumonia (VAP). This acute medical condition always results in increased death rates and associated medical costs among patients. This article reviews several literatures that try to enlighten masses on the diagnosis, medical treatments and VAP prevention methods. In addition, this article outlines recommendations medical practitioners can implement in their daily practices to curb VAP and offers an insight on controversies that usually arise during VAP diagnoses, treatment plans and prevention methodologies. This article defines VAP to be the causative agent of approximately 25 to 54% mortality rates among patients undergoing mechanical ventilation in ICUs. Factors responsible for VAP among patients include patients' population in ICUs, hospital stay durations and antimicrobial treatments. Even though antimicrobial medications are confirmed to reduce VAP casualties, further studies should be undertaken such as the ones outlined in the literatures below to help in early identification and treatment of…
Arroliga, A.C., Pollard, C.L., Wilde, C.D., Pellizzari, S.J., Chebbo, A., Song, J., et al. (2012).
Reduction in the Incidence of Ventilator Associated Pneumonia: A Multidisciplinary
Approach. Respiratory Care, 688-696.
Camargo, L.F., De Marco, F.V., Barbas, C.S., Hoelz, C., Bueno, M.A., Rodrigues Jr., M., et al.
Treatment to Patients
The main objective of providing treatment to patients is to relieve symptoms along with decreasing the progression of the disease as well as the mortality or morbidity. However, in some cases, this objective is not fully achieved, especially in the case of the patients who are admitted to the ICU with some serious and almost always a terminal stage of the disease. For example, when old patients are admitted in the ICU, their immunity is extremely low and this is the perfect time for the opportunistic infections to make matters worse for these patients. There are many infections that are specifically associated with patients admitted in the hospitals. Pseudomonas Aurigeonosa is a micro-organism that is well documented to cause bacterial pneumonia and bacteremia in the patients who are terminally ill and are receiving treatment in the hospital setting. Since most of the patients in the ICU are…
Beekmann, SE;Diekema, DJ; Chapin, KC;Doern, GV (2003) Effects of rapid detection of bloodstream infections on length of hospitalization and hospital charges.J ClinMicrobiol, 41:3119-3125.
Boussekey, N, Leroy, O, Georges, H, Devos, P, d'Escrivan, T, Guery, B (2005).Diagnostic and prognostic values of admission procalcitonin levels in community-acquired pneumonia in an intensive care unit.Infection, 33:257-263.
Charles, PE, Dalle, F, Aho, S, Quenot, JP, Doise, JM, Aube, H, Olsson, NO, Blettery, B: Serum procalcitonin measurement contribution to the early diagnosis of candidemia in critically ill patients. Intensive Care Med, 32:1577-1583.
Digiovine, B; Chenoweth, C; Watts, C; Higgins, M (1999)The attributable mortality and costs of primary nosocomial bloodstream infections in the intensive care unit. Am J. RespirCrit Care Med, 160:976-981.
Prevention and Management of Ventilator-Associated Pneumonia in the Hospitals
Ventilator-associated pneumonia is an infection in the airways that develops more than 48 hours after a patient is intubated. While the prevention and management of pneumonia of any kind is considered as a commendable objective, it is characterized with several concerns given the significant effect of pneumonia linked to ventilator use. Ventilator-associated pneumonia has attracted considerable concern in the recent past because it has become the leading cause of death among infections acquired in the hospital. Actually, the rates of deaths from ventilator-associated pneumonia have exceeded those associated with central line infections, respiratory tract infections, and serious sepsis in the non-intubated patient ("Preventing Healthcare and Community Associated Infections," n.d.). It is increasingly likely that the most concerning aspect of ventilator-associated pneumonia is the high associated mortality (Kalanuria, Zai & Mirski, 2014). Consequently, several peer reviewed studies have been carried out to…
Junega et. al. (2011, May). Prevention and Management of Ventilator-Associated Pneumonia: A
Survey on Current Practices by Intensivists Practicing in the Indian Subcontinent. Indian Journal of Anaesthesia, 55(2), 122-128.
Kalanuria, A.A., Zai, W. & Mirski, M. (2014). Ventilator-Associated Pneumonia in the ICU.
Critical Care, 18(208). Retrieved from http://ccforum.com/content/18/2/208
McClure Case Study
Patient Overview -- Patient, Mr. M., is 49 years old and has smoked for 25 years, quit three years ago when diagnosed with emphysema. He indicates he as shortness of breath for the past 48 hours, with sputum so thick he has difficulty coughing it out. Skin is warm and dry with slight clubbing of fingers noted. Lung sounds diminished with crackles and expiratory wheezes and barrel chest. Vitals are 101.8 Temp, pule 110, respiratory 32, BP 150/82. Blood gases show decreased O2 and increased C02 with an increase in red blood cells and twice the normal white cells.
M's risk factors for emphysema are high. Smoking for so long contributed to decrease of long function and is an abnormal dilation and destruction of the alveolar ducts and air spaces in the lungs. It usually occurs in people over 50, so Mr. M is at the lower…
Cash, J. And Glass, C. (2011). Family Practice Guidelines. New York: Springer.
Dains, J., et al. (2012). Advanced Health Assessment & Clinical Diagnosis in Primary Care.
St. Louis, MO: Mosby/Elsevier.
Mortelli, M., et al. (2002). Acute respirator distress syndrome. American Family Physician. 65 (9): 1823-30.
woman entered the National Institutes of Health esearch Hospital in Bethesda Maryland with a serious, but fairly routine infection; however the subsequent events were to prove anything but routine. The article titled "Tracking a Hospital Outbreak of Carbapenem-esistant Klebsiella pneumoniae with Whole-Genome Sequencing," traced the effort to discover the cause of the woman's illness, as well how the staff at one of America's most advanced hospitals dealt with the subsequent outbreak of disease. (Starr, 2012) This article interested me because it focused on an outbreak of illness, something which anyone could have been affected, but also because it discussed two aspects of the course and it's text: single-celled life forms and genetics.
The woman brought to the NIH research hospital was suffering from an infection caused by an antibiotic-resistant organism, but it was a new strain, never before encountered. About a month after she was treated and discharged, another patient…
"Klebsiella Pneumoniae Morphology" Klebsiella Pneumoniae.org. Retrieved from http://klebsiella-pneumoniae.org/klebsiella_pneumoniae_morphology.html
Melissa Block, Eddie Cornish. (30 Oct 2012). Interview "NIH Takes Extraordinary Steps
In Fighting 'Superbug'." NPR.org. Retrieved from http://www.npr.org/2012/08/23/159931389/nih-takes-extraordinary-steps-in-fighting-super bug
Snitkin, Evan, etal. (Aug 2012). "Tracking a Hospital Outbreak of Carbapenem-Resistant
Oral Hygiene Methodology
There is a significant amount of research that shows statistical correlation between oropharyngeal bacterial colonization and the presence bacteria responsible for ventilator associated pneumonia (VAP). Several interventions have been shown as effective in reducing the incidence of VAP, but many have not gained widespread clinical use in a majority of hospitals. esearch does show that the amount of oropharyngeal bacteria present in the mouth and oral cavity has a relationship to the propensity of developing VAP. This is likely due to the lack of appropriate levels of oral hygiene combined with the bacterial colonization of ventilator equipment. We expect that oral and mouth washes regularly administrated that include chlorohexedine will kill bacteria and reduce incidence of VAP infections on ICU patients. The aim of this study will be to survey the efficacy of chlorohexdedine mouth washes in a randomized group of patients who were placed in an…
Chlebicki, P., & Safdar, N. (2007). Topical chlorhexidine for prevention of ventilator-associated peneumonia: A Meta-analysis. Critical Care Medicine, 35(2), 595-602.
Collard, H., & Saint, S. (2005, June). Prevention of Ventilator Associated Pneumonia. Retrieved from ahrq.gov: http://archive.ahrq.gov/clinic/ptsafety/pdf/chap17.pdf
Dodek, P., et al. (2004). Evidence-Based Clinical Practice Guidelines for Prevention of Ventilator-Associated Pneumomia. Annals of Internal Medicine, 141(4), 305-13.
Lansford, T., et al. (2007). Efficacy of a Pneumonia Prevention Protocol in the Reduction of Ventilatory-Associated Pneumonia in Trauma Patients. Liebert Open Access- Surgical Infections. 8 (5): 5505-10.
Management of Immunocompromised Patients
In beginning I writer specific nursing assignment. The Question: 2000 Words While clinical placement asked prepare a single room an admission. The patient requiring admission isolation room immunocompromised.
Immunocompromised patients usually require isolation in order to prevent them from becoming infected with infections from other patients which is known as protective isolation. For the immunocompromised patients, their immune system is unable to fight the infectious diseases. There are many diseases or conditions that lead to immunodeficiency in patients.
One is AIDS (acquired immunodeficiency syndrome). The pathophysiology of AIDS starts when the person's CD4+ T cell count begins to decrease as the disease kills these cells. This is HIV-induced cell lysis where the virus enters the CD4+ cells where it inserts its genetic information to the cell nucleus thus taking over the cell and replicating itself. The virus then mutates extremely rapidly thus making it more and…
Agusti, C., & Torres, A. (2009). Pulmonary Infection in the Immunocompromised Patient: Strategies for Management. New York: John Wiley & Sons.
Bodey, G.P. (2010). Managing Infections in the Immunocompromised Patient. Clinical Infectious Diseases, 40(Supplement 4), S239. doi: 10.1086/427328
Glauser, M.P., & Pizzo, P.A. (2009). Management of Infections in Immunocompromised Patients New York: Elsevier Health Sciences.
Hayden, R.T. (2008). Diagnostic Microbiology of the Immunocompromised Host. Washington, DC: ASM Press.
Social Ecology of Health Promotion
Module 05 Question 01: explain the rationale behind the federal government's approach to regulatory containments in food.
The federal government's approach in relation to the regulation of the containments in food, aims at protecting the consumers on food insecurity through elimination of food pathogens. It is the role of the government to enhance the health system and conditions of its citizens through adoption and implementation of various rules and regulations in relation to the containments in food. The food supply of the United States integrates multi-faceted production system and delivery components. Some of the critical or essential components of this system include production, processing, preparing, packaging, labelling, distribution, and consumption of the food components (Fortin, 2011).
There is a risk in relation to the concept of each stage of the food supply system in the context of the United States. This makes it ideal for…
Marco-Barba, J., Mesquita-Joanes, F., & Miracle, M. (2013). Ostracod palaeolimnological analysis reveals drastic historical changes in salinity, eutrophication and biodiversity loss in a coastal Mediterranean lake. Holocene, 23(4), 556-567.
Le Bagousse-Pinguet, Y., Liancourt, P., Gross, N., & Straile, D. (2012). Indirect facilitation promotes macrophyte survival and growth in freshwater ecosystems threatened by eutrophication. Journal Of Ecology, 100(2), 530-538.
Riplett, L., Engstrom, D., & Conley, D. (2012). Changes in amorphous silica sequestration with eutrophication of riverine impoundments. Biogeochemistry, 108(1-3), 413-427.
Gareca, E.E., Vandelook, F., Fernandez, M., Hermy, M., & Honnay, O. (2012). Seed
Six days after his initial complaint, the patient returned with worsening symptoms and was admitted to the hospital. No bacterial or viral infections could be found, but the patient was treated with antibiotics anyway as his symptoms suggested that his respiratory distress and other symptoms were due to some sort of infection. The fact that his condition continued to worsen without any notable effect from broad-spectrum antibiotics suggests that perhaps the physicians erred in this assessment, and that the negative results of the many tests for infectious agents administered to the patient were more accurate than the physicians thought. Focusing attentions more immediately on other potential causes and more direct methods of symptom relief, either in addition to or instead of the antibiotic treatment and observation that constituted the primary means of treatment at this stage, might have prevented or at least postponed the need for intubation and the mechanical…
I know whatever major I choose, my first priority is to help others and make a difference in their lives.
I feel I have a lot to offer to your university in my attitude, involvement, and dedication. I am a very sensitive person because of my sister and her condition. She has had many medical problems (including open-heart surgery, heart failure, and several battles with pneumonia). She is an inspiration to me, and my family rejoices in all of her successes. This has made me more open to others, and to understand those who are different, as well as those who fit in. I feel this will make me a better, more compassionate student and peer.
My sister has taught me more than compassion and sensitivity. Despite her health problems and situation, she still holds down a part time job at McDonald's, and is always positive and upbeat. As my…
Leadership and Management in Healthcare
Effective Leadership and Management
Leadership is much like communications in regards to the complexity inherent in these concepts. There are many different perspectives that are used to examine these issues and researchers study leadership and management from such disciplines includes Industrial and Organizational Psychology, Social Psychology, Business, and Sociology. There have been somewhere in the neighborhood of six to eight major approaches, depending on the vantage point, to leadership theory produced in the scientific literature over the last sixty years and even more have emerged from outside academia (Kilburg & Donohue, 2011). Competing theories include such perspectives as trait theory, situational theory, behavioral theory, competencies theory, network theory of leadership and many more.
Much of the work that a nurse-leader engages in on a daily basis rests in their ability to communicate with others; including clients, colleagues, superiors, and subordinates. Therefore, since this…
Judge, J., & Bono, J. (2000). Five factor model of personality and transformational leadership. Journal of Applied Psychology, 751-765.
Kilburg, R., & Donohue, M. (2011). Toward a "Grand Unifying Theory" of Leadership. Consulting Psychology Journal, 6-25.
Marquis, B., & Huston, C. (2011). Leadership Roles and Management Functions in Nursing: Theory and Application. Lippincott Williams & Wilkins.
Straker, D. (2011). Transformational Leadership. Retrieved February 6, 2011, from Changing Minds: http://changingminds.org/disciplines/leadership/styles/transformational_leadership.htm
Omit itles and Degrees]
Klompas M., Speck, K., Howell M.D., Greene, L.R., & Berenholtz, S.M. (2014). Reappraisal of routine oral care with chlorohexidine gluconate for patients receiving mechanical ventilation: systematic review and meta-analysis. JAMA internal medicine, 174 (5), 751-761.
his article deals with the routine oral care of patients using chlorhexidine gluconate as standard care when they receive mechanical ventilation during their hospital stay. heir aim is to assess the overall impact routine oral care has in conjunction with chlorhexidine in regards to patient-centered outcomes for patients receiving the aforementioned mechanical ventilation. hey chose randomized clinical trials that compared a placebo to chlorhexidine and chose only sixteen studies out of the 171 citations they explored because the 3,630 patients observed in the selected studies met criteria.
he results showed chlorhexidine provide patients with a lesser occurrence of infection than with placebo, although pneumonia risk was around the same for both.…
This webpage gives information on what VAP is. It also provides links on possible prevention information. It does not really highlight use of chlorhexidine. However, it does include monitoring practices to check for VAP for early intervention.
15. Beraldo, C.C., & Andrade, D.D. (2008). Oral Hygiene with chlorohexidine in preventing pneumonia associated with mechanical ventilation. Jornal Braisileiro de Pneumologia, 34(9), 707-714
This article failed to provide any new information with the exception of reducing another bacterium through the use of chlorhexidine. It is a search kind of article. They chose eight studies. From those eight studies, seven of them confirmed the use of chlorhexidine reduces instances of VAP.
Chlorhexidine to Prevent Ventilator-Associated Pneumonia
Ventilator-associated Pneumonia (VAP) is one of the most common infections acquired by patients who've utilized mechanical ventilation in health care facilities. This infection is a major concern because it leads to several deaths, extends hospital stay, and increases the costs of medical care services. The infections are commonly developed when pathogenic bacteria colonize the aero digestive tract. According to Babcock et al. (2004), the prevention of these infections has usually entailed preventing bacteria colonization and the subsequent aspiration of the contaminated secretions to the lower airways. Given the increased incidents of ventilator-association pneumonia, this paper proposes the use of chlorhexidine in preventing it. Chlorhexidine has proven effective in prevention of VAP as shown in baseline data. The implementation of this proposed procedure in patient care will entail various logistics based on approval from organizational leadership.
Methods for Obtaining Necessary Approval and Support
One of the…
Babcock, H., Zack, J.E., Garrison, T., Trovillion, E., Jones, M., Fraser, V.J., & Kollef, M.H. (2004). An educational Intervention to Reduce Ventilator-associated Pneumonia in an Integrated Health System. Chest, 125 (6), 2224-2231.
Hoshijima et al. (2013, December). Effects of Oral Hygiene Using Chlorhexidine on Preventing Ventilator-associated Pneumonia in Critical-care Settings: A Meta-analysis of Randomized Controlled Trials. Journal of Dental Sciences, 8(4), 348-357.
Keyt, H., Faverio, P. & Restrepo, M.I. (2014, June). Prevention of Ventilator-associated Pneumonia in the Intensive Care Unit: A Review of the Clinically Relevant Recent Advancements. Indian Journal of Medical Research, 139, 814-821.
Klompas M., Speck, K., Howell M.D., Greene, L.R., & Berenholtz, S.M. (2014). Reappraisal of Routine Oral Care with Chlorohexidine Gluconate for Patients Receiving Mechanical Ventilation: Systematic Review and Meta-analysis. JAMA Internal Medicine, 174 (5), 751-761.
Quality and Accessibility of Information
Quantitative or qualitative data used in the report on how many patients have been admitted for pneumonia over the past several months would need to be complete in that it shows evidence of each of the following characteristics: accuracy, accessibility, comprehensiveness, completeness, consistency, currency, definition, granularity, precision, lineage, relevancy, and timeliness. The same holds true for a scenario in which a drug has been recalled and patients need to be contacted. Data should be quality in both cases, as it informs the reader of pertinent stats and needed facts (Lin, 2013).
In the case of providing a report on the number of patients admitted for pneumonia, an example of accuracy of data would be that the report truly represents the actuality or the reality of the situation. Names, for example, are not misspelled and indicate actually persons in both qualitative and quantitative data and for…
Creswell, J. W. (2007). Qualitative Inquiry and Research Design: Choosing among
Five Approaches. UK: Sage.
Lin, C. (2013). Revealing the "Essence" of Things: Using Phenomenology in LIS
Research. Qualitative and Quantitative Methods in Libraries (QQML), 4: 469-478.
The hospital used for the study already had protocols in place to prevent patients from getting pneumonia. Published data was provided and posters were placed in all units. However, the nurses chose not to follow the protocols set forth. This is the reason the study was conducted. The nurses confessed that they felt oral care was more of a comfort to the patients than a preventative measure to pneumonia. The really did not take the time to learn that improper oral care in these patients lead to the excessive growth of bacteria which eventually found its way down the respirator tube and into the patient's lungs causing pneumonia. Once the nurses went through formal evidence-based program and followed the proper protocol, the rate of ventilator pneumonia decreased by 50%.
Providing proper training in addition to the posters displayed helped to reinforce the significance of proper oral care for their patients.…
Ross, a. And Crumpler, J. (2007). The impact of an evidence-based practice education program
on the role of oral care in the prevention of ventilator-associated pneumonia. Intensive and Critical Care Nursing, 23(3), 132-136.
" (Stone, 2006) Treatment is stated by Stone (2006) to be "diagnosis dependent and may be medical or surgical." Practical modifications include simple steps such as crushing of pills or opening of capsules to ease and facilitate swallowing.
The work of Leibovitz, et al. (2007) entitled: 'Dehydration Among Long-Term Care Elderly Patients with Oropharyngeal Dysphagia" states that long-term care (LTC) residents in the nursing home "especially the orally fed with dysphagia are prone to dehydration. The clinical consequences of dehydration are critical. The validity of the common laboratory parameters of hydration status is far from being absolute, especially so in the elderly." (Leibovitz, et al., 2007) it is related however that "combinations of these indices are more reliable." (Leibovitz, et al., 2007) the study reported by Leibovitz et al. is one that assessed hydration status among elderly LTC residents with oropharyngeal dysphagia and in which a total of 28 orally…
Spieker, Michael R. (2000) Evaluating Dysphagia. American Family Physician 14 Jun 2000. Online available at http://www.aafp.org/afp/20000615/3639.html
Marik, Paul E. And Kaplan, Danielle (2003) Aspiration Pneumonia and Dysphagia in the Elderly. Chest. July 2003. Vol. 1224, No. 1. Online available at http://www.chestjournal.org/content/124/1/328.full
Bautmans, I., et al. (2008) Dysphagia in elderly nursing home residents with severe cognitive impairment can be attenuated by cervical spine mobilization. J. Rehabil Med. 2008 Oct;40(9):755-60. PubMed Online available at http://www.ncbi.nlm.nih.gov/sites/entrez?Db=pubmed&Cmd=ShowDetailView&TermToSearch=18843429
Stone, Rebecca S. (2006) Dysphagia in the Elderly. Inpatient Times. October 2006. Online available at http://www.bmc.org/geriatrics/RStone_DysphagiaintheElderly.pdf
Evidence-Based Practice Project
A literature review conducted by abie and Curtis (2006) aimed at establishing the effects of washing hands in reducing respiratory infections. The literature was obtained by searching CAB Abstracts, PubMed, Embase, Cochrane, and Web of Science library. The inclusion strategy for the review were any studies that reported having an impact of hand washing to reduce respiratory infections. All articles included in the review were published before June 2004. This was a quantitative systematic review, which made it an effective method of analyzing and evaluating the selected studies. After searching for the relevant articles, the researchers found 395 articles, but only 61 articles were selected after the researchers reviewed their abstracts (abie & Curtis, 2006). The review and selection process continued and the final review included only eight articles, which the researchers established were more relevant to their study. Having eliminated the articles that focused on children…
Loeb, M., McGeer, A., McArthur, M., Walter, S., & Simor, A.E. (1999). Risk factors for pneumonia and other lower respiratory tract infections in elderly residents of long-term care facilities. Archives of internal medicine, 159(17), 2058-2064.
Rabie, T., & Curtis, V. (2006). Handwashing and risk of respiratory infections: a quantitative systematic review. Tropical medicine & international health, 11(3), 258-267.
Smith, P.W., Bennett, G., Bradley, S., Drinka, P., Lautenbach, E., Marx, J., . . . Stevenson, K. (2008). SHEA/APIC Guideline: infection prevention and control in the long-term care facility. American journal of infection control, 36(7), 504.
prokaryotes consist of millions of genetically distinct unicellular organisms. A procaryotic cell has five essential structural components: a genome (DNA), ribosomes, cell membrane, cell wall, and some sort of surface layer which may or may not be an inherent part of the wall (1). Functional aspects of procaryotic cells are related directly to the structure and organization of the macromolecules in their cell make-up, i.e., DNA, RNA, phospholipids, proteins and polysaccharides. Diversity within the primary structure of these molecules accounts for the diversity that exists among procaryotes (1). Identifiable groups of prokaryotes are assembled based on easily observed phenotypic characteristics such as Gram stain, morphology (rods, cocci, etc.), motility, structural features (e.g. spores, filaments, sheaths, appendages, etc.), and on distinguishing physiological features (e.g. anoxygenic photosynthesis, anaerobiasis, methanogenesis, lithotrophy, etc.). Prokaryotes are commonly known as bacteria, and it is estimated that bacteria have been around for at least 3.5 billion years…
1. Bergey's Manual of Systematic Bacteriology (2nd Edition). 1989. Williams, S.T., Sharpe, M.E., Holt J.G. Lippincott Williams & Wilkins
2. Breiman RF, Butler JC, Tenover FC, Elliott JA, Facklam RR. (1994). Emergence of drug-resistant pneumococcal infections in the United States. JAMA. 1994 Jun 15;271(23):1831-5.
3. Center for Disease Control and Prevention. Antibiotic/Antimicrobial resistance. http://www.cdc.gov/drugresistance/actionplan/html/
4. Jones RN, Pfaller MA (1998). Bacterial resistance: a worldwide problem. Diagn Microbiol Infect Dis. Jun;31(2):379-88.
Partial vaccination was not effective on children 6-23 months. This meant that full vaccination is necessary to optimally protect children of this age group from Influenza (Shueler et al.).
The results are consistent with those of other evaluative studies on children through randomized, controlled trials for efficacy and observational studies for effectiveness (Shueler et al., 2007). Vaccine effectiveness depends on the characteristics of the study population, specificity of the outcome, and the Influenza season. It was dissimilar to the findings of Ritzwoller and his team in that Shueler and team's subjects had more exposure to Influenza. The more specific outcome of laboratory-confirmed Influenza made the detection possible. And Shueler and his team's findings were similar to Ritzwoller and his team's in that the findings of both teams offered assurance that vaccination of young children would be beneficial, even in a year with sub-optimal match (Shueler et al.).
Vaccination Efficacy not…
Ambrose, C.S., et al. (2008). Current status of live attenuated influenza vaccine in the United States for seasonal and pandemic influenza. Influenza Respiratory Viruses:
Blackwell Publishing. Retrieved on April 26, 2010 from http://www.medscape.com/viewarticle/588302
Eisenberg K.W., et al. (2004). Vaccine effectiveness against laboratory-confirmed
Influenza on children 6 to 59 months of age during the 2003-2004 and 2004-2005
The quality of life was another issue addressed in research of the use of feeding tubes with patients who have dementia (Finucane, 2001).
obert MCCann, MD reports that the everyday imagery of food and its pleasant addition to life cannot be ignored in the discussion of removing natural nutrition and using a feeding tube.
McCann reminds the medical community that the image of a family gathered around the Thanksgiving table, interacting and nurturing each other through the meal presents an entirely different image than an elderly person suffering from dementia alone in a bed in a nursing home with a tube inserted into their stomach. The imagery of food and its measurable impact on a person's life must be accurately envisioned for the decision to be made according to McCann (Finucane, 2001).
McCann studied Hospice cancer patients who were in the end stage of life. According to his research it…
Funicane, Thomas (2001) a Review of the Evidence the American Geriatric Society.
Lebovitz, Lubert, a. Habot (2003) Attitudes of Relatives and Nursing Staff Toward Tube feeding in the Severely Dementia Patients. American Journal of Alzheimer's Disease and Other Dementias.
Ersek, Mary PhD RN (2003) Artificial Nutrition and Hydration. The Journal of Hospice and Palliative Nursing.
Pleural Effusion in Children -- An Overview
Pleural Effusion is a disease resulting from excess production of fluids or a decrease in absorption or in some instances both thereby leading to an abnormal collection of fluids in the pleural space. It is the commonest pleural disease and has etiologies that include symptomatic inflammatory, cardiopulmonary disorders and malignant diseases that require speedy evaluation as well as treatment (Jeffery ubins 2016).
Disorders like an infection are some of the primary afflictions that could lead to the collection of fluids in the pleural space leading to pediatrics pleural effusion. The fluid accumulation can result from poor absorption or an increase in filtration. While mild effusion is asymptomatic, complications like septicemia, pneumothorax, pleural thickening, bronchopleural fistula, and respiratory failure might accompany it (Shahla Afsharpaiman, et al. 2016). a chest ultrasound or lateral decubitus indicates the probability of the existence of a large pleural effusion.…
Andrews CO & Gora ML., 1994. Pleural effusions: pathophysiology and management. SAGE Publications - Anual Pharma, 28(8), pp. 894-903.
Hyeon Yu, 2011. Management of Pleural Effusion, Empyema, and Lung Abscess. Seminars in Interventional Radiology, 28(1), pp. 75-86.
Jeffrey Rubins, 2016. Pleural Effusion. [Online]
Available at: http://emedicine.medscape.com/article/299959-overview
Nurse burnout is a common occurrence. This can exacerbate an ongoing problem that is seen in hospitals, nosocomial infections. Nosocomial infections remain prevalent for patients with extended hospital stays like those in intensive care units. An infection that starts roughly 48 hours after admission, those in intensive care units (ICUs) experience a continued rate of infection leading to increase length of stay, mortality, and morbidity. The number of patients that develop a nosocomial infection are from 7 to 10% internationally (Dasgupta, Das, Hazra, & Chawan, 2015). As such, hospitals have decided to classify nosocomial infection sites based on clinical and biological criteria.
esearch has led to the discovery of several bacterial strains that involve the formation of nosocomial or hospital acquired infections. "The agents that are usually involved in hospital-acquired infections include Streptococcus spp., Acinetobacter spp., enterococci, Pseudomonas aeruginosa, coagulase-negative staphylococci, Staphylococcus aureus, Bacillus cereus, Legionella and Enterobacteriaceae family members,…
CDC. (n.d.). HAI Data and Statistics. Retrieved from https://www.cdc.gov/hai/surveillance/
Cheng, C., Bartram, T., Karimi, L., & Leggat, S. (2016). Transformational leadership and social identity as predictors of team climate, perceived quality of care, burnout and turnover intention among nurses. Personnel Review, 45(6), 1200-1216. doi:10.1108/pr-05-2015-0118
Cimiotti, J. P., Aiken, L. H., Sloane, D. M., & Wu, E. S. (2012). Nurse staffing, burnout, and health care -- associated infection. American Journal of Infection Control, 40(6), 486-490. doi:10.1016/j.ajic.2012.02.029
Dasgupta, S., Das, S., Hazra, A., & Chawan, N. (2015). Nosocomial infections in the intensive care unit: Incidence, risk factors, outcome and associated pathogens in a public tertiary teaching hospital of Eastern India. Indian Journal of Critical Care Medicine, 19(1), 14. doi:10.4103/0972-5229.148633
Elderly in Monrovia, CA
The population of people aged 65 years or greater is steadily escalating, as baby boomers come of age. It is estimated that this age bracket accounts for 10% of the total world population, and is statistically increasing. As this sector of the population steadily increases, there are of course, accompanying health care issues: osteoarthritis, cardiac and kidney issues, Alzheimer's or dementia, and an ever-growing problem with depression. For this essay, we will concentrate on several health issues that plague seniors nationally, but will specifically focus on the aging population over 65 in Monrovia, California.
Monrovia is a smallish city located at the foothills of the San Gabriel Mountains in the San Gabriel Valley, Los Angeles County. Monrovia was settled in the late 1800s as a central hub for the growing orange grove industry, but has now become more of a bedroom community that supports the urban…
Breathe California of Los Angeles County. (2009). Cited in:
California Department of Public Health. (June 2009). "Healthy California -- 2010
Midcourse Review." Executive Summary. Cited in:
Prior to the study, the researcher consulted pertinent literature on both the head-of-bed elevation standard and the Clinical Decision Support System. The sources used were authoritative and relevant. The information presented by the author is in agreement with other research in this clinical area of study (Frederich, Sud, & Sud et al. (2008); Williams, Chan & Kelly (2008).
The author placed considerable emphasis on nurse characteristics, which were not even mentioned as an objective of the study. They seem to have been added into the methodology without justification. The objective of the study addressed patient characteristics, but not nurse characteristics. This added in another variable that was not part of the original research study. Patient characteristics and the affect of the CDSS were discussed sufficiently, as were the limitations of the study. The authors provided enough details of the study to be replicated by other researchers. The authors were careful…
Frederich, J., Sud, S. & Sud, M. et al. (2008), Prone position ventilation for community-acquired pneumonia [letter]. CMAJ 178 (9): 1153-1161.
Lyerla, F., LeRouge, C. & Cooke, D. et al. (2010). A Nursing Clinical Decision Support System and Potential Predictors of Head-of-Bed Position For Patients Receiving Mechanical Ventilation. American Journal of Critical Care, January 2010, 19 (1): 39-47.
Williams, Z., Chan, R. & Kelly, E. (2008). A Simple Device to Increase Rates of Compliance in Maintaining 30-Degree Head-of-bed Elevation in Ventilated Patients. Crit Care Med. 36(4):1155-1157.
"Elimination of these and other pathogens from the lower respiratory tract is made possible by an effective innate immune response, which is necessary yet potentially dangerous to the infected host."
E. coli Outbreak:
There have been numerous E.coli outbreaks over the years. Pakalniskiene, Falkenhorst, Lisby, and Madsen (2009) studied one of the larger single source outbreaks. On November 11th, 2006, there was an outbreak in Greater Copenhagen, Denmark. The director of a high school had contacted the regional health authority to report an outbreak of diarrhea and vomiting among guests of a school dinner party. A total of 750 people, nearly all of the teachers and students at the school, had attended the dinner. The evening, the first people became sick. Three days later, when the director made the report, approximately 200 to 300 teachers and students had reported gastroenteritis. It was found that the fresh basil used in the…
Cegelski, L., Marshall, G., Eldridge, G., Hultgren, S. (Jan 2008). The biology and future prospects of antivirulence therapies. Nature Reviews: Microbiology. (6). Retrieved May 7, 2009, from Proquest.
Hacker, J. & Blum-Oehler, G. (2007). In appreciation of Theodor Escherich. Nature Reviews. Microbiology, 5(12) Retrieved May 7, 2009, from ProQuest.
Justice, S., Hunstad, D., Cegelski, L., & Hultgren, S. (2008). Morphological plasticity as a bacterial survival strategy. Nature Reviews. Microbiology, 6(2). Retrieved May 7, 2009, from ProQuest.
Pakaliniskiene, J., Falkenhorst, G., Lisby, M., Madsen, B., Olsen, K., Nielsen, E., Mygh, A., Boel, J., & Molbak, K. (2009). A foodborne outbreak of enterotoxigenic E. coli and Salmonella Anatum infection after a high-school dinner in Denmark, November 2006. Epidemiology and Infection, 137(3) Retrieved May 7, 2009, from ProQuest.
Empyema Clinical Manifestation
Empyema: Lung Sounds and other Clinical Manifestations
Over the past decade, empyema has consistently been recognized as an acute, potentially life-threatening respiratory disease. A large number of studies have been conducted over the last years that address the unique symptomatology of empyema and the clinical implications of these symptoms.
The biggest diagnostic challenge of empyema is that patient often present with symptoms very similar and difficult to distinguish from an uncomplicated pneumonia. A patient typically shows symptoms such as fever and chills, excessive sweating, malaise, cough, dyspnea, pleuritic chest pain and unintentional weight loss (Sahn, 2007). These symptoms individually do not warrant a diagnosis of empyema. They do, however, require precautionary follow-up testing that should include a pleural fluid aspiration. The presence of pus -- an opaque, whitish-yellow viscous fluid consisting of serum coagulation proteins, cellular debris and fibrin deposition -- aspirated from the pleural space is…
1. Walker W, Wheeler R, Legg J. (2011). Update on the causes, investigation and management of empyema in childhood. Archives of Disease in Childhood, 96, 5, 482-488.
2. Sahn SA. (2007). Diagnosis and management of parapneumonic effusions and empyema. Clinical Infectious Diseases, 45, 11, 1480-1486.
3. Heffner JE, Klein JS, Hampson C. (2010). Diagnostic utility and clinical application of imaging for pleural space infections. Chest, 137, 2, 467-479.
4. Froudarakis ME. (2008). Diagnostic Work-Up of Pleural Effusions. Respiration, 75, 4-13.
Vitamin C for Common Cold
What is Vitamin C?
Vitamin C, also known as ascorbic acid, is a water-soluble ingredient that is essential for the health of human beings. It is essential for normal growth and development and it has consumed regularly. Since Vitamin C dissolves in water, the excess amounts leave the human body through urine and this means the body needs a constant supply of this vitamin everyday. The body cannot store vitamin C in any form.
One of the primary role of vitamin C is to repair the body cells and tissues and to prevent free radicals and toxins from getting accumulated in the body. It repairs wounds and makes them heal faster. The free radicals are known to play a role in cancer and heart diseases and good amount of vitamin C everyday helps to prevent any damage.
Sources of vitamin C
Most fruits and vegetables…
Frances Sienkiewicz Sizer, Leonard A. Piche, Eleanor Noss Whitney. Nutrition: Concepts and Controversies. Kentucky: Cengage Learning. 2011.
Weber, Olaf; Eccles, Ronald. Common Cold. New York: Springer. 2007.
Karl Marlantes' Matterhorn
Karl Marlantes' novel of the Vietnam War, Matterhorn, seems to want to offer the reader an immersive approach towards the experience of Vietnam. If we can say of earlier Vietnam narratives -- whether in film, such as Oliver Stone's Platoon or Stanley Kubrick's Full Metal Jacket, or in fiction, such as Tim O'Brien's novels Going After Cacciato and The Things They Carried or Gustav Hasford's The Short-Timers (a cult classic of Vietnam fiction and the basis for Kubrick's film) -- that they have a sort of expressionistic technique, seeking to capture the experience of the war in a series of vignettes, we can see the originality of Marlantes' approach in greater relief to what has come before: his approach is not so much expressionistic as it is encyclopedic, an attempt to catalogue (in fiction) every single aspect of the one small event, the movement of a Marine…
, 2010). egardless of the cause, infant SV is linked to "significantly more symptoms of wheezing disorder and clinical allergy than controls and were more likely to be sensitized to common inhaled allergens" (Todd et al., 2010). The number of studies and the number of subjects is still small, but the correlations have been consistently large enough to suggest that a serious bout of SV-bronchiolitis in infancy is linked to later lung problems such as asthma, wheezing, and atopy. Therefore, M.C.'s parents should be educated about the possibility that M.C. may experience breathing problems in later life, and told to advise her primary care physician of her SV diagnosis and hospitalization.
Caiulo, V.A., Gargani, L., Caiulo, S., Fisicaro, A., Moramarco, F., Latini, G., & Picano, E.
(2011). Lung ultrasound in bronchiolitis: Comparison with chest x-ray. Eur J. Pediatr, 170, 1427-1433.
Healthwise. (2012). Bronchiolitis- topic overview. etrieved March 9, 2013…
Caiulo, V.A., Gargani, L., Caiulo, S., Fisicaro, A., Moramarco, F., Latini, G., & Picano, E.
(2011). Lung ultrasound in bronchiolitis: Comparison with chest x-ray. Eur J. Pediatr, 170, 1427-1433.
Healthwise. (2012). Bronchiolitis- topic overview. Retrieved March 9, 2013 from WebMD
Antibiotic Resistant Streptococci
There are more than thirty different species of streptococcal bacteria. The infections that strep causes in humans range from "strep throat," which is caused by Group A strep and relatively easily treatable, to diseases such as pneumonia and serious wound infections, both of which can prove deadly.(1)
Antibiotics were first developed during World War II, and have saved many millions of human lives since then that would have been lost to streptococci infections and diseases. Penicillin alone was solely responsible for dramatically decreasing mortality rates of soldiers wounded on the battlefields of World War II compared to corresponding rates of World War I casualties.
The widespread use of penicillin and more modern antibiotics that have been developed since World War II has been accompanied by the natural evolution of some bacterial strains that are resistant to antibiotics. In many respects, the natural ability of bacteria to develop…
Hurst, L., Russell, S. Superbugs and nightmare scenarios: Resistance to antibiotics grows; Toronto Star (Aug. 3, 2002) Accessed at http://www.vaccinationnews.com/DailyNews/August2002/Superbugs&Nightmares15.htm
2. Lopez, T. Study: Drug-resistant infections increasing in U.S. hospitals www.solucient.com (August 5, 2003 Press Release) Accessed at http://www.solucient.com/news_press/news20030805.shtml
Srikameswaran, A. Higher rate of antibiotic resistance here puzzles researchers; Pittsburgh Post-Gazette (February 18, 2004) Accessed at http://www.post-gazette.com/pg/04049/274463.stm
4. Staphylococcal and streptococcal infections
oral chlorhexidine as preventative agent in of ventilator-associated pneumonia (VAP) in adults who are critically ill and mechanically ventilated in intensive care units (ICUs). The process of critiquing published studies leads to higher level of comprehension of empirical and evidence-based research. The discussion devotes some consideration to the way the authors addressed the protection of human participants, the research methodology -- including data collection, data management and analysis -- the research findings, and the conclusions drawn from the study outcomes.
Protection of Human Participants
isks to human participants in this research were minimal since the study is retrospective review of research. The original research studies protected the identity of the research participants, and data was presented in the aggregate form. The current research article is yet another layer away from the original studies and further still from the original information about the participants, none of which was presented in disaggregate…
Snyders, O., Khondowe, O, Bell, J. (2011). Oral chlorhexidine in the prevention of ventilator-associated pneumonia in critically ill adults in the ICU: A systematic review. South African Journal of Critical Care, 27(2). Retrieved from http://www.sajcc.org.za/index.php/SAJCC/article/view/123/127
In critically ill adults (p), how does the daily use of chlorohexidine (I) compared to sterile water reduce VAP (ventilator-associated pneumonia) (O) during hospitalized stay (T)?
oy's Adaptation Model (AM) states that the "nursing process is a problem solving approach for gathering data, identifying the capacities and needs of the human adaptive system, selecting and implementing approaches for nursing care, and evaluation the outcome of care provided" ("Application of oy's Adaptation Model," 2012). This approach seems uniquely well-suited to the question of how to reduce ventilator-associated pneumonia, a common complaint of patients during hospital stays. AM focuses on objective analysis of the problem and attempting to provide solutions which address human needs through a scientific approach to care. The first step of the nursing process is gathering data, in this case determining why pneumonia is so common amongst patients. Next identifying "internal and external stimuli" that give rise to…
Application of Roy's Adaptation Model. (2012). Current Nursing. Retrieved from:
Gonzalo, A. (2011). Betty Neuman: The Neuman Systems Model. Theoretical Foundations of Nursing. Retrieved from: http://nursingtheories.weebly.com/betty-neuman.html
The risk to humans is generally low, however during any outbreak of Avian Flu among poultry, there is always a possible risk to humans who have contact with the infected birds and surfaces contaminated with excretions from the infected fowl (Avian1). The current outbreak of H5N1 among poultry in Asia and Europe is an example of a bird flu outbreak that has caused human infections and death (Avian1). In rare instances, limited human-to-human spread of H5N1 virus has occurred, however transmission has not been observed to continue beyond one person (Avian1). Because all influenza viruses have the ability to change, scientists are concerned that the H5N1 virus could mutate and infect humans with a strain that could easily spread from one person to another (Avian1).
Furthermore, according to the CDC, because these viruses do not commonly infect humans, there is little or no immune protection against them in the human…
Avian1 Influenza. Retrieved November 01, 2005 from Centers for Disease
Control and Prevention Web site: http://www.cdc.gov/flu/avian/gen-info/avian-flu-humans.htm
Avian Influenza. Retrieved November 01, 2005 from World Health Organization Web site: http://www.who.int/csr/disease/avian_influenza/avian_faqs/en/index.html#whatis
History1 of the Avian Flue. The Avian Flu Information Site. Retrieved November 01, 2005 at http://www.avian-flu-info.org/history_of_bird_flu.asp
Because some children have developed brain damage after the immunizations, some parents are concerned that the vaccine is responsible for neurologic impairment, however research does not indicate a definitive link between the pertussis vaccine and brain damage, although research is still ongoing (hooping 2005). Yet, as a precaution, children with a history of seizures or brain disorders may not be proper candidates for the DTaP vaccine (hooping 2005).
2001 study revealed that pertussis was the cause of chronic cough in 19.9% of the patients studied. Once a disease that ravaged children worldwide, whooping cough is once again on the rise (Green 2002). Today, approximately 300,000 children worldwide die every year from whooping cough, usually in areas where immunization rates are low (Green 2002). Nonetheless, even in the United States, where immunization rates are high, roughly 1 out of every 200 babies who get whooping cough will die from it, another…
Green, Alan. (2002). Pertussis. Retrieved September 18, 2006 at http://www.drgreene.com/21_1155.html
Whooping Cough. (2005). Mayo Clinic. Retrieved September 18, 2006 at http://www.mayoclinic.com/health/whooping-cough/DS00445/DSECTION=3
Whooping Cough. (2006). MedlinePlus: U.S. National Library of Medicine and the National Institutes of Health. Retrieved September 18, 2006 at http://www.nlm.nih.gov/medlineplus/whoopingcough.html
Whooping cough a continuing problem. (2002, June 29). British Medical Journal.
Sampling Data Analyses the single-study critique paper 2 individual assignment. Develop individual response Single-Study Paper 2 IOM topic area. Use article Single Study Critiques 1-2. It a requirement a quantitative study paper.
Quantitative article analysis
The Nursing esearch article "Effectiveness of an Aspiration isk-eduction Protocol" addresses a proposed method to reduce the risk of aspiration in critically ill patients through a three-pronged intervention strategy. The intervention strategy components include "maintaining head-of-bed elevation at 30 degrees or higher, unless contraindicated; inserting feeding tubes into distal small bowel, when indicated; and using an algorithmic approach for high gastric residual volumes" (Metheny, Davis-Jackson & Stewart 2010: 1). It used a two-group quasi-experimental design of critically ill, mechanically ventilated adult patients receiving tube feedings. 329 were in the control population, 145 in the experimental group (Metheny, Davis-Jackson & Stewart 2010: 1). The patients were all drawn from the same five ICUs at a Level…
Metheny, Norma A., Jami Davis-Jackson & Barbara J. Stewart. (2010). Effectiveness of an Aspiration Risk-Reduction Protocol. Nursing Research, 59(1): 18 -- 25. Retrieved: doi:10.1097/NNR.0b013e3181c3ba05.
Progressive Mobility Protocol
This paper is a project based on PICO. The clinical question that serves as the foundation for this data-based design is; for immobile critical care patients, does the use of a nurse driven progressive mobility protocol reduce ICU LOS compared to every hour of repositioning? In this paper, the adult patients admitted to an ICU represent the population (P) of interest. The nurse driven progressive mobility represents the intervention (I), the comparison (C) is the critical care patients repositioned every two hours, and the reduction in LOS represents the result.
Most hospitals place critically ill patients on bed rest and reposition them every two hours in the intensive care unit. Some literature reviews provide evidence in favor of progressive mobility protocols. In addition, the paper also reviews the safety of mobilization of the critical patients and the negative effects bed rest may have on…
Plis, L. (2009). The Effectiveness of A Nurse-Driven Progressive Mobility Protocol on Reducing
Length of Stay in the Adult Intensive Care Unit. Retrieved from https://www.chatham.edu/ccps/pdf/Plis.L.Final_Capstone.pdf
Melnyk, B.M. & Fineout-Overholt, E. (2005). Evidence-Based Practice in Nursing & Healthcare: A Guide to Best Practice.Philadelphia, PA: Lippincott Williams & Wilkins
Goldhill, D., Imhoff, M., McLean, B., & Waldmann, C. (2007). Rotational Bed Therapy to Prevent and Treat Respiratory Complications: A Review and Meta-analysis. American Journal of Critical Care, 16(1), 50-61.
Evidence-Based Solution to educing Incidence
The goal of this assignment is to increase my ability to appraise and synthesize evidence to provide experience a logical argument in support of a proposal for practice change, and to provide experience in designing a detailed implementation and evaluation plan for my project. I need to discuss my project plan with you.
An evidence-based solution to reducing incidence of hospital acquired infections through indwelling medical devices
Hospital-acquired or nosocomial infections are the fourth leading cause of disease in developed countries. The increased insertion and implanting of prosthetic or indwelling medical devices is a leading cause of these infections since the introduction of a foreign body significantly reduces the body's immunity and decreases the number of bacteria needed to produce an infection. Prosthetic or indwelling medical devices such as urethral catheters, suprapublic catheter, nasogastric tubes, hemodialysis catheters, central venous catheters, and tracheostomy tubes are associated…
Chambless, J.D., Hunt, S.M., & Stewart, P.S. (2006). A three-dimensional computer model of four hypothetical mechanisms protecting biofilms from antimicrobials. Appl Environ Microbiol, 72(3), 2005-2013. doi: 10.1128/aem.72.3.2005-2013.2006
Chu, V.H., Crosslin, D.R., Friedman, J.Y., Reed, S.D., Cabell, C.H., Griffiths, R.I., . . . Fowler, V.G., Jr. (2005). Staphylococcus aureus bacteremia in patients with prosthetic devices: costs and outcomes. Am J. Med, 118(12), 1416. doi: 10.1016/j.amjmed.2005.06.011
Cookson, S.T., Ihrig, M., O'Mara, E.M., Denny, M., Volk, H., Banerjee, S.N., . . . Jarvis, W.R. (1998). Increased bloodstream infection rates in surgical patients associated with variation from recommended use and care following implementation of a needleless device. Infect Control Hosp Epidemiol, 19(1), 23-27.
Digiovine, B., Chenoweth, C., Watts, C., & Higgins, M. (1999). The attributable mortality and costs of primary nosocomial bloodstream infections in the intensive care unit. Am J. Respir Crit Care Med, 160(3), 976-981. doi: 10.1164/ajrccm.160.3.9808145