American journal of critical care : an official publication, American Association of Critical-Care Nurses
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Little research has been done on pain assessment in critical care, especially in patients who cannot communicate verbally. ⋯ Pain documentation in medical files is incomplete or inadequate. The lack of a pain assessment tool may contribute to this situation. Research is still needed in the development of tools to enhance pain assessment in critically ill intubated patients.
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Sleep deprivation is common in critically ill patients and may have long-term effects on health outcomes and patients' morbidity. Clustering nocturnal care has been recommended to improve patients' sleep. ⋯ The high frequency of nocturnal care interactions left patients few uninterrupted periods for sleep. Interventions to expand the period around 3 AM when interactions are least common could increase opportunities for sleep.
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Comparative Study
Comparison of 3 methods of detecting acute respiratory distress syndrome: clinical screening, chart review, and diagnostic coding.
Although the incidence of acute respiratory distress syndrome has been studied, few researchers have prospectively assessed the search tool used to identify cases. ⋯ The incidence of acute respiratory distress syndrome is underestimated when based on either diagnostic coding or physicians' notes without testing of the accuracy of coding. Both physicians and medical record coding specialists may require training in use of terms related to acute respiratory distress syndrome.
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B-type natriuretic peptide is a neurohormone secreted from the cardiac ventricles in response to ventricular stretch and pressure overload. It counteracts the vasoconstriction that occurs as a compensatory mechanism in heart failure. A new test for measuring plasma levels of B-type natriuretic peptide can help in the diagnosis and treatment of patients with congestive heart failure. ⋯ Thus, incorporating measurement of B-type natriuretic peptide into clinical evaluation helps physicians and nurses diagnose heart failure more quickly, especially in patients who have multiple comorbid conditions. Elevated levels of B-type natriuretic peptide indicate a poor prognosis in terms of a higher mortality and more hospital readmissions. Levels of B-type natriuretic peptide could be used to guide therapy and discharge planning for patients admitted with decompensated heart failure.
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Oral health is influenced by oral microbial flora, which are concentrated in dental plaque. Dental plaque provides a microhabitat for organisms and an opportunity for adherence of the organisms to either the tooth surface or other microorganisms. In critically ill patients, potential pathogens can be cultured from the oral cavity. ⋯ Although 2 studies indicated reductions in rates of ventilator-associated pneumonia in cardiac surgery patients who received chlorhexidine before intubation and postoperatively, the effects of chlorhexidine in reducing ventilator-associated pneumonia in other populations of critically ill patients or its effect when treatment with the agent initiated after intubation have not been reported. In addition, no evaluation of the effectiveness of pharmacological and mechanical interventions relative to each other or in combination has been published. Additional studies are needed to develop and test best practices for oral care in critically ill patients.