October Issue: Treating Hemorrhagic Shock, Pain Management and Opioid Use Disorder, Workplace Violence, More

“Violent behavior seems to be an . . . increasingly frequent occurrence in hospitals and nursing care facilities. More and more, such violence is the result of intentional harm.” —editor-in-chief Shawn Kennedy in her October editorial

The October issue of AJN is now live. Here are some of the articles we’re pleased to have a chance to publish this month.

CE: The Use of Resuscitative Endovascular Balloon Occlusion of the Aorta in Treating Hemorrhagic Shock from Severe Trauma

Efforts to prevent death from hemorrhagic shock have resulted in the emergence of a new tool—resuscitative endovascular balloon occlusion of the aorta (REBOA), a less invasive option for controlling hemorrhage in noncompressible areas of the body. This article outlines REBOA, describes its evolution, and discusses various considerations, pitfalls, and nursing implications.

CE: Perspectives on Palliative Nursing: Acute Pain Management for People with Opioid Use Disorder

The authors of this article—one in a series on palliative care developed with the Hospice and Palliative Nurses Association—discuss how to manage acute pain effectively in patients receiving medication-assisted treatment for opioid use disorder, which incorporates methadone, buprenorphine, or naltrexone.

Original Research: Journalists’ Experiences with Using Nurses as Sources in Health News Stories

The authors of a 2018 replication of the […]

2018-09-28T10:05:14-04:00September 28th, 2018|Nursing|0 Comments
Read More

Upper-Extremity Deep Vein Thrombosis: How Clinicians at One Hospital Achieved Lower Rates

By Sylvia Foley, AJN senior editor

At a suburban hospital in Indiana, clinicians noticed that the incidence of secondary upper-extremity deep vein thrombosis (DVT) at their facility seemed to be on the rise. As Lancaster and colleagues report in the May Emergency, this was alarming: upper-extremity DVT, once thought benign, is now known to be potentially dangerous, leading to complications such as symptomatic or asymptomatic pulmonary embolism, chronic venous insufficiency, and postthrombotic syndrome. Secondary upper-extremity DVT, which accounts for a majority of cases, can be linked to an identifiable risk factor. Patients may present with pain, swelling, and bruising in the area of the thrombosis—but many patients show no symptoms. So it’s essential that nurses know which patients are at risk and how to minimize that risk.

The Indiana clinicians reviewed the literature to deepen their understanding. They also tracked all patients who underwent ultrasonography at their facility and conducted retrospective chart reviews, gathering data for a full year. Several new risk factors were identified, including

  • the use of the large veins at the antecubital fossa for peripheral IV access;
  • the use of harsh medications administered via peripheral IV; and
  • certain peripherally-inserted central catheter (PICC) flushing and care practices.

What they learned prompted several changes to nursing care, and the incidence of secondary upper-extremity DVT at this facility has since declined. To learn more about this quality improvement project and the changes that were implemented, read […]

2016-11-21T13:17:55-05:00April 30th, 2010|nursing perspective, nursing research|0 Comments
Read More

Emergency—Bleeding Esophageal Varices: What Nurses Need to Know

By Sylvia Foley, AJN senior editor

This month’s  CE feature opens with a patient with alcoholic cirrhosis who suddenly vomits large amounts of blood. She’s experiencing variceal hemorrhage from esophageal varices, an often deadly complication of alcoholic liver disease, as author Melissa M. Smith explains. Esophageal varices occur in roughly half of all people with alcoholic cirrhosis; about one-third of these will experience variceal hemorrhage.

Smith describes the etiology of esophageal varices, then discusses the risk factors for variceal hemorrhage, noting that risk for initial hemorrhage increases with:

  • larger variceal size
  • presence of red spots or wales on the varices
  • more severe portal hypertension
  • more severe cirrhosis, with or without ascites

And the above factors as well as the following increase risk for recurrent hemorrhage:

  • severity of initial bleed
  • age over 60 years
  • bacterial infection
  • renal failure
  • active alcoholism

Smith discusses emergent treatment and outlines further treatment options, which include endoscopic variceal ligation, endoscopic injection sclerotherapy, balloon tamponade, and transjugular intrahepatic portosystemic shunt (TIPS) placement. The patient case vividly illustrates what can happen when bleeds recur.

Have you cared for patients with variceal hemorrhage? We invite you to share your experiences with us in the comments.

Bookmark and Share

2016-11-21T13:19:42-05:00February 1st, 2010|nursing perspective|2 Comments
Read More

Trauma in Pregnancy: An Expert’s Calm Look at What Nurses Need to Know

PregnantTrauma.

By Sylvia Foley, AJN senior editor

In this month’s CE feature on Trauma in Pregnancy, author Laura M. Criddle takes a calm look at a distressing subject. After outlining possible mechanisms of injury, Criddle reminds readers that “trauma care priorities don’t change when the patient is pregnant.” Initial interventions will still focus on the “ABCs”—airway, breathing, and circulation. She also points out that the fetus’s best chance for survival is “vigorous resuscitation of the mother,” since most fetuses will not survive maternal death.

However, the normal changes of pregnancy can affect both the nature of injury and the body’s responses; this has important implications for nursing care. Among Criddle’s key points:

  • Compression and displacement of various organs occur as pregnancy advances. This makes some injuries more likely, others harder to detect.
  • The normal changes of pregnancy can mask the signs of decompensation.
  • Pregnancy and its changes can also make complications after injury more likely.

Criddle provides several examples for each point. She also offers strategies for assessment and interventions for both mother and fetus.

Have you cared for pregnant trauma patients? What was the experience like? Please tell us in the comments.

Bookmark and Share

2016-11-21T13:21:20-05:00November 3rd, 2009|nursing perspective|2 Comments
Read More

Comment ground rules

1. Please be respectful.
2. We moderate all comments.

Content disclaimer

Views expressed on the blog are solely those of the authors or persons quoted. They do not necessarily reflect AJN’s views or those of Wolters Kluwer Health/Lippincott Williams and Wilkins.
Go to Top