Update on Preeclampsia: What Nurses Need to Know

Illustration by Sara Jarret.

Preeclampsia is the most common hypertensive disorder of pregnancy, yet there is still much we don’t know about why it develops and how to prevent it. It can present in different ways, from hard-to-ignore symptoms such as constant headache or severe right upper quadrant pain, to no symptoms at all before elevated blood pressure or urine protein is detected at a routine prenatal visit.

Did you know that:

  • despite a long list of known risk factors, most cases of preeclampsia are diagnosed in healthy nulliparous women?
  • both moms diagnosed with preeclampsia and infants exposed to it in utero are at greater risk for cardiovascular disease?

Update your knowledge by reading “Preeclampsia:  Current Approaches to Nursing Management” in the November issue of AJN. This CE article provides a helpful clinical update, including the pathogenesis of preeclampsia, diagnostic criteria, screening tests on the horizon, 2017 recommendations for pharmacologic management, optimal timing of delivery, and nursing management.

2017-11-06T09:49:41+00:00 November 6th, 2017|Nursing, patient safety|0 Comments

Through Song, a Nurse’s Renewed Connection to An Ailing Mother

Illustration by Barbara Hranilovich for AJN.

Millions of Americans are now acting in some capacity as caregivers for an ailing parent. This month’s Reflections column is by a nurse who describes a moment in time as she helps to care for her home-bound and dying mother. Her mother remains, on occasion, as judgmental and offputting as the mother of her childhood.

But in such cases, there’s little to gain by dwelling on old disappointments and hurts—and in this instance, there are good memories as well.

The common language of song.

These good memories are primarily associated with her mother’s love of and talent for singing. “Moon River and Mom” describes this nurse’s experience of tending her mother’s leg wound as the Meals on Wheels man visits, and what happens afterward when the author prompts her mother to sing. […]

2017-11-03T07:50:46+00:00 November 3rd, 2017|family experience, Nursing, nursing stories|0 Comments

Despite Outreach Cuts, Open Enrollment for the ACA Underway

Open enrollment for insurance through the Affordable Care Act (ACA) starts tomorrow, and ends December 15, allowing people half the time to enroll compared with previous years. There is much confusion and misinformation surrounding the ACA, particularly after recent executive orders by President Donald Trump to stop cost-sharing reduction (CSR) payments.

In addition, budgets for ACA advertising and outreach have been slashed by the Trump administration this year, which will inevitably lead to fewer people getting covered.

Bridging the ACA outreach gap.

To help bridge the gap left by the reduction in outreach, advocacy groups such as Get America Covered are reaching out to inform the public about enrollment. And nursing groups such as the American Nurses Association have stated their commitment to informing patients on how and when they can enroll. Below is some information for patients who might be confused about the law and how it currently stands. […]

2017-10-31T11:36:37+00:00 October 31st, 2017|health care policy, Patients, Public health|0 Comments

AJN in November: Preeclampsia Management, Health Conditions Associated with Military Service, More

The November issue of AJN is now live. Here are some articles we’d like to bring to your attention.

CE: Preeclampsia: Current Approaches to Nursing Management

A clinical review of current practice related to preeclampsia risk assessment, prediction, and management, plus updated diagnostic criteria from the American College of Obstetricians and Gynecologists Task Force on Hypertension in Pregnancy.

CE: Original Research: Primary Care Providers and Screening for Military Service and PTSD

Evidence shows that veterans who receive their health care from private sector employers are less likely to be screened for military service—and therefore may not be treated for service-related health conditions. Here, the authors explore whether rural Pennsylvania providers offer this screening to their patients.

Creating a Fair and Just Culture in Schools of Nursing

What strategies can nursing schools use to create a fair and just culture? The second part in a two-part series.

Perspectives on Palliative Nursing: Liberty and Justice for All 

When an unauthorized immigrant suffers a brain injury, who decides when treatment is withdrawn? An ethical dilemma touches on issues of clinician autonomy and justice versus patient and family autonomy.

There’s much more in our November issue, including:

  • Teaching for Practice column on promoting nursing students’ ethical development
  • An AJN Reports on recent legislation to […]
2017-10-30T09:25:26+00:00 October 30th, 2017|Nursing|0 Comments

Sepsis Perfusion Assessment: A Matter of Seeing and Touching

A heightened level of care.

Sepsis is estimated to strike up to 3.1 million people in the United States each year, and in 2014 resulted in over 182,000 deaths. Patients who develop sepsis are subjected to an onslaught of procedures and interventions, from cardiac monitoring and transfer to the ICU to frequent blood sampling and insertion of central lines and urinary catheters. It is a frightening experience and requires attention to the patient’s experience and interventions to mitigate stress.

According to a clinical feature article in our October issue, “Assessing Patients During Septic Shock Resuscitation,” the revised six-hour bundle from the Surviving Sepsis Campaign includes a recommendation that, after initial fluid resuscitation, patients’ perfusion and volume status should be reassessed.

Noninvasive bedside indicators of perfusion and volume status.

click image to expand

This article focuses on measuring capillary refill time (CRT) and the skin mottling score (SMS; see figure at right) and details the evidence underlying the correct way to perform these assessments and how to incorporate findings into the overall plan of care.

One of the key advantages of these two measurements is that they are noninvasive and require no equipment—just the eyes and touch of an astute nurse—yet they are highly valuable in the overall indication of whether resuscitation […]

2017-10-27T10:05:47+00:00 October 27th, 2017|Nursing|0 Comments