Critical Care Nursing Commons^™

Association Of Lung Cancer With Pneumonia And Chlamydia Pneumoniae Infection, Johnny Zakhour Md, Daniel Muller, Alex Glynn, Jose Bordon

The University of Louisville Journal of Respiratory Infections

Introduction: The degree of association and type of causal versus non-causal relationship between pneumonia and lung cancer (LC) are evolving discussions. We reviewed English publications on the degree of association between pneumonia and subsequent LC.

Methods: We searched the PubMed database using key words for pneumonia, LC, and chlamydia infection. We selected peer-reviewed studies of patients with pneumonia and LC. Case reports and other literature reviews were excluded from this review.

Results: Five studies examined the incidence and/or risk of LC for a total of 415,750 patients, and four studies examined cases with Chlamydia pneumoniae chronic infection at the time …

Pulmonary Inflammation And Injury Triggered By Spine Surgery In Recovered Covid-19 Patients Demand Consideration, Luciano Rodrigo Lopes, Silvana Kertzer Kasinski

The University of Louisville Journal of Respiratory Infections

No abstract provided.

Why Should People Use Face Masks In The Time Of Covid? The Jri Position, Jose Bordon, Alex Glynn, Forest W. Arnold

The University of Louisville Journal of Respiratory Infections

No abstract provided.

Preventing Ocular Surface Disease In The Pediatric Intensive Care Unit, Emily Mallette

Dissertations

Preventing Ocular Surface Disease in the Pediatric Intensive Care Unit

Problem: Ocular surface disease in the Pediatric Intensive Care Unit is a significant problem in intubated patients due to altered eye protective mechanics, leading to exposure of the eye surface and dry eye. The purpose of this quality improvement project was to evaluate how an eye care protocol affected the frequency of artificial tear ointment administration.

Method: A descriptive, cohort design utilizing a retrospective chart review with convenience sampling of intubated children in the PICU from two cohorts was used. Comparisons were made between the preintervention cohort in 2020 and …

Implementation Of A Postdischarge Virtual Visit And Nurse Follow-Up Protocol To Decrease 30-Day Readmission Rates For Patients With Pulmonary Arterial Hypertension, Kimberly Thompson

The Eleanor Mann School of Nursing DNP Capstone Projects

Pulmonary arterial hypertension (PAH) is a rare, chronic disease with no cure. Patients with this disease have high mortality and morbidity, experience frequent hospitalizations, readmissions, and psychosocial burdens, and require a high degree of self-care management skills (Doyle-Cox et al., 2016; Lattimer et al., 2016; McDevitt & Walter, 2019). More than half of PAH patients are hospitalized within the first year following diagnosis, and about 20% are readmitted to the hospital within thirty days of discharge (Bhattacharya et al., 2019: Tonelli, 2020). These patients also have a high symptom burden, and these symptoms significantly affect their physical and mental quality …

Implementation Of Same Day Discharge Following Elective Percutaneous Coronary Intervention, Kaitlyn Miller Jeffcoat

The Eleanor Mann School of Nursing DNP Capstone Projects

High rates of Cardiovascular disease (CVD) and ischemic heart disease (IHD) have led to ever-increasing numbers of percutaneous coronary interventions (PCI) performed. The prevalence of IHD and subsequent PCI has been found to limit bed availability and access to cardiovascular care. Historically, the standard of care following elective PCI has included overnight observation (OO) though clinical advances to PCI procedures have made it possible for same day discharge (SDD) following elective PCI. There are many benefits of SDD following elective PCI that include increased access to cardiovascular care, hospital cost savings, and patient satisfaction without compromising patient safety. The DNP …

Implementation Of Telephone-Based Medication Adherence Conferences To Improve Health Outcomes Of Heart Failure Patients, Diana Marie Broadway

The Eleanor Mann School of Nursing DNP Capstone Projects

Cardiovascular disease (CVD) has been a significant health problem worldwide and is the leading cause of death globally. Heart failure (HF) is a chronic progressive form of CVD that affects millions of adults in the United States. The treatment for heart failure is very complex and requires an ongoing regimen of medications. In heart failure, many patients report nonadherence to their medication regimens, which leads to a magnitude of preventable deaths annually. With frequent medication nonadherence of the HF patients, there must be an intervention used to combat this problem. The use of telephone-based interventions (TBI) can modify nonadherent medication-taking …

Improving Door To Transfer Times For St Segment Elevation Myocardial Infarction In Small Emergency Departments: A Quality Performance Improvement Project, Amber Ryals

Doctoral Projects

Heart disease is a leading cause of death in the United States (Centers for Disease Control [CDC], 2020). ST-elevation myocardial infarctions are around 38% of all coronary syndrome patients that present to the emergency department (Akbar et al., 2020). Smaller, outlying facilities can be at a disadvantage due to the lack of readily available specialties and services, such as a cardiac catheterization laboratory, which has the potential to cause a delay in inpatient care. With standardized cardiac protocols in place at many facilities, initial identification and treatment of myocardial infarctions are begun long before a patient enters a facility, often …

Nurse-Initiated Protocols For Chest Pain In The Emergency Department, Matthew Hodges

Student Scholarly Projects

Practice Problem: Emergency department crowding inhibits the ability to provide safe patient care to chest pain patients and negatively impact patient outcomes. A Veteran Affairs emergency department has identified a similar concern and implemented a nurse-initiated protocol to decrease the length of stay and improve patient outcomes.

PICOT: This evidence-based practice (EBP) project was guided by the following PICOT question: In the emergency department (ED), how does a nurse-initiated protocol (NIP) for chest pain (CP) patients compared to no protocol use influence length of stay (LOS) in the ED over 8 weeks?

Evidence: The reviewed literature supported the evidence of …

Reducing The Incidence Of Pressure Injuries In Adult Icu Patients At Mcallen Medical Center With The Implementation Of A Pressure Injury Preventive Bundle: A Quality Improvement Project, Cheryl Cruz

Student Scholarly Projects

Practice Problem: Pressure injuries (PIs) are a significant healthcare problem globally. Adult patients in the intensive care setting are especially vulnerable to the development of PIs given the acuity of their diagnoses requiring extensive treatments, procedures and the use of multiple medical devices.

PICOT: The PICOT question that guided this project was, “In adult intensive care unit (ICU) patients, how does the effect of implementing a pressure injury prevention bundle compare in patients who received the bundle, and patients receiving standard pressure injury prevention in reducing the incidence of pressure injuries after two months?”

Evidence: Evidence exist that bundle implementation …

Sepsis Pathophysiology, Samantha Kingsley

Nursing Student Class Projects (Formerly MSN)

Sepsis is one of the most common diagnoses in medical intensive care units (MICUs) worldwide. Sepsis is a medical emergency where prompt intervention is vital to promoting positive patient outcomes. Septic shock develops when sepsis has progressed to the point of persistent hypotension despite appropriate fluid resuscitation. It is important to recognize the early signs of sepsis and intervene to prevent further progression. As the understanding of the pathophysiology has developed further over the years, the treatments and outcomes associated with sepsis have also improved. However, prompt recognition and intervention have always been at the forefront of management and should …

Acute Kidney Injury, Mary Boadu

Nursing Student Class Projects (Formerly MSN)

This poster presents up to date information regarding acute kidney injury (AKI) which often presents in patients in the intensive care unit (ICU). Most patients may not have identifiable symptoms therefore, advanced practice clinicians are charged with a great responsibility to diagnose, treat and follow-up with such patients. It is pertinent that clinicians recognize AKI early in an effort to prevent adverse consequences as seen in the progression of AKI to chronic kidney disease (CKD).

Chronic Thromboembolic Pulmonary Hypertension, Alyssa Curry

Nursing Student Class Projects (Formerly MSN)

Chronic pulmonary hypertension (CTEPH) is a rare and underdiagnosed complication of unresolved acute pulmonary embolism (PE). A chronic fibrotic thrombus replaces the unresolved emboli in the pulmonary vascular bed causing pre-capillary pulmonary hypertension (Mahmud et al., 2018). Symptoms rang from mild nonspecific such as exercise intolerance and dyspnea. As the disease progresses, symptoms present similarly to right ventricular heart failure (Gopalan et al., 2016). Although the pathophysiology and etiology of CTEPH is still not fully understood, risk factors include increased size of the PE, right ventricular strain, chronic inflammation, and defects in fibrinolysis among others (Fernandes et al., 2016). Treatment …

Molecular Genetic Cancer Screening: Role Of Prediction Of Colorectal Disease In The Clinic Setting, Samantha Spinks

DNP Research Projects

Colorectal Cancer is the third most common cancer in men and women and the second leading cause of cancer related deaths (ACS, 2019). Colonoscopy screening can prevent colon cancer by early detection and removal of adenomatous colon polyps. The ACS has been lowered from age 50 to 45 due to an increase in the prevalence of colon cancer in people below the age of 50 years of age. Molecular genetic screening is a tool that providers can use to identify patients who are at risk for premature adenomas. People who have a genetic variant are more likely to develop adenomas …

The Observational Investigation Of Vitamin D And The Effect On Hypertension (Oiveh) Study, Warren Burke

DNP Research Projects

Background

It is uncertain if vitamin D supplementation improves cardiovascular health, more specifically, the systolic and diastolic blood pressures, and the data from previous trials investigating supplementation and the effects on the blood pressure are limited.

Methods

The following scholarly project was a retrospective observational study, examining randomly selected participants with chronic kidney disease and hypertension from a local nephrology practice. The Student’s t-test, Pearson’s r correlation, and ANOVA statistical tests were utilized to determine if vitamin D supplementation improved the systolic and diastolic blood pressures.

Results

A total of 260 participants were examined. The mean systolic blood pressure …

Age And Functional Outcomes Post-Neurologic Insult In Patients Attending Inpatient Rehabilitation, Jonathan Bowman Spt, Elena Crooks Pt, Dpt, Phd, Doug Weeks Phd, Kimberly Honn Phd

2020 Symposium Posters

Introduction

Neurologic insults such as strokes and traumatic brain injuries (TBI) affect over 1 million Americans every year. The lack of current knowledge informing accurate prognoses causes victims and their loved ones distress, and is a focus of much research. The purpose of this study was to determine whether patient age at time of insult could predict change in functional outcomes during inpatient rehabilitation.

Methods

Subjects were patients of an inpatient rehabilitation facility (IRF) post-stroke or TBI. The Functional Independence Measure (FIM) assessed functional independence and cognitive status at admission and discharge from the IRF. The Montebello Rehabilitation Factor Score …

Evaluation Of A Concussion Management And Discharge Education Training Module For Emergency Department Nurses, Carmen Frede

DNP Projects

Purpose: The purpose of this project was to improve the Emergency Department (ED) nurses’ knowledge on identifying patients at risk for concussions and delivering effective concussion discharge education using an educational training intervention.

Methods: This project used a descriptive, non-randomized pre-post survey design. Participation involved three stages: a pre-education survey to assess baseline concussion education knowledge, an educational intervention consisting of a narrated PowerPoint presentation, and a post-education survey to evaluate knowledge on concussion discharge education. The intervention was delivered online via the UK Canvas educational platform.

Results: The majority of nursing staff participants were female (97%) and had a …

Don't Just Check The Box: Check Your Athlete's Heart: Adding A 12-Lead Ecg To Pre-Participation Screening To Identify High Risk Of Sudden Cardiac Arrest In Male High School Athletes, Shannon King

DNP Projects

PURPOSE: Sudden cardiac arrest (SCA) continues to be the leading cause of death in male high school athletes participating in competitive sports. There is gap in the current preventative screening practice of history and physical alone. The purpose of this project is to evaluate adding a 12-lead electrocardiogram (ECG) to pre-participation screening captures cardiac abnormalities that identify male athletes at a higher risk for developing SCA. METHODS: A descriptive secondary analysis design to determine the incidence of cardiac abnormalities detected with the addition of a 12-lead ECG during pre-participation screenings (annual sports physical) of high school-aged male athletes. The study …

Is It Fair To Compare? A Patient And Family Experience Of Two Healthcare Systems And Neurosurgical Teams Within A Two-Week Period, Laura Miller Cpxp

Patient Experience Journal

As the mother of a 28-year-old son with cerebral palsy and hydrocephalus, and as a healthcare consultant focused on patient experience and professional development, I have a unique perspective and skill set. Recently he experienced symptoms that included an excruciating headache, neck pain and lethargy. Fearing his ventriculoperitoneal shunt had malfunctioned, he went to the emergency room and was later admitted on the neuro inpatient floor for a three-day hospitalization. His original shunt had been placed in 1991, and he never had an issue with until August 2018. While in the hospital, he was informed that he was no longer …

Transient Dynamics Of Infection Transmission In An Intensive Care Unit, Christopher Short, Matthew S. Mietchen, Eric T. Lofgren

Annual Symposium on Biomathematics and Ecology Education and Research

No abstract provided.

Safe To Sleep In The Icn, Megan Kelly, Alexandra (Lexi) Van Noy, Molly Kruse, Megan English, Hannah Culbertson, Brianne Truitt, Ziryan Salihparkhy, Jenny Mckee, Brecklyn Findley

Posters

The CDC states that 1,545 infants passed away from SIDS in 2014. Safe sleep includes supine, in a crib, head of bed flat, firm sleep surface, tightly fitted sheet, no loose blankets, no toys or supplies in crib with infant. It is important for nurses to model safe sleep practices in the hospital setting. Current compliance with safe sleep in the Intensive Care Nursery is 50%.

AIM Statement:

By August 1, 2019 we want to increase the compliance of modeling safe sleep behaviors for patients who qualify for safe sleep from 50% to 90% in the Intensive Care Nursery.

Improving Care Of The Small Baby, Beckie Palmer, Abdebayo Oshodi, Brandy Huitt, Kaylee Hurt, Pamela Kliethermes, Trudy Koons, Patricia Lanzer, Ashley Mirabile, Allyson Owen, Christian Anthony Schneider, Betsi Anderson, Steven Olsen

Posters

Hierarchy of Aims:

• Global Aim: Create a Small Baby Unit for infants admitted to our NICU that arebirth, in which 90% of our patients are admitted to F pod on day of admission, by March 2019
• Interim Aim: Staff 80% of our micropremie patients with a Small Baby Team nurse from admission until >32 weeks by May 2019.
• Sub Aim: Increase rates of developmentally appropriate care (2 person cares, kangaroo care compliance) by 50% by August 2019.

Safe Sleep In The Nicu, Ashley Mirabile, Barb Haney, Dianne Wilderson, Beckie Palmer, Ashley Domsch, Eugenia K. Pallotto

Posters

Goal: To evaluate a staff education program on approach to improve in the rate of eligible NICU infants in safe sleep in a busy 84-bed level IV NICU.

Outcome Measures; Improve safe sleep compliance for eligible patients to 90% or greater by December 2019.

Process Measures: Audits from bedside RNs showing compliance with safe sleep.

Planned Intervention: In December of 2018 a multidisciplinary work group brainstormed and implemented best practice safe sleep education for staff and parents. September 2019 a Safe Sleep Educational Toolkit was made available for staff.

Results: Safe Sleep compliance has gone from 53% to 90% in …

Lighting The Way To Ensure Safe Transition Home, Barb Haney, Ashley Mirabile, Dianne Wilderson, Beckie Palmer, Ashley Lewis, Cris Mills, Eugenia K. Pallotto

Posters

All aspects of discharge (education, screenings, appointments, plans and home services" must be completed and appropriately communicated prior to discharge to ensure safe transition to home.

Goal: Standardize all aspects of discharge in a large, busy 84-bed Level IV NICU with >1000 admissions/year and >300 nurses, >60 NNPs, and >25 neonatologists.

• 95% of patients with lengths of stay >3 days have all discharge planning completed prior to discharge/Parent Care Unit overnight stay

Clabsi Prevention Through Prevention Huddles And Clabsi Risk Assessment And Prevention Form In Electronic Medical Record, Tara Benton, Barb Haney, Lacey Bergerhofer, Yolanda Ballam, Kaitlyn Hoch

Posters

Our aim is to increase the awareness of high risks for central line associated bloodstream infection (CLABSI) and decrease the CLABSI rate with the implementation of CLABSI prevention huddles and an electronic medical record (EMR) "CLABSI Risk Assessment and Prevention" form.

The Kanga-Croo: Nurse Resident Champions Creating Momentum For Improvement, Brett Butler, Jacob Burden, Carly Creekmore, Blair Griffin, Taylor Godemann, Taylor Hagen, Theresa Koelling, Mary Anne Kucera, Halle Magid, Makenna Miller, Monica Page, Mary Riffel, Madison Stebbins, Sarah Stokes, Skylar Suppes

Posters

Topic Summary:

Kangaroo Care (skin to skin care) is a parent-led, evidence-based intervention which improves outcomes in neonatal patients including: decreased apnea, increased weight gain, increased parent satisfaction and decreased length of stay.

Results:

Nurse resident team interventions to support parent engagement and remove barriers to Kangaroo Care (KC) through iterative PDSA cycles from January 2018 to July 2019 yielded positive results within a subset of ICN patients.

Who Codes In The Nicu: An Analysis Of Demographics And Factors That Place Neonates At Higher/Lower Risk Of A Serious Code Event And Prognosis Post-Code, Danielle N. Gonzales, Ashley K. Sherman, Jennifer Dremann, Staci Elliott, Amelia Gute, Amber Bellinghausen, Jessica Brunkhorst, Danielle Reed

Posters

This study analyzed resuscitation events in a level IV neonatal intensive care unit from 2012-2017 to determine whether there are identifiable differences between those who have a rapid response event and those with a short or long code and determine factors post-event that may impact survival to discharge.

Minimizing Unplanned Extubations In The Intensive Care Nursery, Lindsay Barrosse, Blaire Collins, Cassidy Horton, Jodie Seitzer, Brittney Hunter, Jenny Mckee

Nurse Presentations

Describes a project to ensure compliance with a standardized process for endotracheal tube management in the intensive care nursery in order to reduce the number of unplanned extubations and their consequent adverse effects.

Sepsis: Triage Triggers, Outcomes Quicker, Rylee Ainge, Mackenzie Flaws, Natalie Heim, Emily Herndon, Hayley Norris, Amy L. Scott

Posters

No abstract provided.

Incidence And Predictor Variables Of Pressure Injuries In Patients Undergoing Ventricular Assist Device And Total Artificial Heart Surgeries: An Eight-Year Retrospective Review, Christopher T. Brindle

Theses and Dissertations

BACKGROUND

Cardiac surgery patients have some of the highest reported incidence and prevalence of pressure injuries (PI). A growing subset of cardiac surgery include patients with end-stage heart failure who undergo ventricular assist device (VAD) or total artificial heart (TAH) surgery. The risk of PI and their natural history of development in this population are unknown and the specific risk factors for PI development remain unexplored.

OBJECTIVES

To perform a systematic review of the literature to identify the incidence and risk factors of PI development in patients undergoing VAD-TAH surgery and thereby inform study design and variables in an eight-year …