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Donna Jarzyna MS RN-BC CNS-BC Carla R. Jungquist PhD RN-C FNP Chris Pasero MS RN-BC FAAN Joyce S. Willens PhD RN BC Allison Nisbet MSN RN CPHON AOCNS CNS-BC Linda Oakes MSN RN-BC CCNS Susan J. Dempsey MN RN-BC CNS Diane Santangelo MS RN ANP-C Rosemary C. Polomano PhD RN FAAN 《Pain Management Nursing》2011,12(3):118-145
As the complexity of analgesic therapies increases, priorities of care must be established to balance aggressive pain management with measures to prevent or minimize adverse events and to ensure high quality and safe care. Opioid analgesia remains the primary pharmacologic intervention for managing pain in hospitalized patients. Unintended advancing sedation and respiratory depression are two of the most serious opioid-related adverse events. Multiple factors, including opioid dosage, route of administration, duration of therapy, patient-specific factors, and desired goals of therapy, can influence the occurrence of these adverse events. Furthermore, there is an urgent need to educate all members of the health care team about the dangers and potential attributes of administration of sedating medications concomitant with opioid analgesia and the importance of initiating rational multimodal analgesic plans to help avoid adverse events. Nurses play an important role in: 1) identifying patients at risk for unintended advancing sedation and respiratory depression from opioid therapy; 2) implementing plans of care to assess and monitor patients; and 3) intervening to prevent the worsening of adverse events. Despite the frequency of opioid-induced sedation, there are no universally accepted guidelines to direct effective and safe assessment and monitoring practices for patients receiving opioid analgesia. Moreover, there is a paucity of information and no consensus about the benefits of technology-supported monitoring, such as pulse oximetry (measuring oxygen saturation) and capnography (measuring end-tidal carbon dioxide), in hospitalized patients receiving opioids for pain therapy. To date, there have not been any randomized clinical trials to establish the value of technologic monitoring in preventing adverse respiratory events. Additionally, the use of technology-supported monitoring is costly, with far-reaching implications for hospital and nursing practices. As a result, there are considerable variations in screening for risk and monitoring practices. All of these factors prompted the American Society for Pain Management Nursing to approve the formation of an expert consensus panel to examine the scientific basis and state of practice for assessment and monitoring practices for adult hospitalized patients receiving opioid analgesics for pain control and to propose recommendations for patient care, education, and systems-level changes that promote quality care and patient safety. 相似文献
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Malissa A. Mulkey PhD APRN CCNS CCRN CNRN Sikandar Khan DO MS Anthony Perkins MS Sujuan Gao PhD Sophia Wang MD Noll Campbell PharmD MS Babar Khan MD MS 《Journal of the American Geriatrics Society》2023,71(6):1873-1880
Background
Studies suggest Angiotensin-Converting Enzyme inhibitors (ACEI) and Angiotensin Receptor Blockers (ARB) may slow the decline of memory function in individuals with mild to moderate Alzheimer's disease by regulating migroglial activation and oxidative stress within the brain's reticular activating system. Therefore, we evaluated the relationship between delirium prevalence and being prescribed ACEI and ARB in participants admitted to the intensive care units (ICU).Methods
A secondary analysis of data from two parallel pragmatic randomized controlled trials was performed. ACEI and ARB exposure was defined as being prescribed an ACEI or an ARB within six months prior to the ICU admission. The primary endpoint was the first positive delirium assessment based on Confusion Assessment Method for the ICU (CAM-ICU) for up to thirty days.Results
A total of 4791 patients admitted to the medical, surgical, and progressive ICU and screened for eligibility for the parent studies between February 2009 and January 2015 from two level 1 trauma and one safety net hospital in a large urban academic health system were included. Delirium rates in the ICU were not significantly different among participants with no exposure to ACEI/ARB (12.6%), or exposure to ACEI (14.4%), ARB (11.8%), or ACEI and ARB in combination (15.4%) in six months prior to the ICU admission. Exposure to ACEI (OR = 0.97[0.77, 1.22]), ARB (OR = 0.70 [0.47, 1.05]), or both (OR = 0.97 [0.33, 2.89]) in six months prior to ICU admission was not significantly associated with odds of delirium during the ICU admission after adjusting for age, gender, race, co-morbidities, and insurance status.Conclusions
While the impact of ACEI and ARB exposure prior to the ICU admission was not associated with the prevalence of delirium in this study, further research is needed to fully understand the impact of antihypertensive medications on delirium. 相似文献24.
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Carol Turnage Carrier MSN RN CNS Marlene Walden PhD RNC NNP CCNS 《Newborn and Infant Nursing Reviews》2001,1(2)
Consistent quality pain management for neonates and infants necessitates development of hospital guidelines that define the minimum acceptable practice. Standards and research literature form the foundation for teams charged with developing unit guidelines that are evidence-based and meet accreditation requirements. Nursing is in a unique position to lead a multidisciplinary team in drafting a collaborative pain management guideline that incorporates both quality and clinical usefulness. It is a first step toward continuing performance improvement in neonatal and infant pain management. Copyright © 2001 by W.B. Saunders Company 相似文献
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Marla J. De Jong Joseph SchmelzKaren Evers MS RN Patricia BradshawKathleen McKnight PhD Elizabeth Bridges PhD RN CCNS FCCM FAAN 《Heart & lung : the journal of critical care》2011,40(1):31