This edition is dedicated to alert and educate critical care nurses on diverse challenges that develop from hematologic conditions and to offer pertinent aspects of care. Every article proposes best practice and aims to improve patient outcomes.
The first article delivers key points on hypertensive crisis management in the acute care setting associated with intracranial hemorrhage (ICH), thus leading to stroke and death if not immediately treated with appropriate measures. Bedside nurses are uniquely positioned to improve systolic blood pressure control in patients with ICH by being aware of the efficacy and safety of potential agents, including key monitoring parameters and dose titrations. Specialized knowledge related to the use of these agents is critical to promote the safe and effective use of antihypertensive agents in ICH.
The second article is a sequel to the first one. Here, the authors focus on the management of chronic hypertension following intracerebral hemorrhagic insult. This review provides nurses with a summary on long-term blood pressure management to minimize the risk of secondary ICH and ischemic stroke. It focuses on oral antihypertensive medications that may be utilized to manage chronic hypertension immediately after the post-acute phase of care to lower blood pressure and to improve long-term outcomes.
Uncontrolled blood loss is a major cause of preventable death worldwide. Many valuable practices have been instituted in the medical field through lessons learned from the battlefield. The author of this article is a retired Army Major who was with the first 5-man surgical team to enter Afghanistan in the fall of 2001, as well as one of the first medical teams to enter Iraq in 2003, and has cared for more than 1000 combat casualties. His commentary covers the current hemostatic agents that have been applied on the battlefield for decades and now are starting to appear in hospitals with the goal of better patient survival rates, no matter the type of bleed.
Will prehospital blood draws impact the time of care delivery in the emergency department (ED) and expedite the diagnosis of an acute myocardial infarction and treatment? This pilot study retrospectively investigated the impact of having cardiac biomarkers drawn in the prehospital setting compared with being drawn in the ED. The research was a collaborative interprofessional effort.
Receiving a blood transfusion is a reality for many critically ill patients. Utilization of blood and blood products is pervasive to surgery and is "understood" as part of the preprocedural process for most elective and emergent procedures. The author examines factors that review cost, quality, and outcome considerations. Multiple strategies that have a high level of evidence regarding utilization, cost containment, and decreased mortality are presented.
Institution of evidence-based practice to reduce perioperative and postoperative blood transfusions in cardiac surgery patients are discussed in this article. The author, a former acute care nurse in a cardiac surgical intensive care unit (CSICU), shares original research that brought heightened blood conservation awareness to the CSICU team and clinical leadership. Through her project interventions were instituted that improved screening processes, utilized an anemia order set, and activated blood conservation protocols.
When patients can receive alternative treatments instead of a blood transfusion, they have a reduced risk of being subjected to blood-borne diseases and to human error that can occur during blood processing. A combination of interventions is explored in this edition that focuses on minimizing blood loss and building the patient's own blood supply. Appropriate management and strategies that provide an understanding of ethical and legal issues, including care for Jehovah's Witnesses, are presented because the nurse plays a vital role in educating the patient and the caregiver regarding risks, benefits, and alternatives.
Diagnosis and treatment of some blood disorders prove to be complicated. Porphyria, a rare and often devastating disease, is one of those. The variety of symptoms ranges from mild to severe and can affect internal organs, the brain, and the skin or present itself with a combination of symptoms. This can lead to misdiagnosis and inappropriate treatment, putting the patient at risk. There are many forms of porphyria, one exhibiting serious photosensitivity, also known as Vampire's disease. Attacks can be triggered through sunlight and contact with diverse substances, including medications. Etiology, clinical presentation, and medical management are introduced.
Since the 1970s newborns are screened for sickle cell disease (SCD) and sickle cell trait (SCT) in the United States; yet, to this day, studies report that only 16% of Americans with SCT know their status, which reveals a huge knowledge deficit. This extremely distressing and expensive disease continues to afflict 1 in 365 children. Despite these striking statistics, there appears to be no standardized method for reporting positive SCT results of newborn screening to doctors or families of affected persons. Primary prevention of SCD is a public health focus that can be championed by registered nurses who have the tools and experiences to effectively handle case management and patient education. The author's initiative stems from her personal experience. Deeply distressed over this condition, its implications, and the gaps in knowledge, the author of this featured article is sending an appeal to nursing for help.
Blood loss in the newborn infant can occur prenatally, intrapartally, and during the neonatal period. In this article, the author, a neonatal authority, discusses the many common risks and treatments, whereby bringing awareness on how to recognize those problems and how to act appropriately in those situations.
Recent trends show that parents are electing not to have their children immunized from day 1, while still in the hospital. This can lead to many serious complications, including bleeding disorders and death. With an abundance of information and misinformation available about immunizations, the nurse needs to guide the parents through this process and help parents make an educated decision that will benefit their children, instead of putting them at risk. This article proposes strategies to better facilitate parental knowledge.
Pivotal to the success of an organization is the engagement of the provider staff, particularly physicians. The importance of collaboration within the healthcare team when instituting quality improvement measures is essential. Interestingly, there is a void on providing the necessary education, skills or tools to promote front line physician involvement. This article discusses the experience and key themes in the journey towards physician engagement of a teaching hospital to successfully integrate their expertise into committee work and practice changes that were priorities for the organization.
The vanguard of health care consists of research, evidence-based practice, prevention, patient education, the delivery of quality care, practicing with a cost-conscious mind, and being able to offer suitable alternatives. Treatment should be patient-centered and personalized. As nurses, we have an obligation to meet those needs, and as issue editor, I hope to have provided the reader with an informative collection of topics that will enhance their practice.
-Kerstin Hudgins, MSN, RN, CCRN, CEN
Issue Editor