Tag Archives: Nursing Assessment

Hourly rounding/hourly physiologic monitoring by nurses

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This collection contains 51 articles on hourly rounding/hourly physiologic monitoring of acute care patients by nurses. It does not include articles that were specific to inpatient rehab, inpatient psychiatric patients, and epilepsy monitoring units. Many of the articles are meta-analyses or systematic reviews.

Here is one search technique that was used to find articles in PubMed: (“rounds hourly” OR “round hourly” OR “rounded hourly” OR “rounding hourly” OR “hourly rounding” OR “hourly rounds” OR “hourly physiologic” OR “physiologic monitoring hourly” OR ((“monitor hourly” OR “monitors hourly”) AND (“vital signs” OR physiologic))) AND (nurse OR nurses OR nursing)

To access the collection and to read abstracts and access full text (where available) using the Find it @ Emory button, please first open Emory’s instance of PubMed. Once you have accessed PubMed, copy/paste the following url into the same browser window: https://www.ncbi.nlm.nih.gov/sites/myncbi/1HMKnKhQm_d5i/collections/55355546/public/
If are an Emory Healthcare employee and do not have access to an article you need, send the citation(s) to Ask a Librarian.

Criteria for unavoidable pressure ulcers

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Seven articles were found that provide information on criteria for unavoidable pressure ulcers.

In order to be able to use the Find it @ Emory button within article entries to look at the full text, please use these instructions to access the collection.
1. Go to the Woodruff Health Sciences Center Library’s homepage at http://health.library.emory.edu/
2. Click on “PubMed.”
3. Copy and paste the url into the address bar of your browser: https://www.ncbi.nlm.nih.gov/myncbi/collections/54337732/?reload=updatePermissionSuccess

Vasopressor agents and development of pressure ulcers

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Five articles were found that provide evidence on patients’ usage of vasopressor agents and subsequent development of pressure ulcers.

In order to be able to use the Find it @ Emory button within article entries to look at the full text, please use these instructions to access the collection.
Go to the Woodruff Health Sciences Center Library’s homepage at http://health.library.emory.edu/
Click on “PubMed.”
Copy and paste the url into the address bar of your browser: https://www.ncbi.nlm.nih.gov/sites/myncbi/1HMKnKhQm_d5i/collections/54337604/public/

Post-falls assessment tools to help in post-fall decision making in acute care settings

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Joanna Briggs Institute (JBI) has a recommended practice entitled “Observation Following Falls in Acute Care: Older People” that is available via login with your Emory Healthcare login; search for the document by title in JBI, click “Display Results,” and then click “JBI Database PDF”: http://pid.emory.edu/h78zp

There are a variety of relevant post-falls assessment tools online:
1. Royal Devon Exeter National Health Service Foundation Trust pdf: https://tinyurl.com/yansp8t4
2. Intermountain Healthcare pdf: https://tinyurl.com/ydgxar6n
3. A Veterans Affairs Word document: https://tinyurl.com/ybvfoq2z
4. Ohio State University Medical Center pdf: https://tinyurl.com/y6usjgk8
5. South Western Ambulance Service National Health Service pdf: https://tinyurl.com/y8xqoxod

Please follow these instructions to access 8 relevant articles in PubMed.

a. Go to the Woodruff Health Sciences Center Library homepage (http://health.library.emory.edu)
b. Click on PubMed.
c. Then copy and paste this link into your browser address bar: https://www.ncbi.nlm.nih.gov/sites/myncbi/1HMKnKhQm_d5i/collections/52782984/public/
d. The references will appear in  PubMed. Click on a reference, and you will see a Find it at Emory to the right of it which will provide availability for full text. If you are not able to access full text, you may submit citation(s) to Ask a Librarian. Library staff will get article(s) for you and email them to you.

For inpatients and outpatients, how frequently is Vitamin D screening conducted and how frequently is it done on request versus routinely?

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Bottom line:  Apart from special populations with known risk for Vitamin D deficiency, there is no evidence regarding practices of Vitamin D screening in general inpatient or outpatient populations.

PubMed search:   vitamin d AND “mass screening”[mesh] AND routine*
This search includes 2 papers published in American Family Physician in 2013.  They present opposing viewpoints on routine screening.  It is probably worth looking at those papers, especially the reference lists.
No papers reported on provider practices regarding Vitamin D screening.

A broader PubMed search of vitamin D and “mass screening”[mesh] seems to address screening in special populations, such as pregnant women, the elderly, and individuals with diabetes.

Web of Science:  Similar results to the PubMed search were found. A recent review presents evidence on Vitamin D screening.

Kulie, Teresa, et al. “Vitamin D: an evidence-based review.” Journal of the American Board of Family Medicine 22.6 (2009):698-706. (cited 33 times)
The last sentence of abstract reads: Unfortunately, little evidence guides clinicians on when to screen for vitamin D deficiency or effective treatment options.

You might be able to use the National Ambulatory Medical Care Survey to determine an estimation of how many patient visits included vitamin D tests, but you wouldn’t be able to tell if they were routine.  There is also a National Hospital Care Survey that might provide similar data; again you wouldn’t be able to tell if they were ordered as a routine or in response to clinical findings or patient history.  If you are interested, we can investigate that further.

Measuring blood pressure (BP) on arm; nursing interventions to facilitate BP control

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Measuring blood pressure (BP) on the arm:

1) DynaMed Plus is a evidenced-based medicine tool that provides bulleted summaries on given topics. Take a look at their blood pressure measurement and monitoring pages, in particular the Manual BP Measurement section for evidence based recommendations and links to the referenced studies. There is also a section on Guidelines and Resources which provides links to the  American Heart Association recommendations which are summarized here: Am Fam Physician 2005 Oct 1;72(7):1391

Nursing interventions in ambulatory settings to facilitate patient’s BP control

2) A few articles may be found in PubMed on nurse-led care for controlling blood pressure may be found using searches: a) blood pressure AND intervention AND nurse AND ambulatory and b) “Blood Pressure Monitoring, Ambulatory”[Mesh] and “Nurses”[Mesh]

Please see below for some helpful citations.

Cheng, Mei, et al. “The effect of continuous nursing intervention guided by chronotherapeutics on ambulatory blood pressure of older hypertensive patients in the community.” Journal of clinical nursing 23.15-16 (2014):2247-54.

Bosworth, Hayden B, et al. “Home blood pressure management and improved blood pressure control: results from a randomized controlled trial.” Archives of internal medicine 171.13 (2011):1173-80.

Ulm, Kurt, et al. “Effect of an intensive nurse-managed medical care programme on ambulatory blood pressure in hypertensive patients.” Archives of cardiovascular diseases 103.3 (2010):142-9.

Bosworth, Hayden B, et al. “Hypertension Intervention Nurse Telemedicine Study (HINTS): testing a multifactorial tailored behavioral/educational and a medication management intervention for blood pressure control.” The American heart journal 153.6 (2007):918-24.

 

What is the evidence of the effects of electrolyte imbalances and fluid resuscitation on outcomes for patients undergoing surgery? Of particular interest is the population of cardiac surgery patients.

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ELECTROLYTE IMBALANCES

A review of evidence in DynaMed identified the following:

Hyponatremia, Prognosis Section Large cohort study (N=950,000+ patients having major surgery).  Patients with preoperative hyponatremia had statistically significantly higher rates of 30-day all-cause mortality,perioperative major coronary events,wound infections, and pneumonia as compared to patients with normal sodium levels.  Arch Intern Med 2012 Oct 22;172(19):1474,

Hypokalemia, Complications Section.  A large prospective cohort study of patients undergoing elective coronary artery bypass grafting showed that patients with hypokalemia may have increased odds of having a perioperative arrhythmia and need for CPR.  JAMA 1999 Jun 16;281(23):2203

A PubMed search (“hypocalcemia”[mesh] OR “hypercalcemia”[mesh] OR “hyperkalemia”[mesh] OR “hypokalemia”[mesh] OR “hypophosphatemia”[mesh] OR “hyperphosphatemia”[mesh]) AND (“Surgical Procedures, Operative”[Mesh]) AND (case-control OR cohort study OR retrospective) identified several additional studies which are available in this MyNCBI Collection.

FLUID RESUSCITATION

Consult the book “Clinical Fluid Therapy in the Perioperative Setting”, 2011.  It is available in the EUH Library and cites evidence for fluid therapy in various settings.

In PubMed, this search will include reports of clinical trials that address fluid therapy in perioperative care of cardiac surgery patients:

(“Isotonic Solutions”[Mesh] OR “Fluid Therapy”[Mesh] OR “Ringer’s solution, potassium-free” [Supplementary Concept] OR “Ringer’s lactate” [Supplementary Concept] OR “bicarbonated Ringer’s solution” [Supplementary Concept] OR “Ringer’s solution” [Supplementary Concept] OR “crystalloid solutions” [Supplementary Concept] OR “Plasmalyte A” [Supplementary Concept] OR “Plasmalyte R” [Supplementary Concept] OR hetastarch) AND “Perioperative Care”[Mesh] AND ( “Thoracic Surgery”[Mesh] OR “Cardiac Surgical Procedures”[Mesh] ) Limits: Clinical Trials, Meta-analysis, Systematic Review