Abstract There has been extensive documentation on hospital-acquired infections, and of these, catheter-associated urinary tract infections are the most common. In fact, catheter-related infections account for up to 40% of nosocomial infections. Among those with nosocomial urinary tract infections, 10-20% of patients had genitourinary or urological manipulation, while 80% had placement of a permanent urethral catheter. Despite the significant contribution of urethral catheterization, many patients are inserted with a urinary catheter upon admission to the emergency department without proper justification. The author of the paper suggests a protocol that is evidence-based and that provides evidence that supports the proper identification of patients who must undergo catheterization and limits this to those patients only.
Outline:
Introduction
Define the Problem
Critique Research: Review of Related Literature
Evidence-based Practice Plan
Bibliography
From the Paper "Unlike the intact genitourinary system, indwelling catheters have no innate defense mechanism; hence, biofilm formation occurs. Biofilms consist of microorganisms that adhere together, along with host urinary components such as proteins, electrolytes, and other organic molecules (Trautnere and Daraouiche, 2004). More bacteria attach to this material and thrive on them. Biofilms are found within the catheter lumen and on the external surface of the catheter. Biofilms are difficult to eradicate because they are able to resist being swept away by simple shear forces, resist phagocytosis, and resist antimicrobial agents. Therefore, they continuously flourish until microorganisms reach pathologic levels. The presence of biofilms and their resistance to conventional treatment supports the fact that catheters should be avoided or removed the soonest time possible to reduce the exposure on biofilm infections (Crosby, 2005). Current recommendations for short-term catheterization make use of indwelling catheters that are made of latex rubber, siliconized latex, or plastic. However, it seems that none of these are impervious to biofilm formation. Therefore, it is only rational and supported by studies that catheters are limited only to those who need it."
Abstract This paper proposes research into the issue of the inappropriate use of urinary catheters. The paper points out that, in the past three decades, the major focus of catheter-associated urinary tract infection (CAUTI) prevention research has been evaluation of new devices or materials that will prevent CAUTI. The paper states that a common theme emerging from the literature is that not all indwelling urinary catheters are appropriate for the duration of the catheterization, which places the patient at an increased risk of CAUTI. The proposed study will be administered in a 149 bed rural for-profit hospital using a descriptive, correlation design. Objectives of the mandatory nursing staff education will be to educate all nurses on the relationship of increased catheter days to hospital-acquired urinary tract infection, and to report the findings of the survey. In conclusion, the paper suggests that catheter days be collected over the next three months to determine the effect of the study.
Outline:
Introduction
Significance
Problem Statement
Purpose
Research Question and Research Hypothesis
Definition of Terms
Conceptual Framework
Review of the Literature
Methodology
Ethical Considerations
Measurement Method
Limitations
Communication of Findings
Appendices
From the Paper "Catheter-associated urinary tract infection (CAUTI) has been a leading cause of morbidity and mortality in hospitalized patients (Somwang & Chertsak, 2005). The Centers for Disease Control developed the first guideline for prevention of CAUTI in 1981, and CAUTI has been repsonsible for at least forty percent of healthcare-acquired infection since that time (Centers for Disease Control, 1981). More than four decades ago, Dr. Paul Beeson argued against the routine use of indwelling urinary catheters (Saint, 2002). He argued that the decision to use the devices should be made with the knowledge that they could lead to serious consequences or disease for the patient (Saint). In addition ot increased morbidity and mortality, infections associated with the use of urinary catheters lead to increased healthcare costs and patient discomfort (Saint). In 2007, Medicare decided to disallow incremental payments associated with eight secondary conditions that it sees as preventable complications of healthcare (Rosenthal M., 2007). Catheter-associated urinary tract infection, if not present at the time of admission, will no longer be taken into account in calculating payment to hospitals after October 1, 2008 (Rosenthal). After twenty-seven years, the Centers for Disease Control will issue new draft guidelines for the prevention of CAUTI in June 2008 (Brennon, 2008). Appropriate catheter placement and avoiding inappropriate catheter days will be addressed in the new guidelines (Brennon). New guidelines will assist the infection control practitioner in mitigating patient risk for CAUTI through development of process improvements designed to decrease the number of catheter days experienced by the patient."
Abstract This paper evaluates the effectiveness of a protocol that addresses patient, family and staff activities and competencies, as opposed to regular care. This is in an effort to reduce the use of Foley catheters in long-term care facilities and the associated higher incidence of urinary tract infections.
From the Paper "Finally, while Smith emphasizes that sterile techniques create an optimal condition during insertion of the indwelling Foley catheter and basic urinary catheter care and maintenance exceed any commercially available Foley catheter product (Smith, 2003, p. 5), an interesting study by Dr. R. Ramirez and his colleagues at the North Broward Hospital District (NBHD) in northern Broward County, Florida concerned two acute care facilities, Coral Springs Medical Center (CSMC) and Imperial Point Medical Center (IPMC), which elected to trial a silver/hydrogel coated Foley catheter as a quality improvement project to reduce the incidence of nosocomial urinary tract infections (NUTI)."
This paper researches the subject of medical dressings and examines the article "Impact of Dressing Materials on Central Venous Catheter Infection Rates".
2,250 words (approx. 9 pages), 1 source, 2005, $ 89.95
Abstract This paper offers a critique of the article "Impact of Dressing Materials on Central Venous Catheter Infection Rates." The writer discusses research into the use of such dressings at one medical facility, based on records covering several years. Further the writer examines the use of three different dressings over that time. In this article, the writer also looks at the way the report is written, how the research was conducted, how valid it may be and similar issues.
From the Paper "Based on the fact that transparent, semipermeable, polyurethane dressings are widely accepted for dressing central venous catheter (CVC) insertion sites today, it is noted that there have been differing results with this method, meaning differences in their association with microbial growth under the dressing and with the risk of subsequent CVC-associated infection. This is the problem, and the purpose of this study is to report on the positive experience of the authors in terms of the impact of a highly permeable transparent dressing on CVC-associated infection among patients at their facility."
Abstract The paper evaluates the importance of existing guidelines regarding catheter insertion and maintenance in promoting safe and effective techniques for nursing practice. The paper explains that it is often very difficult for nurses to improve their practices and techniques without sufficient knowledge in hand. The paper discusses how with research-based practice, there are considerations to be made for future practice.
From the Paper "The topic that has been selected for this discussion is research related to vascular catheter infection, with a guideline title of "Guidelines for the prevention of intra-vascular catheter-related infections." The above referenced guidelines suggest the following in reducing the incidence of catheter-related infections: 1) Promoting effective training mechanisms regarding catheter use for nurses and other professionals to identify infection and other problems at catheter sites through routine monitoring and the understanding of warning signs; 2) Utilize appropriate measures of hygiene when examining or working at catheter insertion sites by regularly washing hands with antiseptic soap or other anti-bacterial options."
Abstract The paper focuses on a case of an 8-month old female with gastroschisis and details her clinical situation, treatment in the hospital, the family's functional status and an assessment of the child's development and growth. The paper provides a discussion of gastroschisis, including its prevalence, external and internal factors that affect it and its pathophysiology. The paper also describes the management needs this child has and outlines current research on catheter use and sepsis.
Outline:
Introduction
The Child and her Family
Developmental Milestones
Laboratory Results
Fluids and Nutrition
Medications
Client Learning Needs
Pathophysiology of Gastroschisis
Application of a Nursing Research
Summary
From the Paper "Gastroschisis is a congenital abdominal wall defect and is associated with a significant fetal and neonatal mortality rate of less than 10% (Vu, Nobuhara, Laurent, and Shaw, 2008). The intestines protrude through the defect and are exposed to the amniotic fluid, which has toxic substances, such as urine and small quantities of antenatally-defecated material. This may result to life-crippling complications such as bowel atresias and increased risk for sepsis. Such effects in the child's quality of life may lead to a prolonged stay in hospitals and consequent high health care cost."
Abstract This study reviews and assesses data from previous meta-studies that compared the actions of the skin antiseptics, Chloraprep and Providone Iodine among others, with regard to sterilization prior to catheter insertion. The study reassess the available data in an attempt to understand whether the findings remain conclusive in supporting the use of chlorhexidine over Providone Iodine solution in prevention of catheter related blood stream infection (CRBSIs). The paper relates that the clinical problem statement is 'What are the most effective antiseptic techniques to use to minimize risk of infection from use of intravenous catheters". The study attempts to solve this clinical problem statement through a thorough review of the clinical trials which have been conducted globally since the introduction of chlorhexidine.
Outline:
Definitions
Introduction
Problem Statement
Description of Methodology
Presentation of Findings
Synthesis of Findings
From the Paper "Several studies have now been completed to compare the actions of the skin antiseptics Chloraprep and Providone Iodine among others. The results of a Meta-Analysis study "found that the use of Chlorhexidine gluconate rather than Providone Iodine can reduce the risk for catheter-related blood stream infection by approximately 50% in hospitalized patients who require short-term catheterization." The study goes on to state "Given the extent of the benefit and the small incremental cost, chlorhexidine gluconate should be considered as a replacement for Providone Iodine solution, particularly in patients at high risk for catheter related blood stream infection."
An analysis of Coronary CT, explaining why it may eliminate the need for non-interventional heart catheterization, and stands ready to serve as the preliminary choice for diagnostic evaluation of the native coronary vessels.
Abstract The paper explains how our society is increasingly at risk; the number of fatalities each year from coronary artery disease continues to rise in spite of efforts to educate the populace on methods to reduce risk factors. The paper lists the steps that must be taken to identify those individuals at risk and provide them with treatment options. The paper identifies angiography as providing the best method of coronary evaluation available, and lists the three types currently in use: magnetic resonance, catheter, and computed tomography. The paper analyzes the specific benefits and limitations of each type. Of the three, the paper finds that computed tomographic angiography (CTA) provides the greatest versatility and has the least associated risks and limitations, and also provides the greatest volume of information and detail. In conclusion, the paper anticipates that the CTA will likely become the diagnostic tool of choice and ultimately supplant catheter angiography.
From the Paper "The super-sized, rapid paced, high stress society we inhabit contributes daily to the demise of our fellow citizens. The epidemic rise of obesity and diabetes compounds the risk of America's number one killer: heart disease. The number of Americans succumbing to heart disease will nearly double from 500,000 in 2002 to 930,000 in 2005. The cost to treat cardiovascular patients in 2005 will cap at just under $400 billion (Kazerooni, 2005). Emphasis on risk reduction should be made, but it falls short of real impact. Steps must be taken to diagnose patients at risk and provide treatment options appropriate to their level of disease."
Abstract Catheterization as a medical technique has been in practice for more than two millennia. While it first began as an experimentation with animals, it gradually became part of human treatments. The procedure of cardiac catheterization in humans was first put to clinical use more than five decades ago and has undergone many changes since then. What was once a purely experimental technique is now one of the most common invasive medical procedures in Europe and North America, with more than eighty-percent of those procedures performed to diagnose suspected heart disease. Animal cardiac catheterization was first accomplished in 1844 with a horse. The characterization of the human heart was first accomplished by a German medical student in 1929. By the 1940's, the practice had become improved and was starting to become common practice in a few hospitals in North America and Europe. By entering a catheter through an arm vein, surgeons were able to reach the atrium of the heart. Today, cardiac catheterization is accomplished with a great deal of skill and technology, but is much easier and less dangerous than when it first was being used. It is the purpose of this paper to examine the history of cardiac catheterization and its import to medicine today.
Abstract This paper examines the system most suited for the use of evaluation of the catheter positioning in the chest of the patient in the intensive therapy unit environment. Traditionally, these images are difficult to process. The paper determines whether the images produced through digital radiography or those produced through computed radiography are optimal in terms of the best system in order to reduce risk to the patient due to higher radiation doses or incorrect positioning.
From the Paper "The Department of nuclear medicine and diagnostic Imaging, at Kyoto University School of Medicine and the physicians named as Tadamura, Kubo, Yamamuro, and Konishi wrote in their work that "Nuclear cardiology has played a significant role in the diagnosis and risk stratification of patients with coronary artery disease. MRI and multidector-row CT (MDCT) has recently been introduced in the filed of clinical cardiology. For the management of patients with suspected coronary artery disease, it is important to understand the advantages and disadvantages of various imaging modalities. Tadamura, Kubo, Yamamuro, & Konishi (1998). The work entitled "Digital Imaging with a Photostimulable Phosphor in the Chest of Newborns" states that when comparing imaging of newborn mediastinum, lung bones, and soft tissues the images ere "significantly better on computed radiographs than on half-exposure computed radiographs and that visualization of the lungs, bones and soft tissues was statically significantly better on screen-film radiographs than half-exposure computed radiographs."
Abstract This paper discusses the procedure of percutaneous transluminal coronary angioplasty (PTCA). It discusses the rationale of the procedure as well as the fundamentals of the procedure itself. The paper also touches on the evolution of the catheter used in interventional cardiology as well as their specific applications. It finally discusses the pros and cons of the procedure.
From the Paper "Percutaneous coronary intervention (PCI) have become a mainstay in modern medicine and revolutionized the medical management of a variety of coronary pathologies from life-threatening acute myocardial infarctions, unstable angina to valvular heart disease. PCI have one distinct advantage over pharmacological therapy (i.e. thrombolysis or "clot-busters"), now considered to be conservative (albeit first-line) therapy for myocardial infarctions: time-saving. The importance of this lies in the fact that the arteries supplying the heart are "functional end arteries" - they not only conduct oxygen and nutrients directly to the surrounding myocardium through diffusion, but are also the only arteries supplying a certain region. With its very high oxygen and nutrient consumption, any obstruction in any of the arteries by as much as half would significantly hamper overall pumping of the heart."
Abstract This paper addresses the symptoms, diagnosis and treatment of deep vein thrombosis. It provides an overview of the body's two systems of veins and discusses how deep vein thrombosis can occur. The paper also discusses the methods of diagnosis of the disease and then looks at the various ways that it can be treated - both surgically and non-surgically.
Table of Contents:
Abstract
Overview
Symptoms
Diagnosis
Treatment
From the Paper "In instances of complicated thrombosis, including patients with pulmonary embolus, most often these patients are admitted to an acute care inpatient unit. There they receive an unfractionated IV heparin drip and then are subsequently converted to enoxaparin at a rate of 1 mg/kg, injected subcutaneously, every 12 hours. Eisenson (2007) cites Buller et al. as recommending against the use of an inferior vena cava filter in addition to anticoagulants, for the initial treatment, unless there is a contraindication for or complication of anticoagulant treatment. Or if thromboembolism is recurrent, despite anticoagulation."
Abstract This paper explains that the numerous factors of kidney disease can directly affect a sufferer's state of mind. Not only is there physical pain involved, but also there is the humiliation of having a catheter, the burden of dialysis, the stress of the potential of transplant surgery and the possibility of putting a loved one in danger if they become a donor. The author points out that diagnosis and appropriate treatment of a psychiatric problem related to chronic kidney disease depends on a rational assessment of numerous contributing factors and the strengths and weaknesses of the individual. The paper stresses that one of the most important roles the advanced practice nurse is early detection and intervention.
Table of Contents:
Introduction
Overview of Kidney Disease
Implications for Mental Health
Diagnosis and Treatment
Role of the Advanced Practice Nurse
From the Paper "Statistically, men and women over 55 face an increasing probability of acquiring some chronic disease (Birren & Sloane, 2001). A psychiatric symptom such as poor memory may be related to organic illness, for example, a brain disorder, or represent a psychological aspect of an illness, for example, depression. Depression is the most frequent incapacitating psychiatric problem throughout life. More than half the victims of a serious depression have their first episode after 60, and estimates are that careful clinical examination would confirm depression in 10 to 30 percent of those over 65."
Abstract In order to deliver safe and effective practice a Registered Nurse is required to maintain his or her professional competence by ensuring knowledge and skills remain current. Furthermore there exists a need for the nurse to facilitate the effective development of the knowledge and skills base any student who they may be teaching. This paper attempts to demonstrate how a potential student (female) was identified and how her needs were explored and assessed. The paper also discusses how, after the students learning style was identified, a plan of action was drawn up and a lesson was given and evaluated.
The paper is dived into a number of related sections. These are the main paper (Teaching and Learning in Clinical Practice), a detailed lesson plan for performing, recording and interpreting a urinalysis (appendix a), a series of colored photographs showing different urinary samples (appendixes b - e), a learner assessment sheet (appendix f) and urinalysis tables (appendixes g and h).
From the Paper "Contact with regularly attending potential learner's within my placement area was sporadic, but following eventual identification of a second year nursing student (with whom I would again come into contact within the clinical area), I made my first approach with the intention of creating a good first impression. A positive start to a first meeting may not actually be essential for the successful development of a potential teacher/learner relationship and indeed the idea that it is even "useful", rather than "essential", may contradict some authors views (Carr, 2005). Those views have suggested that the teacher/learner relationship should be one which is formal and impersonal. In a selfish attempt to make the forthcoming teaching session easier for me and to create a positive and lasting influence on my learner's impending experience, (which would hopefully improve future patient care), I aimed to develop a relationship which was relaxed from the outset and based on trust and support (Brookfield, 1986)."
Abstract This paper presents a case study of a patient that is in a state of hypovolemic shock and relates the signs and symptoms of this state as well as the risks and complications in introducing IV fluid resuscitation. A description of the procedure for IV therapy is presented and it is emphasized that the patient must be checked routinely for signs of infection, dislodgement of the IV catheter or aggressive resuscitation. Fluid resuscitation, the paper concludes, is deemed effective if the blood pressure and heart rate are within an acceptable range and signs of inflammation and infection have disappeared.
Table of Contents:
Indications
Risks and Complications
Signs and Symptoms of Developing a Complication
Performing the Intervention and Any Complications
Assessing Its Effectiveness
From the Paper "Ideally, patients who lose blood must be given blood. However, when an emergency arises, it may not be practical as certain procedures such as cross-matching are required for the patient to obtain blood. In an acute situation, management with fluid resuscitation is critical. Once any sign of bleeding has been ruled out, fluid resuscitation may be provided. If the patient does not have an intravenous line, a large-bore IV catheter must be placed to initiate parenteral fluid replacement. "
