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)."

Tags:LifeCare, hydrophilic, CDC

Abstract
This paper examines the standards set by the National Service Framework for coronary heart disease regarding emergency cardiac care for patients presenting to the accident and emergency system at a hospital. The paper explains that these standards place a priority on aggressive management and providing early thrombolysis and that this type of treatment is controversial because it is questionable whether, given the suggested timeline and the need to differentiate from non-cardiac causes of chest pain, an adequate history and physical can be performed to prevent the administration of thrombolytics in patients where they are contraindicated. To further examine this topic, the paper gives a clear definition of acute myocardial infarction, looks at how to diagnose a patient with acute chest pain, explores the history, indications, and contraindications of thrombolysis, and reviews a multidisciplinary approach to thrombolytic administration.

From the Paper
"The definitive diagnosis of AMI is best obtained by following a standard chest pain protocol. Most accident and emergency wards have these in place. It is standard to initially obtain a 12 lead electrocardiogram (ECG) and begin cardiac monitoring. Patient's routine laboratory studies include electrolytes, blood urea nitrogen (BUN), complete blood count (CBC) and markers for myocardial injury (Creatinine Kinase isoenzyme-myocardial (CK-MB) or troponin). Normal serial CK values rule out an acute infarction but are negative in the setting of acute unstable angina. A slight rise in CK-MB or troponin indicates myocardial injury but is not specific for ischemic syndromes. Troponin assay is highly sensitive for identifying acute coronary syndromes. Troponin has longer half life in the system than CK-MB but is less specific for the identification of infarction as opposed to repeated episodes of myocardial ischemia. As the total CK greater than two times the upper ranges of normal is indicative of infarction it can be used as an adjunct in diagnosis ischemia versus infarction and also in determining the relative efficacy of reperfusion. Serum troponin may take up to six hours to become diagnostically sensitive enough (Dougan, 2001)."

Tags:electrocardiogram, (ecg), monitoring, electrolytes, acute, infarction, unstable, angina

Abstract
This paper studies how medical professionals diagnose and treat thrombolysis during critical care for patients experiencing chest pain. The paper provides a detailed analysis of scientific and clinical evidence indicating that patients experiencing acute myocardial infarction benefit from the early administration of thrombolytic therapy. The paper then discusses the challenge for multidisciplinary providers in ensuring that patients give true informed consent for all procedures, from administration of medication to invasive procedures. The paper explains that the setting can be chaotic, however, it maintains that effective communication between patients and providers is imperative.

From the Paper
"The definitive diagnosis of AMI is best obtained by following a standard chest pain protocol. Most accident and emergency wards have these in place. It is standard to initially obtain a 12 lead electrocardiogram (ECG) and begin cardiac monitoring. Patient's routine laboratory studies include electrolytes, blood urea nitrogen (BUN), complete blood count (CBC) and markers for myocardial injury (Creatinine Kinase isoenzyme-myocardial (CK-MB) or troponin). Normal serial CK values rule out an acute infarction but are negative in the setting of acute unstable angina. A slight rise in CK-MB or troponin indicates myocardial injury but is not specific for ischemic syndromes. Troponin assay is highly sensitive for identifying acute coronary syndromes. Troponin has longer half life in the system than CK-MB but is less specific for the identification of infarction as opposed to repeated episodes of myocardial ischemia. As the total CK greater than two times the upper ranges of normal is indicative of infarction it can be used as an adjunct in diagnosis ischemia versus infarction and also in determining the relative efficacy of reperfusion. Serum troponin may take up to six hours to become diagnostically sensitive enough (Dougan, 2001)."

Tags:heart, attack, chest, pain, hospital, doctor, nurse, informed, consent, myocardial, cardiac, arrest, emergency, room

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."

Tags:disease, urinary, tract, infection

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."

Tags:nursing, article, critique

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."

Tags:nursing, practice, research

Abstract
The paper relates that the occurrence of urinary tract infection (UTI) in the intensive care unit (ICU) is, according to Marklew (2004), "a nursing procedure, the importance of which is sometimes overlooked" (p. 21) with potentially catastrophic results, as a UTI in this setting increases patient mortality. The paper discusses how Sheehan and Mooka (2005) explain that bacteremia takes place in 1-3% of UTIs caused by catheterization, and that 13 percent of these cases are mortal (p. 905).

From the Paper
"The occurrence of urinary tract infection (UTI) in the intensive care unit (ICU) is, according to Marklew (2004), "a nursing procedure, the importance of which is sometimes overlooked" (p. 21) with potentially catastrophic results, as a UTI in this setting increases patient mortality. Sheehan and Mooka (2005) explain that bacteremia takes place in 1-3% of UTIs caused by catheterization, and that 13 percent of these cases are mortal (p. 905)."

Tags:uti, icu, foley

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."

Tags:DVT, compression stockings, catheter thrombolysis

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."

Tags:intestines, bowels, liver, nutrition, medication, sepsis, catheter, feeding

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."

Tags:maximum, effectiveness, sterilization, antiseptic, techniques