Change Fatigue in Health Care Professionals--An Issue of Workload or Human Factors Engineering?

In the demanding and fast-paced world of health care, it is not uncommon for nurses and other health care professionals to have days where they are pushed to their limits. Despite these pressures, each year, new initiatives and practice recommendations are shared within organizations that the nurses must learn, embrace, and include in their practice. Each new initiative can be additive to the nurse's workload; most changes are not time neutral but require staff to expend an allotment of time from their day to complete.

Perianesthesia nursing-beyond the critical care skills.

Provision of patient care within the perianesthesia specialty is demanding in nature. Although a nurse may be well equipped with the assessment, planning, and critical thinking skills required for these fast-paced areas, there are other competencies to be developed. These include skills in mentorship, communication, crisis management, and competency as an ambassador of patient safety.

Blood products and the phases of perianesthesia care-reviewing the implications.

Perianesthesia nurses often provide care for patients who have received blood products. Over the years, great advances in the safety and technology around blood products have occurred, yet transfusions are not without risk. Because 50% of blood transfusions are administered in the surgical setting, the perianesthesia nurse must know the indications and potential adverse reactions.

Glycemic control and surgery-optimizing outcomes for the patient with diabetes.

Diabetes mellitus (DM) has reached epidemic proportions globally, and its incidence continues to rise. Considering the increasing number of patients diagnosed with diabetes and the associated complications, such as cardiovascular and renal disease, the complexity of care for this population can be very challenging. In addition, specific postoperative complications, such as delayed wound healing, infections, and cardiac dysrhythmias, are more likely to occur in the presence of perioperative hyperglycemia.

Meeting the challenge of obstructive sleep apnea: developing a protocol that guides perianesthesia patient care.

Caring for a patient postoperatively with a medical history of diagnosed or suspected obstructive sleep apnea (OSA) is not uncommon. OSA is estimated to be present in 2%-26% of the general population, and the National Sleep Foundation proposes that one in four Americans are at high risk for OSA. Also of concern is that the incidence of OSA may increase as our population ages.

Selective and nonselective nonsteroidal anti-inflammatory drugs in perianesthesia pain management.

Despite advances in pain management techniques, there remains room for further improvement in optimizing postoperative patient comfort. Although nonsteroidal anti-inflammatory drugs (NSAIDs) that are more selective in the inhibition of the cyclooxygenase (COX) enzyme have become more popular over recent years, the use of traditional nonselective NSAIDs remains efficacious in reducing postoperative pain. Both nonselective and selective NSAIDs have an important role in perianesthesia pain management.

Improving pain management for critically ill and injured patients.

The under-treatment of pain continues to be a problem in patient care. Evidence shows a significant percentage of patients suffering with acute and chronic pain, despite the treatment options available. This must be addressed, as undertreating pain has a long list of negative outcomes.

From Aldrete to PADSS: Reviewing discharge criteria after ambulatory surgery.

Nurses working in perianesthesia care areas use discharge scoring criteria to complete patient assessments and ensure patient readiness for discharge or transfer to the next phase of recovery. However, all discharge criteria have both advantages and disadvantages. Comparative studies on the reliability of the different discharge criteria in use are extremely limited.

Post-anesthesia tracheal extubation.

Caring for the patient in the post-anesthetic period requires an understanding of the intubation and extubation process. The nurse must be knowledgeable of the numerous tracheal extubation-related complications that can occur. Tracheal extubation is a vulnerable period for the patient; there is risk of aspiration, laryngospasm, a cardiovascular response, or hypoventilation occurring.

Review of laryngospasm and noncardiogenic pulmonary edema.

Laryngospasm is an emergency situation that requires rapid identification and resolution of the obstructed glottis. Although there is a low incidence of laryngospasm, it is important to remember that any patient has the potential for post-extubation laryngospasm. Nurses must know about the causes, risk factors and treatment for this respiratory emergency.

Quantitative studies of the vasculature of the carotid body in the chronically hypoxic rat.

The carotid bodies of rats made chronically hypoxic by breathing 12% O2 in a normobaric chamber (inspired PO2 91 mmHg) were compared with those of controls. Serial 5-microm sections of the organs were examined using an interactive image analysis system. The total volume of the carotid bodies was increased by 64%.

The carotid body of the spontaneous insulin-dependent diabetic rat.

The carotid bodies from adult spontaneous insulin-dependent diabetic rats (strain BB/S) were perfusion-fixed at normal arterial blood pressure with 3% phosphate-buffered glutaraldehyde and compared with the organs from control rats (strain BB/Sc) prepared in the same way. Serial 5-micron sections were cut, stained, and using an interactive image analysis system, were analysed to determine the volumes of the carotid body and its vascular and extravascular compartments. There was no evidence of systemic arterial disease in the carotid stem arteries in either group of animals, and the microvasculature of the organs appeared normal by light microscopy.

A morphological study of the size of the vascular compartment of the carotid body in a non-human primate (Cercopithecus ethiopus), and a comparison with the cat and rat.

The carotid bodies from 5 adult non-human primates (mean body weight 2.9 kg) were perfusion-fixed at normal arterial blood pressure with 3% phosphate-buffered glutaraldehyde. Serial 5-microns sections were cut, stained, and, using an interactive image analysis system, determinations were made of the volumes of the carotid body and of its vascular and extravascular compartments.

Quantitative studies of the vasculature of the carotid body in fetal and newborn sheep.

Resetting of the hypoxic sensitivity of the carotid chemoreceptors from the fetal to the adult arterial PO2 range follows the rise in PO2 which occurs after birth. The mechanism of this resetting is unknown. To study whether it is accompanied by a change in the carotid body microvasculature, 2 pairs of carotid bodies from fetal sheep (145 days gestation) and 2 pairs from 7-8 days-old lambs were examined.

Synthesis and biological activities of some pyrrolopyrazoles and 2-pyrazolines.

Cycloaddition reactions of the nitrilimines 4-6 with N-arylmaleimides 7 and acrylamide (11) yield the pyrrolopyrazole derivatives 8-10 and 2-pyrazolines 12, respectively, in excellent yield. The regioselectivity and biological activities of some of the new compounds were investigated.

Comparison of the size of the vascular compartment of the carotid body of the fetal, neonatal and adult cat.

The carotid bodies from full-term fetal cats, 3- to 4-day-old neonates and adult cats were perfusion-fixed at normal arterial blood pressure with 3% phosphate-buffered glutaraldehyde. Serial 5-microns sections were cut and stained by the MSB method. Using an interactive image analysis system, determinations were made of the volumes of the carotid body and of its vascular and extravascular compartments.