2.50
Hdl Handle:
http://hdl.handle.net/10755/156949
Category:
Abstract
Type:
Presentation
Title:
Observations of Care Interventions to Improve Care for Therapeutic Hypothermia Patients
Author(s):
Armola, Rochelle R.; Tucker, Deborah; Hutchinson, Linda
Author Details:
Rochelle R. Armola, RN,MSN,CCRN, The Toledo Hospital, Toledo, Ohio, USA, email: rochelle.armola@promedica.org; Deborah Tucker; Linda Hutchinson
Abstract:
POSTER PURPOSE: In June 2008, a therapeutic hypothermia protocol for patients after cardiac arrest based on published best practices was started. Nursing interventions including sedation are integral to caring for these complex patients. The purpose of this study was to identify what methods were provided to manage various physiological behaviors, such as shivering, seizures, and variations in blood pressure and temperature. BACKGROUND/SIGNIFICANCE:It was hypothesized that multiple interventions were used for perceived shivering in hypothermia patients, including neuromuscular blockade (NMB) as a first-line choice of treatment. Exploring nursing observations and interventions used to manage shivering in patients who are hypothermic after cardiac arrest may help identify what nurses can implement independently and support more consistent orders from physicians on pharmacological management if required. METHOD: A research study titled "Effects of Sedation in the Therapeutic Hypothermic Patient After Cardiac Arrest" was approved by the institutionÆs review board. A descriptive study through retrospective chart review of 25 hypothermia protocol patients (15 male, 10 female) was conducted by using a specially designed data tool from June to August 2008 (n = 10) and January to April 2009 (n = 15). Physician orders, nursing notes, medication records, and a new nursing record for cooling therapy were used to collect data. Of the 25 patients reviewed, 20 experienced shivering. Eighteen patients were treated with a NMB and 2 with propofol. Two of the 18 NMB patients were later identified as having seizure activity. RESULTS: Signs of shivering and correlation of interventions (including medications) were inconsistently documented despite a specific hypothermia documentation flow sheet that was in use. Findings indicate a possible lack of knowledge of shivering signs versus seizure activity and potential interventions to abate the adverse effects of shivering. Diverse physician orders when shivering or a decrease in temperature water of the cooling device was identified. The only interventions documented for shivering was pharmacological treatment with NMB, sedatives, and analgesics. No pattern for treatment could be established. CONCLUSIONS: The physician-nurse best practice hypothermia team reviewed results and recommended using the published Bedside Shivering Assessment Scale that quantifies shivering and denotes specific interventions. Providing consistency may lessen various physiological behaviors and now provides consistent physician orders. Education of nursing staff on surface warming options, the Bedside Shivering Assessment Scale, identification of shivering and seizures, and the need for more in-depth documentation is in process.
Repository Posting Date:
26-Oct-2011
Date of Publication:
26-Oct-2011
Citation:
2010 National Teaching Institute Research Abstracts. American Journal of Critical Care, 19(3), e15-e28. doi:10.4037/ajcc2010866
Conference Date:
2010
Conference Name:
National Teaching Institute and Critical Care Exposition
Conference Host:
American Association of Critical-Care Nurses
Conference Location:
Washington, D.C., USA
Note:
This is an abstract-only submission. If the author has submitted a full-text item based on this abstract, you may find it by browsing the Virginia Henderson Global Nursing e-Repository by author. If author contact information is available in this abstract, please feel free to contact him or her with your queries regarding this submission. Alternatively, please contact the conference host, journal, or publisher (according to the circumstance) for further details regarding this item. If a citation is listed in this record, the item has been published and is available via open-access avenues or a journal/database subscription. Contact your library for assistance in obtaining the as-published article.

Full metadata record

DC FieldValue Language
dc.type.categoryAbstracten_GB
dc.typePresentationen_GB
dc.titleObservations of Care Interventions to Improve Care for Therapeutic Hypothermia Patientsen_GB
dc.contributor.authorArmola, Rochelle R.en_GB
dc.contributor.authorTucker, Deborahen_GB
dc.contributor.authorHutchinson, Lindaen_GB
dc.author.detailsRochelle R. Armola, RN,MSN,CCRN, The Toledo Hospital, Toledo, Ohio, USA, email: rochelle.armola@promedica.org; Deborah Tucker; Linda Hutchinsonen_GB
dc.identifier.urihttp://hdl.handle.net/10755/156949-
dc.description.abstractPOSTER PURPOSE: In June 2008, a therapeutic hypothermia protocol for patients after cardiac arrest based on published best practices was started. Nursing interventions including sedation are integral to caring for these complex patients. The purpose of this study was to identify what methods were provided to manage various physiological behaviors, such as shivering, seizures, and variations in blood pressure and temperature. BACKGROUND/SIGNIFICANCE:It was hypothesized that multiple interventions were used for perceived shivering in hypothermia patients, including neuromuscular blockade (NMB) as a first-line choice of treatment. Exploring nursing observations and interventions used to manage shivering in patients who are hypothermic after cardiac arrest may help identify what nurses can implement independently and support more consistent orders from physicians on pharmacological management if required. METHOD: A research study titled "Effects of Sedation in the Therapeutic Hypothermic Patient After Cardiac Arrest" was approved by the institutionÆs review board. A descriptive study through retrospective chart review of 25 hypothermia protocol patients (15 male, 10 female) was conducted by using a specially designed data tool from June to August 2008 (n = 10) and January to April 2009 (n = 15). Physician orders, nursing notes, medication records, and a new nursing record for cooling therapy were used to collect data. Of the 25 patients reviewed, 20 experienced shivering. Eighteen patients were treated with a NMB and 2 with propofol. Two of the 18 NMB patients were later identified as having seizure activity. RESULTS: Signs of shivering and correlation of interventions (including medications) were inconsistently documented despite a specific hypothermia documentation flow sheet that was in use. Findings indicate a possible lack of knowledge of shivering signs versus seizure activity and potential interventions to abate the adverse effects of shivering. Diverse physician orders when shivering or a decrease in temperature water of the cooling device was identified. The only interventions documented for shivering was pharmacological treatment with NMB, sedatives, and analgesics. No pattern for treatment could be established. CONCLUSIONS: The physician-nurse best practice hypothermia team reviewed results and recommended using the published Bedside Shivering Assessment Scale that quantifies shivering and denotes specific interventions. Providing consistency may lessen various physiological behaviors and now provides consistent physician orders. Education of nursing staff on surface warming options, the Bedside Shivering Assessment Scale, identification of shivering and seizures, and the need for more in-depth documentation is in process.en_GB
dc.date.available2011-10-26T19:17:11Z-
dc.date.issued2011-10-26en_GB
dc.date.accessioned2011-10-26T19:17:11Z-
dc.identifier.citation2010 National Teaching Institute Research Abstracts. American Journal of Critical Care, 19(3), e15-e28. doi:10.4037/ajcc2010866en_GB
dc.conference.date2010en_GB
dc.conference.nameNational Teaching Institute and Critical Care Expositionen_GB
dc.conference.hostAmerican Association of Critical-Care Nursesen_GB
dc.conference.locationWashington, D.C., USAen_GB
dc.identifier.citation2010 National Teaching Institute Research Abstracts. American Journal of Critical Care, 19(3), e15-e28. doi:10.4037/ajcc2010866en_GB
dc.description.noteThis is an abstract-only submission. If the author has submitted a full-text item based on this abstract, you may find it by browsing the Virginia Henderson Global Nursing e-Repository by author. If author contact information is available in this abstract, please feel free to contact him or her with your queries regarding this submission. Alternatively, please contact the conference host, journal, or publisher (according to the circumstance) for further details regarding this item. If a citation is listed in this record, the item has been published and is available via open-access avenues or a journal/database subscription. Contact your library for assistance in obtaining the as-published article.-
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