American Journal of Critical Care. 2007;16: 335
Copyright © 2007 by the American Association of Critical-Care Nurses.
Clinical Pearls
By
Mary Jo Grap, RN, PhD, ACNP, Section Editor.
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Comparing Methods for Glucose Analysis
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Are all types of glucose measurement equal? Does it matter if you use fingerstick, arterial, or catheter blood? Lacara and colleagues found that
- glucose measures are equal
- the source of blood does not matter unless your patient has
- low hematocrit
- low serum carbon dioxide
Care should be taken with patients who have abnormal hematocrit or carbon dioxide levels. Clinicians can verify the accuracy of point-of-care (POC) glucose testing by comparing the POC value with the laboratory value of a sample obtained at the same time.
See Article, pp 336–347
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Anxiety and Your Cardiac Patients
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Did you know that your patient’s anxiety level may negatively affect his or her outcome after myocardial infarction, especially in-hospital complications? As Moser notes:
- Women experience more anxiety than men and the difference is present in both Western and Eastern cultures.
- Higher anxiety levels might help to explain poorer outcomes experienced by women, but more research is needed.
- Anxiety assessment and treatment should be part of the care of every cardiac patient.
How do you evaluate anxiety in patients? One common tool is the Spielberger State-Trait Anxiety Inventory, though the authors preferred the anxiety subscale of the Brief Symptom Inventory.
See Article, pp 361–369
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Efficacy of a Fecal Incontinence Management System
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Are you using tubes and devices not originally designed for rectal use for fecal diversion and collection? Fecal incontinence is a difficult problem to manage and increases the risk of pressure ulcers.
The article by Padmanabhan and colleagues describes a system for fecal incontinence that, according to the nurses who used it,
- was easy to use
- saved time, and
- maintained or improved the patient’s skin integrity.
In addition, in this small study, no change in rectal mucosa was found after use of the fecal incontinence management device.
See Article, pp 384–393
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Reproduced with permission of E. R. Squibb & Sons, LLC.
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Use of Atrial Electrograms After Cardiac Surgery
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Do you use atrial pacemaker wires to record electrocardiograms (ECGs) in your cardiac surgery unit? The American Heart Association practice standards recommend that these ECGs be recorded whenever a tachycardia of unknown origin occurs. Miller and Drew describe the procedure, but find that this previously common practice is being abandoned. In their article they make several clinically relevant observations:
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Figure originally published in: Weigand DJL-M, Carlson KK, eds. AACN Procedure Manual for Critical Care, 5th edition, section 6, procedure 43, page 301. Copyright Elsevier, 2005.
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- Compared with routine ECGs recorded from skin electrodes, P waves in atrial electrograms are larger and easier to read.
- Easier-to-read P waves aid in diagnosing arrhythmias.
- To prevent microshocks, staff should wear gloves if they come into contact with epicardial wires.
- The bare metal tip of the epicardial wire that is not insulated should be covered in an insulating material if it is not securely attached to the temporary pacemaker generator.
See Article, pp 350–359
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Making the Case for Genetic Testing
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Beery and colleagues describe a very rare case of ventricular arrhythmias and atrioventricular block in a 4-day-old infant that were caused by a genetic mutation. Although there was no family history of similar occurrences, the parents were advised to consider genetic testing to understand the risks for themselves and any future children.
See Article, pp 416, 412–415
Clinical Pearls is designed to help implement evidence-based care at the bedside by summarizing some of the most clinically useful material from select articles in each issue. Readers are encouraged to photocopy this ready-to-post page and share it with colleagues. Please be advised, however, that any substantive change in patient care protocols should be carefully reviewed and approved by the policy-setting authorities at your institution.
Related articles in AJCC:
- Comparison of Point-of-Care and Laboratory Glucose Analysis in Critically Ill Patients
- Teresita Lacara, Caroline Domagtoy, Donna Lickliter, Kathy Quattrocchi, Lydia Snipes, Joánne Kuszaj, and MaryClare Prasnikar
AJCC 2007 16: 336-346.
[Abstract]
[Full Text]
- Atrial Electrograms After Cardiac Surgery: Survey of Clinical Practice
- Jane N. Miller and Barbara J. Drew
AJCC 2007 16: 350-356.
[Abstract]
[Full Text]
- "The Rust of Life": Impact of Anxiety on Cardiac Patients
- Debra K. Moser
AJCC 2007 16: 361-369.
[Abstract]
[Full Text]
- Clinical Evaluation of a Flexible Fecal Incontinence Management System
- Anantha Padmanabhan, Mark Stern, Judith Wishin, Mari Mangino, Karen Richey, Mary DeSane, and on behalf of the Flexi-Seal Clinical Trial Investigators Group
AJCC 2007 16: 384-393.
[Abstract]
[Full Text]
- Neonatal Long QT Syndrome Due to a De Novo Dominant Negative hERG Mutation
- Theresa A. Beery, Kerry A. Shooner, and D. Woodrow Benson
AJCC 2007 16: 416-412.
[Abstract]
[Full Text]
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