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Updates and Clinical Implications of Pediatric Delirium
Delirium is a fluctuating level of awareness based on a physiologic disease process. Within pediatrics, delirium affects approximately 30% of patients admitted to critical care units and is associated with increased mortality, morbidity, length of stay, and care costs. Multiple pediatric critical care societies recommend the implementation of screening practices using validated delirium tools. Delirium remains underrecognized because of suboptimal screening and protocol implementation in pediatric critical care units nationally and internationally. The mainstay of delirium prevention and management is nonpharmacologic, foc...
Source: Critical Care Nursing Clinics of North America - June 4, 2023 Category: Nursing Authors: Lauren K. Flagg, Jennifer A. Mauney Source Type: research

Unplanned Extubation in the Pediatric Intensive Care Unit
Unplanned extubations (UEs) are common, potentially avoidable complications of endotracheal intubation among pediatric patients. UE can be associated with adverse patient outcomes including increased length of stay, hospitalization cost, and cardiorespiratory decompensation. Inconsistency in the definition of UE has led to underreporting. Staff must be able to recognize and intervene appropriately when an UE occurs. Risk factors have been identified and quality improvement initiatives aimed at reducing UE have shown to be effective in reducing the incidence. The lack of consistent definition may lead to underreporting and ...
Source: Critical Care Nursing Clinics of North America - May 29, 2023 Category: Nursing Authors: Julianne Moss, Brieann Maurer, Cynthia Howes Source Type: research

Pediatric Critical Care Nursing: Our Past, Present, and Future
Close to 250,000 children are admitted to pediatric intensive care units each year, and that number continues to rise as our care for this complex and vulnerable population improves. These units combine two specialties: caring for pediatric patients, which consists of understanding the child ’s developmental stage and ability, and working with their families, who are integral parts of their existence and critical care. As medical advances for pediatric patients continue, these patients are able to have increased life expectancies and greater quality of life. (Source: Critical Care Nursing Clinics of North America)
Source: Critical Care Nursing Clinics of North America - May 29, 2023 Category: Nursing Authors: Melissa Nunn Tags: Preface Source Type: research

Evidence-Based Trauma Pearls
CRITICAL CARE NURSING CLINICS OF NORTH AMERICA (Source: Critical Care Nursing Clinics of North America)
Source: Critical Care Nursing Clinics of North America - April 30, 2023 Category: Nursing Authors: Jeanette Vaughan, Whitney Villegas Source Type: research

Copyright
ELSEVIER (Source: Critical Care Nursing Clinics of North America)
Source: Critical Care Nursing Clinics of North America - April 30, 2023 Category: Nursing Source Type: research

Contributors
DEBORAH GARBEE, PhD, APRN, ACNS-BC, FCNS (Source: Critical Care Nursing Clinics of North America)
Source: Critical Care Nursing Clinics of North America - April 30, 2023 Category: Nursing Source Type: research

Contents
Jeanette Vaughan and Whitney Villegas (Source: Critical Care Nursing Clinics of North America)
Source: Critical Care Nursing Clinics of North America - April 30, 2023 Category: Nursing Source Type: research

Forthcoming Issues
Pediatric Intensive Care Nursing (Source: Critical Care Nursing Clinics of North America)
Source: Critical Care Nursing Clinics of North America - April 30, 2023 Category: Nursing Source Type: research

Evidence-Based Pearls
Trauma remains a leading cause of death among adults. Care of the trauma patient requires highly skilled trauma teams. Trauma care begins in the field, then presents to the emergency room, proceeds to intensive care in many cases, and finally reaches recovery and rehabilitation. For patients, it can be a long road. To be effective, multidisciplinary trauma teams must expertly drill and practice skills, communicate among team members in closed loops, make split decisions affecting patient outcomes, and see the care through to the end. Many disruptions during the course of providing trauma care can alter safe outcomes for pa...
Source: Critical Care Nursing Clinics of North America - March 27, 2023 Category: Nursing Authors: Jeanette Vaughan Source Type: research

Acute Management of Cervical Spinal Cord Injuries
This article focuses on the pathophysiology, initial presentation, and treatment of cervical spinal cord injury by body system. (Source: Critical Care Nursing Clinics of North America)
Source: Critical Care Nursing Clinics of North America - March 27, 2023 Category: Nursing Authors: Alexandra Hunt, Karen A. McQuillan Source Type: research

Evidence-Based Pearls
The challenge in caring for patients who sustain traumatic chest injuries centers on their complex needs from high acuity and the potential for multisystem effects and complications. Hemorrhage and respiratory compromise are common sequela of thoracic trauma. Patients must be resuscitated and their injuries managed with the primary goals of restoring cardiopulmonary structural integrity and preventing complications. There are evolving strategies for the management of the thoracic trauma victim including damage control resuscitation and surgery, endovascular repairs, and assessments implementing severity scores to aid in pl...
Source: Critical Care Nursing Clinics of North America - March 27, 2023 Category: Nursing Authors: Eleanor R. Fitzpatrick Source Type: research

Geriatric Trauma and Frailty
Geriatric trauma is increasing in the United States. The care of patients with geriatric trauma is complex due to age-related changes and comorbidities. Patients with geriatric trauma have increased risk of poor outcomes compared with younger patients with trauma, and the highest risk groups are those who have frailty. These patients require special care considerations. Multidisciplinary care can improve outcomes in frail patients with geriatric trauma. (Source: Critical Care Nursing Clinics of North America)
Source: Critical Care Nursing Clinics of North America - March 27, 2023 Category: Nursing Authors: Whitney Villegas Source Type: research

Evidence-Based Pearls
Falls in the ICU are multifaceted, affecting patients of all ages. Historically, falls have been associated with patients in the hospital environment, but fall rates after discharge and readmission rates following a fall are now areas of concern. Recent innovations to prevent risks related to sedation and immobility in the hospital have revealed their impact on ICU patients and fall risk. Risk factors for falls in the ICU relate to length of stay and acuity-related care requirements, such as mechanical ventilation, sedation, and prolonged immobilization. Evidence-based fall prevention includes screening tools, prevention b...
Source: Critical Care Nursing Clinics of North America - March 27, 2023 Category: Nursing Authors: Alison H. Davis, Aimme J. McCauley Source Type: research

Evidence-Based Pearls
Traumatic brain injury (TBI) is a leading cause of death and disability in the United States, predominantly impacting men. The highest risk for the development of a TBI includes athletes, construction workers, military personnel, and law enforcement. TBI is classified as mild, moderate, or severe. The degree of TBI will determine the severity of clinical manifestations. Management of TBI may be a combination of operative and non-operative interventions. Nursing considerations and management include frequent assessment of vital signs and neurologic status, maintaining hemodynamic stability, early identification of worsening...
Source: Critical Care Nursing Clinics of North America - March 27, 2023 Category: Nursing Authors: Mary Ritter Source Type: research

The Complexity of Trauma for LGBTQ+ People
Trauma care is complex. Acute and critical care clinicians perceive trauma as a skilled response to critical injury or accident that occurs to patients, but trauma exists on many levels. One of those is a grim reality for patients who are lesbian, gay, bisexual, transgender, queer or questioning, and from other sexual and gender minorities (LGBTQ+). A lifetime of trauma through stigma, discrimination, and victimization is too often present. Owing to distrust of the health care system and clinicians, LGBTQ+  experience health and health care disparities. (Source: Critical Care Nursing Clinics of North America)
Source: Critical Care Nursing Clinics of North America - March 27, 2023 Category: Nursing Authors: Damon B. Cottrell, Lori Aaron-Brija, Emily Berkowitz, Jeffrey Williams Source Type: research