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Objective:To explore the establishment of a cluster intervention strategy by multi-criteria decision analysis (MCDA) to provide a basis for the early removal of indwelling catheters in severe neurological patients.Methods:Through literature retrieval and MCDA, the catheter cluster intervention strategy was constructed, and the expert consultation was adopted to finally form 7 item cluster intervention strategies. The convenience sampling method was used to select 122 patients with severe neurological diseases as the research objects. A total of 61 patients with indwelling catheters from November 2018 to April 2019 were selected as the control group, and routine nursing care was performed according to indwelling catheters. A total of 61 patients with indwelling catheters from May 2019 to October 2019 were selected as the intervention group to compare the success rate of removing catheters, the number of days of indent catheters and the incidence of catheter-associated urinary tract infection ( CAUTI) in the two groups, as well as to analyze the indicators related to indent catheters in the intervention group with different diagnoses. Results:CAUTI incidence, successful catheter removal rate, indwelling days of catheter in the intervention group were 39.3% (24/61), 32.79% (20/61), 17 (14,22) days, which were significantly higher than 59.0% (36/61), 8.19% (5/61), 21 (15, 27) days in the control group, and the difference was statistically significant (χ 2 values were 4.723, 11.775, Z value was -9.211, P<0.05 or 0.01); In the intervention group, stroke patients′ indwelling time of catheter were 7-20 days, and the highest success rate of removing urinary catheters 36.6% (15/41), compared with other diseases, the difference was statistically significant ( Z values were -2.448, -2.109, P<0.05). Conclusion:MCDA construction of early catheter removal strategy can significantly shorten the indwelling time of the catheter in patients with severe neurological diseases, improve the success rate of early catheter extubation, reduce the CAUTI rate, to provide evidence-based basis for clinical nursing.
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Objective:To explore the application effect of optimizing the anti-epileptic drug (AED) administration nursing procedure for patients with severe epilepsy at the first time after ICU admission.Methods:A quasi-experiment study was conducted by convenience sampling. The 44 patients with severe status epilepticus admitted in our department from January 2016 to December 2017 were selected as the control group .The 44 patients with status epilepticus admitted in our department from January 2018 to December 2019 were selected as the experimental group .The experimental group was implemented the optimized administration procedure after ICU admission. The control group was implemented the routine administration procedure after ICU admission. Some data of the two groups were compared, including baseline data, first administration time after admission, administration step time, AED dose reserve, and seizures at different time periods and so on.Results:Comparative analysis of the time of the first drug administration after admission into the two groups .The administration time of the control group was 31.0 (10.0-69.0) min, which was significantly longer than that of the experimental group, 25.0 (16.0-31.8) min ( χ2 value was -2.760, P<0.05). Comparison and analysis of the time taken for each step of drug administration: The time taken for step 1(Patient admission—medical order confirmation) in the control group was significantly greater than that in the experimental group ( χ2 value was -2.811, P<0.05); step 2 (medical order confirmation—Prepare medicines)in the control group was significantly greater than that in the experimental group ( χ2 value was -4.327, P<0.05).There was no significant difference in the time taken for step 3(Prepare medicines—Drug delivery to complete)between the two groups ( χ2 value was -1.137, P>0.05). Control group AED reserve ratio 63.6% (28/44), experimental group AED reserve was 100.0% (44/44), and the difference was statistically significant ( χ2 value was 19.556, P<0.05). Epilepsy control in two groups of patients: the total control rate after the first administration of the experimental group was 93.2% (41/44), which was significantly higher than 61.4% (27/44) of the control group ( Z value was -3.445, P<0.001). Conclusion:It can shorten the time to first give AED and improve the patient's clinical symptoms that optimizing the first drug administration procedure for patients with status epilepticus after admission.
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Objective@#To discuss the correlation between different muscle strength of lower extremitiess and the formation of deep vein thrombosis (DVT) in neurological ICU patients, and to provide evidence for effective nursing intervention.@*Methods@#A questionnaire was developed to investigate the factors related to lower extremities DVT in patients with neurological ICU.By collecting clinical data of 195 patients from neurological ICU in Xuanwu Hospital of Capital Medical University, using the UK Medical Research Council(MRC) scale of freehand muscle strength for grading evaluation, patients were divided into a muscle strength grade 4-5 group (at least one extremities muscle strength grade 4) and a muscle strength grade 0-3 group (both lower extremities muscle strength grade 3).Gender, age, deep venous catheterization, Glasgow Coma Scale(GCS) score, bed time, fibrinogen value, D-dimer value were compared between the two groups.The main influencing factors of lower extremities DVT with different muscle strength were analyzed, and the incidence of lower extremities DVT with different muscle strength was compared.@*Results@#The comparison between muscle strength grade 4-5 group and muscle strength grade 0-3 group in neurological ICU patients showed that bed time, GCS score, and D-dimer of the 0-3 muscle strength group were 18.96(14.00, 27.00) d, 9.00(6.00, 10.15), and 2.15(1.24, 3.58) mg/L, while those of the 4-5 muscle strength group were 13.50(5.75, 22.00)d, 13.50(10.00, 15.00), 1.52(0.76, 2.99) mg/L, the difference was statistically significant (Z=-3.767, -5.811, -2.296, P<0.01 or 0.05).While gender, catheterization, fibrinogen, anticoagulant use and age had no statistical significance (P > 0.05). Grouping comparison of unilateral lower extremities muscle strength showed that the left lower extremities muscle strength group,the incidence of thrombosis in grade 0-3 group was 26.9%(32/119), and that in grade 4-5 group was 14.5%(11/76), the incidence of left lower extremities DVT had statistical significance (χ2=4.160, P<0.05),and the right lower extremities muscle strength group,the incidence of thrombosis was 32.8%(41/125) in the 0-3 group and 15.7%(11/70) in the 4-5 group, the incidence of right lower extremities DVT had statistical significance (χ2=6.698, P<0.05).@*Conclusions@#Patients with grade 0-3 lower extremities muscle strength in neurological ICU have more factors influencing DVT.The incidence of DVT is high in the lower extremities with unilateral extremities muscle strength grade 0-3, and early monitoring of lower extremities DVT should be strengthened to prevent the occurrence of lower extremities DVT.
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This article reviews the nursing care of recent years to assist neurotic patients to turn over to prevent pressure sore. The present situation of nursing research on the prevention effect of pressure sore with different turn over method, different turn over angle, different turn over interval time combined with the nature of mattress and patient's condition were introduced, and the effect of preventing pressure sore with different turn over auxiliary appliance was introduced in order to provide a reference for the development of individual nursing guidelines for neurocritical patients.
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[Absrtact] This article reviews the nursing care of recent years to assist neurotic patients to turn over to prevent pressure sore. The present situation of nursing research on the prevention effect of pressure sore with different turn over method, different turn over angle, different turn over interval time combined with the nature of mattress and patient's condition were introduced, and the effect of preventing pressure sore with different turn over auxiliary appliance was introduced in order to provide a reference for the development of individual nursing guidelines for neurocritical patients.