Clinical Pearls

Abstract

Guidelines for appropriate patient assessments after procedures are often not evidence based. The standard after removal of temporary pacer wires is to monitor “routine” vital signs (VS) at set intervals. To determine if current procedures for obtaining VS after temporary pacemaker wire removal (TPWR) effectively identify risks for cardiac tamponade (CT), Mahon and colleagues reviewed 23 717 cardiothoracic surgery cases with 23 reoperations for CT following TPWR. Blood pressure changes were the most common single symptom after TPWR and before reoperation for CT. Other findings were bleeding in 6 cases (26%), dyspnea in 26% of reviewed patients, and infrequent heart rate changes. Based on these findings, the authors suggest the following:—Elisabeth George,rn, phdSee Article, pp 432–440In a retrospective study, Nye and colleagues compared scores of the Glasgow Coma Scale (GCS) and 3 published “slim” versions of the National Institutes of Health Stroke Scale (NIHSS) with the full NIHSS to evaluate the value of these measures in detecting neurologic disability. Study findings revealed the following:These findings uphold the American Stroke Association and Brain Attack Coalition Guidelines for use of the NIHSS to quantify neurologic disability in acute stroke patients.— Karen A. McQuillan,rn, ms, cns-bc, ccrn, cnrnSee Article, pp 442–448McAdam and colleagues studied the levels of psychological distress in family members of high-risk intensive care unit (ICU) patients and found that psychological symptoms decreased 3 months after the ICU stay but remained high enough to warrant concern. Nurses may be able to recognize symptoms of stress in family members by observing the following:Preventive measures to respond to family needs may include these techniques:—Janet Mulroy,rn, msn, acnp, ccns, ccrnSee Article, pp 386–394