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Item Rapid appraisal project: Marik protocol for sepsis management(2018-11) Klein*, Emily; Aguilar, Brianna; Holm, Ashley; Robinson, Britta; Hoppe, Lesa, PhD, MSN, RNDo patients diagnosed with severe sepsis who are treated with hydrocortisone, thiamine, and vitamin C have a better prognosis than those treated with the current standard practice? Through extensive searching of the Cochrane Collection, PubMed, and the Bryan College of Health Sciences Library, this medication regimen effectiveness was analyzed. To research this regimen, three primary research articles were chosen. Because this topic is new, available research was limited. Criteria for the primary article included the full medication regimen, a critical care setting, and the diagnosis and prognosis of sepsis. Additionally, one systematic review was chosen that analyzed the effectiveness of hydrocortisone in the treatment of sepsis. To supplement the article and review, a registered nurse was interviewed. With over 30 years of experience in the intensive cardiac unit at an urban hospital, she detailed her experiences with sepsis and shared that this protocol has been in discussion at intensive care conventions. Through the research, we found that this protocol decreased mortality by 32%, decreased the need for dialysis by 17%, and decreased vasopressor use by an average of 35 hours. Ultimately, this medication regimen shows great potential but will need to be studied further before it becomes standard practice.Item Nutrition Related to Wound Healing(2018-12) Grieve, Mackenzie; Wurtz, Laura; Hoppe, Lesa. PhD, MSN, RNThrough clinical experiences amongst patients with wounds, an inquiry arose regarding interventions that could be used to expedite the healing process—specifically nutrition. Through extensive searching of Bryan Fusion, inclusive of scholarly works found in databases such as PubMed and CINAHL, articles were found comparing wound healing and nutrition. An interview with an expert clinician was also conducted. A primary outcome of this literature review process was the finding that malnutrition is highly prevalent in patients with pressure ulcers. According to our research, proper nutrition and supplementations are proven to be beneficial in wound prevention and healing. The nutrients that had the greatest effect on wound healing include arginine, zinc, antioxidants, and protein supplementation.Item What current research can teach medical personnel about sepsis management and treatment(Nebraska Academy of Sciences, 2019-04-12) Klein*, Emily; Holm, Ashley; Aguilar, Brianna; Robinson, BrittanyDo patients diagnosed with severe sepsis who are treated with hydrocortisone, thiamine, and vitamin C have a better prognosis than those treated with the current standard practice? Through extensive searching of the Cochrane Collection, PubMed, and the Bryan College of Health Sciences Library, this medication regimen effectiveness was analyzed. To research this regimen, three primary research articles were chosen. Because this topic is new, available research was limited. Criteria for the primary article included the full medication regimen, a critical care setting, and the diagnosis and prognosis of sepsis. Additionally, one systematic review was chosen that analyzed the effectiveness of hydrocortisone in the treatment of sepsis. To supplement the article and systematic review, a critical care nurse was interviewed. With over 30 years of experience in the intensive cardiac unit at an urban hospital, she detailed her experiences with sepsis and shared that this protocol has been in discussion at intensive care conventions. Through research, we found that this protocol decreased mortality by 32%, decreased the need for dialysis by 17%, and decreased vasopressor use by an average of 35 hours. Ultimately, the current research on this medication regimen shows great potential in benefiting patient outcomes.Item Rapid Appraisal Project: Nutrition Related to Wound Healing(2019-04-22) Grieve, Mackenzie; Wurtz, LauraThrough clinical experiences amongst patients with wounds, an inquiry arose regarding interventions that could be used to expedite the healing process—specifically nutrition. Through extensive searching of Bryan Fusion, inclusive of scholarly works found in databases such as PubMed and CINAHL, articles were found comparing wound healing and nutrition. An interview with an expert clinician was also conducted. A primary outcome of this literature review process was the finding that malnutrition is highly prevalent in patients with pressure ulcers. According to our research, proper nutrition and supplementations are proven to be beneficial in wound prevention and healing. The nutrients that had the greatest effect on wound healing include arginine, zinc, antioxidants, and protein supplementation.Item Delayed Umbilical Cord Clamping(2019-05) Boller, Southern; Young, Shayna; Hoppe, Lesa. PhD, MSN, RNThe purpose of this research project was to look at the effect and assess the delaying of the umbilical cord clamping at birth. The articles obtained were from CINAHL and PubMed. The PICO question that gave results included: in neonates (greater than 34 weeks gestation), does delayed umbilical cord clamping, compared to early umbilical cord clamping, affect hematocrit/hemoglobin. This evidence-based practice of delayed cord clamping has been implemented in medical centers around the country and world as the beneficial effects has been shared through research and trials. Delayed umbilical cord clamping, as compared to early, has shown benefits including a decrease in mortality, an increase in the hemoglobin and hematocrit, and an overall increase in the baby's well-being, especially in pre-term infants. This research included data sources from randomized controlled trials and systematic reviews - meta analysis. The studies can be applied to a general population through the labor and delivery process. One specific finding of the research articles was the commonalities in relationship to hematological components related to delayed cord clamping. The intervention group saw a higher hematocrit and hemoglobin without increases in hyperbilirubinemia or symptomatic polycythemia. This leads to an increase in oxygen available to the newborn, which helps to increase the oxygen saturation and better perfuse the organs. The infant's vital signs will show an improvement including the cardiac output, heart rate, and blood pressure. Other findings included in the research were a decrease in mortality in infants and a higher APGAR score at birth. The delaying of the clamping caused a reduction of the incidence of blood transfusions, infection, and sepsis. Many of the benefits were documented later on in the infants' life. This included a lower incidence of anemia and iron deficiency. The selected studies gave collected data and reviewed bias related to delayed versus early umbilical cord clamping. The researchers saw many benefits through the subjects including improvement to the infant's health and development throughout their lifespan. The benefits included an increase in hemoglobin and hematocrit, a higher APGAR score, lower bilirubinemia, and lower incidence of hospital mortality. Delayed umbilical cord clamping has shown to be safe, beneficial, and is now being implemented in health care facilities around the world.Item Nitrous oxide use in labor(2019-05) Nevels, Kelci; Petsch, Priscilla; Sevcik, Emily; Hoppe, Lesa, PhD, MSN, RNThere is a great amount of literature exploring the effects of nitrous oxide (N2O) as a method of pain relief for laboring women. However, a majority of this research was published prior to 2010 and conducted in other countries. Since the emergence of epidural analgesia, N2O has not been the method of choice for labor pain management in the United States. Despite this trend, many hospitals have recently seen a reemergence of this less expensive and less invasive gas. Many women are choosing this method of pain relief due its benefits of having a shorter half-life, ability to encourage feelings of empowerment, and the requirement of fewer interventions that would be needed with epidural analgesia (e.g., bladder catheterization, intravenous fluid bolus, blood pressure monitoring). This gas is also an appropriate option for women if epidural analgesia is contraindicated, ineffective, or inadequate. Since this drug is self-administered by the patient, there are minimal risks of adverse effects for hospital staff and caregivers. Side effects of N2O inhalation include dizziness, nausea, vomiting, and drowsiness. Research on this intervention has not found a significant relationship between maternal N2O inhalation and neonatal APGAR scores. Overall, many studies are indicating positive benefits of N2O inhalation as a method of pain management during labor. Unfortunately, a majority of these studies were of poor quality with bias and inconsistency among expected outcomes. Furthermore, many of these studies are qualitative, gaining mothers' views of N2O use after deliveries. Clearly, further quantitative research regarding this form of pain management during labor is needed to accurately assess its effectiveness as well as the potential risks to mother, neonate, and medical staff.Item What Current Research Can Teach Medical Personnel About Sepsis Management and Treatment(2019-10-19) Klein*, Emily; Aguilar, BriannaDo patients diagnosed with severe sepsis who are treated with hydrocortisone, thiamine, and vitamin C have a better prognosis than those treated with the current standard practice? Through extensive searching of the Cochrane Collection, PubMed, and the Bryan College of Health Sciences Library, this medication regimen effectiveness was analyzed. To research this regimen, three primary research articles were chosen. Because this topic is new, available research was limited. Criteria for the primary article included the full medication regimen, a critical care setting, and the diagnosis and prognosis of sepsis. Additionally, one systematic review was chosen that analyzed the effectiveness of hydrocortisone in the treatment of sepsis. To supplement the article and systematic review, a critical care nurse was interviewed. With over 30 years of experience in the intensive cardiac unit at an urban hospital, she detailed her experiences with sepsis and shared that this protocol has been in discussion at intensive care conventions. Through research, we found that this protocol decreased mortality by 32%, decreased the need for dialysis by 17%, and decreased vasopressor use by an average of 35 hours. Ultimately, the current research on this medication regimen shows great potential in benefiting patient outcomes.Item Bezoar(Bryan College of Health Sciences, 2019-11) Klein, Randa; Julie Morbach, MA, RDMS, RVT, RT(R)Although uncommon, bezoars are a well-recognized accumulation of partially or completely undigested material present anywhere in the gastrointestinal tract. There are multiple types of bezoars, each classified according to their contents. In this case study, a female child presented to her primary care physician with generalized abdominal pain. Physical examination verified the presence of a palpable mass in the epigastric region. The primary care provider ordered an abdominal ultrasound examination, which was followed up with a computed tomography (CT) contrast exam. Comparison of the two imaging modalities resulted in the diagnosis of a gastric bezoar. Onset of bezoar symptoms does not occur until the mass becomes relatively large in size. Once symptoms are present it is important for doctors and healthcare professionals to diagnose and treat bezoars in an accurate and timely manner. Early detection provides the patient enough time to attempt noninvasive treatment options before the bezoar becomes life threatening.Item Incarcerated Left Inguinal Hernia(2019-11-08) Sedivy, Allison; Morbach, Julie, MA, RDMS, RVT, RT(R), Bryan College of Health SciencesThe patient of this case had undergone a unique experience as he had minimal risk factors for an inguinal hernia. He presented to the emergency department with a sudden onset of a severe left incarcerated inguinal hernia. After an ultrasound and CT imaging, he immediately was sent to surgery for a left-sided inguinal hernia repair. During surgery complications were discovered as some of the bowel had been incarcerated. Twelve days after the surgical procedure, the patient presented again to the emergency department with symptoms of a right inguinal hernia. After additional imaging, he was sent back for another surgical repair. With the proper imaging modalities of computed tomography and ultrasound available to evaluate his condition, he was able to receive necessary care for a good outcome.Item Sacrococcygeal teratoma(2019-11-19) Berkey, Holly; Morbach, Julie, MA, RDMS, RVT, RT(R), Bryan College of Health SciencesSacrococcygeal tumors are the most common congenital anomaly in fetuses. This presentation focuses on the pathogenesis of sacrococcygeal teratomas. In the case study presented, a pregnant female patient was referred to Maternal-Fetal Medicine following an abnormal ultrasound with her primary obstetric care office. Through a detailed examination of the fetus, it was determined that a mostly cystic sacrococcygeal teratoma was present. The fetus was then monitored weekly via ultrasound leading to delivery. The mass continued to increase in size leading to intrauterine growth restriction in the fetus. The fetus was delivered via cesarean section at 36 weeks and six days gestation and surgical intervention of the mass was performed. Early intervention from the healthcare team in this patient’s case was vital in creating a treatment plan that would result in a healthy mother and fetus. Appropriate imaging and procedures early in pregnancies like this are important so that the mother can evaluate all her options and so that surgical teams can develop proper treatment plans for the post-natal time period.Item Dandy-Walker variant(Bryan College of Health Sciences, 2019-12-03) Heckathorn, Mikayla; Julie Morbach, MA, RDMS, RVT, RT(R)Fetal anatomy scans are one of the most important tools in evaluating a fetus for abnormalities. A primary focus of the fetal ultrasound is the brain. Ultrasound of the fetal brain can detect abnormalities in the brain like those with characteristics that fall under the dandy-walker complex. Detection of a brain abnormality can alert the obstetrics doctor and the imaging team that there may be abnormalities elsewhere in the body. Detecting abnormalities early can place the patient under a high-risk pregnancy flag and get the patient to maternal fetal medicine for further assessment and counseling. This case study looks at a pregnant patient coming to her initial 20-week fetal anatomy scan. Findings of an abnormal cerebellum and suboptimal views of the face and heart prompted a recommendation to the maternal fetal medicine clinic for a follow-up. Dandy-Walker malformation falls under the category of dandy-walker complex, it is the most common malformation of the cerebellum. After being referred to the maternal fetal medicine clinic the patient had a detailed fetal anatomy ultrasound. This confirmed the finding of an abnormal cerebellum consistent with dandy-walker variant. A hypoplastic or absent nasal bone was also discovered and because of the patient’s advanced maternal age raised the probability of the fetus having Down Syndrome. Following the referral to maternal fetal medicine, the team at MFM closely monitored the patient due to maternal factors that placed her in a high-risk category. Detection of this abnormality allowed the patient to receive many options and the level of care and counseling necessary following a diagnosis of dandy-walker variant and Down Syndrome.Item Invasive papillary breast carcinoma: A case study(Bryan College of Health Sciences, 2019-12-03) Hixson, Malerie; Julie Morbach, MA, RDMS, RVT, RT(R)Papillary breast carcinoma constitutes approximately 0.5% of invasive breast cancers (Pal et al, 2010). Patients are usually postmenopausal females, especially the age range of 40-75, who present with bloody nipple discharge, a palpable mass, or abnormalities on medical imaging such as mammography or ultrasonography. Histology reports show that distinguishing papillary carcinoma from other breast cancers can be determined by a proliferation of malignant papillary cells which do not contain an intact layer of myoepithelial cells within the papillae. Patients have a good prognosis, with a ten year survival rate of 86% (Schneider, 1989). There are several options for treatments including mastectomy, lumpectomy, or chemotherapy treatment.