Patients outcomes

After the nursing diagnoses are formulated, the nurse develops expected outcomes, which are patient oriented. An expected outcome is a direct statement of nurse-patient goals to be achieved. The expected outcome describes the maximum level of wellness that is reasonably attainable for the patient. For example, common expected patient outcomes related to drug administration, in general, include ... 

Report SERIOUS adverse events. An event is serious when the patient outcome is ... 

Pare D, Freed M. Clinical practice guidelines for quality patient outcomes. Nurs Clin North Am 1995 30 183-96. 

Romano PS, Roos LL, Luft HS, et al. A comparison of administrative versus clinical data coronary artery bypass surgery as an example. Ischemic Heart Disease Patient Outcomes Research Team. / Clin Epidemiol 1994 47 249-60. 

Schiller MJ, Shumway M, Hargreaves WA (1999). Treatment costs and patient outcomes with use of risperidone in a public mental health setting. Psyehiatr Serv 50,228-32. 

Pharmacoeconomic studies of other dmgs are fewer and, as with clozapine, rely on less robusr merhods. Risperidone is probably associared wirh lower costs. A Swedish study applying UK costs to patient outcomes showed a reduction in mean direct costs of about 7500 per patient per year (Guest et al, 1996). Other studies, however, show risperidone ro be cost-neutral (Revicki, 1999). There are fewer studies of olanzapine (although there are many publications), and taken together they suggest the dmg is at least cost-neutral with respect to immediate costs (Fichner et al, 1998 Hamilton et al, 1999). 

Patients with massive cerebral infarction may require ICP monitoring, as this may help to guide therapy and predict outcome. Schwab et al. ° evaluated 48 patients with massive hemispheric infarctions and clinical signs of elevated ICP. They found that ICP measurements correlated well with the patient s clinical status, CT findings and outcome, although they did not find a significant effect of their therapies for elevated ICP on patient outcomes. Multiple methods of monitoring ICP are avail-... 

Newer techniques include monitors capable of performing microdialysis, or measuring brain oxygenation and lactate, which may be useful in monitoring penumbral tissue adjacent to a large area of infarction. No randomized studies have been performed to clearly document their impact on patient outcomes to date. 

The use of blue food coloring and methylene blue should be avoided, as it has low sensitivity and has been associated with adverse patient outcomes... 

Diuretics have been the mainstay for HF symptom management for many years. 0 Diuretics are used for relief of acute symptoms of congestion and maintenance of euvolemia. These agents interfere with sodium retention by increasing urinary sodium and free water excretion. No prospective data exist on I the effects of diuretics on patient outcomes.14 Therefore, the... 

Given that VTE is often clinically silent and potentially fatal, prevention strategies have the greatest potential to improve patient outcomes.2 To rely on the early diagnosis and treatment of VTE is unacceptable because many patients will die before treatment can be initiated. Furthermore, even clinically silent disease is associated with long-term morbidity from the postthrombotic syndrome and predisposes the patient to future thromboembolic events. Despite an immense body of literature that overwhelmingly supports the widespread use of... 

Given that VTE is often clinically silent and potentially fatal, strategies to increase the widespread use of prophylaxis have the greatest potential to improve patient outcomes. 

With either type of dialysis, studies suggest that recovery of renal function is decreased in ARF patients who undergo dialysis compared with those not requiring dialysis. Decreased recovery of renal function may be due to hemodialysis-induced hypotension causing additional ischemic injury to the kidney. Also, exposure of a patient s blood to bioincompatible dialysis membranes (cuprophane or cellulose acetate) results in complement and leukocyte activation which can lead to neutrophil infiltration into the kidney and release of vasoconstrictive substances that can prolong renal dysfunction.26 Synthetic membranes composed of substances such as polysulfone, polyacrylonitrile, and polymethylmethacrylate are considered to be more biocompatible and would be less likely to activate complement. Synthetic membranes are generally more expensive than cellulose-based membranes. Several recent meta-analyses found no difference in mortality between biocompatible and bioincompatible membranes. Whether biocompatible membranes lead to better patient outcomes continues to be debated. 

Describe the clinical course of the disease and typical patient outcomes. 

Since early detection and intervention in schizophrenia is important for maximizing outcomes, treatment with antipsychotic medications should begin as soon as psychotic symptoms are recognized. Antipsychotic medications are the cornerstone of therapy for people with schizophrenia, and most patients are on lifelong therapy since non-adherence and discontinuation of antipsychotics are associated with high relapse rates. If other symptoms are present such as depression and anxiety, these symptoms should also be aggressively treated. Additionally, psychosocial treatments should be used concomitantly to improve patient outcomes. 

Lehman AF, Kreyenbuhl J, Buchanan RW, et al. The schizophrenia patient outcomes research team (PORT) updated treatment recommendations 2003. Schizophr Bull 2004 30 193-217. 

It is important to carefully document core ADHD symptoms at baseline to provide a reference point from which to evaluate effectiveness of treatment. Improvement in individualized patient outcomes are desired, such as (1) family and social relationships, (2) disruptive behavior, (3) completing required tasks, (4) self-motivation, (5) appearance, and (6) self-esteem. It is very important to elicit evaluations of the patient s behavior from family, school, and social environments in order to assess the preceding. Using standardized rating scales (e.g., Conners Rating Scales-Revised, Brown Attention-Deficit Disorder Scale, and IOWA Conners Scale) in both children and adults with ADHD helps to minimize variability in evaluation.29 After initiation of therapy, evaluations should be done every 2 to 4 weeks to determine efficacy of treatment, height, weight, pulse, and blood pressure. Physical examination or liver function tests may be used to monitor for adverse effects. 

Physical disability from RA can be measured through the Stanford Health Assessment Questionnaire (HAQ).39,40 This patient self-assessment tool was developed to evaluate patient outcomes in five dimensions of chronic conditions ... 

Hugonnet S, Eggimann P, Borst F, et al. Impact of ventilator-associated pneumonia on resource utilization and patient outcome. Infect Control Hosp Epidemiol 2004 25 1090-1096. 

Patient outcomes rely on the clinicians ability to recognize NF early in the course of disease. This is often difficult because early disease tends to be indistinguishable clinically from cellulitis. I The clinical presentation of NF is presented in Table 70-4. 

Many studies have been conducted evaluating or comparing the effectiveness of antimicrobials for treatment of intraabdominal infections. Substantial differences in patient outcomes from treatment with a variety of agents generally have not been demonstrated. 

If symptoms do not improve, the patient should be evaluated for persistent infection. There are many reasons for poor patient outcome with intraabdominal infection improper antimicrobial selection is only one. The patient maybe immunocompromised, which decreases the likelihood of successful outcome with any regimen. It is impossible for antimicrobials to compensate for a nonfunctioning immune system. There may be surgical reasons for poor patient outcome. Failure to identify all intraabdominal foci of infection or leaks from a GI anastomosis may cause continued intraabdominal infection. Even when intraabdominal infection is controlled, accompanying organ system failure, most often renal or respiratory, may lead to patient demise. 

Assess complications of sepsis and discuss their impact on patient outcomes. 

Discuss the epidemiology and impact of surgical wound infections on patient outcomes and health care costs. 

SSIs negatively affect patient outcomes and increase health care costs. Patients who develop SSIs are five times more likely to be readmitted to the hospital and have twice the mortality of patients who do not develop an SSI.1 A patient infected with an SSI is also 60% more likely to be admitted to an intensive care unit.1 Clinical studies have shown that SSIs increase lengths of hospital stay and costs.1,3,4 The type of SSI can also affect outcome. Deep SSIs, involving organs or spaces, result in longer durations of hospital stay and higher costs compared to SSIs that are limited to the incision.5... 

Prophylactic antimicrobials should be started within an hour of the first incision to optimize patient outcomes. Exceptions to this include vancomycin and fluoroquinolones. 

Recent advances in the treatment of cancer of the colon and rectum now offer the potential to improve patient survival, but for many patients, improved disease- and progression-free survival represent equally important therapeutic outcomes. In the absence of the ability of a specific treatment to demonstrate improved survival, important outcome measures should include the effects of the treatment on patient symptoms, daily activities, performance status, and other quality-of-life indicators. Individualized patient care to balance the risks associated with treatment with the benefits of a specific treatment regimen is necessary to optimize patient outcomes. 

Clinical trial data supporting the use of specialty formulas in niche populations typically are unconvincing in terms of patient outcomes. 

Specialty formulas designed for use in specific clinical situations generally are much more expensive than standard polymeric formulas. Strong clinical trial data supporting use of these specialty formulas in niche populations typically are unconvincing in terms of patient outcomes. 

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