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This is a case study describing a young woman with a chief complaint of low back pain (LBP) symptoms. Initially, she was evaluated and treated for LBP. Her back pain worsened over the course of 16 weeks, and she eventually developed chills and fever. Knowledge of the presentation, assessment, and differentials in patients with LBP is essential to quickly identifying, diagnosing, treating, and referring patients with uncommon etiologies.

Background Patients with isolated left ventricular failure may have positive outcomes after being implanted with a left ventricular assist device. Unfortunately, almost half of patients with heart failure and reduced ejection fraction also have evidence of right ventricular dysfunction. For a subset of this population with severe biventricular failure, or those who develop right ventricular dysfunction after left ventricular assist device implantation, patients may necessitate biventricular assist devices or the total artificial heart. Objectives This overview of mechanical circulatory support devices will enhance nurses' ability to differentiate criteria for implantation, current practice, and outcomes with a focus on durable ventricular assist devices and the total artificial heart. Methods A review of the literature involved searching CINAHL and PubMed databases using keywords biventricular assist devices, total artificial heart, and durable mechanical circulatory support. Results were narrowed to articles based on adults, 18 years or older. Seventy-eight relevant articles were identified, and 8 articles compared the durable biventricular assist devices. Results Similar patient outcomes were found when comparing the use of left ventricular assist devices as biventricular support versus the total artificial heart. Discussion The decision to implant the appropriate durable mechanical circulatory support for a patient in biventricular failure is complex and dependent on patient factors.

The Rapid Ultrasound for Shock and Hypotension (RUSH) examination is used for patients with hypotension without clear cause or undifferentiated hypotension. In the emergency department setting, clinicians may perform the RUSH examination to supplement the physical assessment and differentiate the diagnosis of hypovolemic, obstructive, cardiogenic, and distributive forms of shock. The key elements of the RUSH examination are the pump, tank, and pipes, meaning potentially causes of the hypotension are examined within the heart, vascular volume and integrity, and the vessels themselves. Clinicians follow a systemic protocol to seeking evidence of specific conditions including heart failure exacerbation, cardiac tamponade, pleural effusion, pneumothorax, abdominal aortic aneurysm, and deep vein thrombosis. Because ultrasonography is a user-dependent skill, the advanced practice nurse in the emergency department should be educated regarding the RUSH protocol and prepared to implement the examination.

The Rapid Ultrasound for Shock and Hypotension (RUSH) examination is used for patients with hypotension without clear cause or undifferentiated hypotension. In the emergency department setting, clinicians may perform the RUSH examination to supplement the physical assessment and differentiate the diagnosis of hypovolemic, obstructive, cardiogenic, and distributive forms of shock. The key elements of the RUSH examination are the pump, tank, and pipes, meaning potentially causes of the hypotension are examined within the heart, vascular volume and integrity, and the vessels themselves. Clinicians follow a systemic protocol to seeking evidence of specific conditions including heart failure exacerbation, cardiac tamponade, pleural effusion, pneumothorax, abdominal aortic aneurysm, and deep vein thrombosis. Because ultrasonography is a user-dependent skill, the advanced practice nurse in the emergency department should be educated regarding the RUSH protocol and prepared to implement the examination.

Background: There is a lack of diversity in the master's prepared nursing workforce. One nursing school implemented a scholarship program for students from disadvantaged backgrounds enrolled in the Family Nurse Practitioner and Adult Gerontology Primary Nurse Practitioner tracks. Method: Awardees were required to be full-time students from disadvantaged backgrounds with financial need. Each student was matched with a faculty member for regular mentorship. Student progress was evaluated every three months, with follow-up 1 year after graduation. Results: A total of 45 students received the Scholarship for Disadvantaged Students (SDS) over 2 consecutive years. Of the 45 students, 26 (58%) identified themselves as Hispanic and 11 (24%) as black. A total of 42 (93%) of 45 SDS students completed the original plan of study and passed the national certification board. Conclusion: The SDS serves as a model of an effective mentorship program to assist nurse practitioner students from disadvantaged backgrounds. [ J Nurs Educ . 2020;59(5):287–290.]

More than 5 million central lines are placed in the United States each year. Advanced practice providers place central lines and must understand the importance of ultrasound guidance technology. The use of anatomic landmarks to place central lines has been employed in the past and in some instances is still used. This method may make accessing the target vessel difficult in the patient with anomalous anatomy or in the obese patient. These characteristics decrease successful placement and increase complications. Different organizations have agreed that the use of ultrasound during central venous access has decreased rates of complication and cost. In addition to cannulating and accessing a central vein, ultrasound can be used to rapidly confirm placement and to rule out complications such as pneumothorax. Utilizing ultrasound to assist in performance of procedures, and in assessment of patients, is a skill that should be optimized by nurse practitioners.

Background Endotracheal intubation using direct laryngoscopy is a fundamental skill for health care professionals who are tasked with the job of securing a patient's airway. Teaching this skill is often challenging because of the inability of a faculty member to share the same vantage point as the learner. The aim of this study was to determine feasibility and acceptability of the use of telehealth glasses to guide teaching the skill of endotracheal intubation. Method This study used a qualitative descriptive design through transcript analysis of open-ended survey questions completed by 14 nurse practitioner students in the Southeastern United States. Results Three categories emerged from the students’ responses regarding use of the telehealth glasses: advantages, disadvantages, and recommendations. Conclusions Although the findings were mixed, the researchers learned powerful lessons that could be helpful to educational researchers who would like to use a form of glasses.

Acute care nurse practitioners manage a wide range of patient diagnoses and problems encountered in critical care, including management of delirium. As such, they are positioned to be leaders in the prevention, recognition, and management of delirium in the intensive care unit setting. Delirium in the hospitalized patient is linked with a prolonged length of stay, higher risk of death, and cognitive decline. Delirium will occur in up to 87% of intensive care unit patients with severe illness or recovering from major surgery. This overview of current evidence-based practice guidelines and an accompanying case study will assist interdisciplinary teams of health care providers to diagnose, treat, and manage hospitalized patients with delirium, with a focus on the complex care of the critically ill patient population.

Use of bedside ultrasonography to identify life-threatening injuries for patients with blunt and penetrating trauma is the standard of care in the emergency department. The "FAST" examination-focused assessment with sonography for trauma-ultrasound scan of the chest and abdomen allows clinicians to assess critical regions for free fluid without use of invasive procedures as quickly and as often as needed. In addition, ultrasonography has a high degree of sensitivity and specificity and is safe during pregnancy. For patients requiring evaluation of the pleura, the "eFAST" (or extended FAST) may be conducted, which may serve to locate pleural effusions, hemothorax, and pneumothorax. However, ultrasound quality is operator dependent and is recommended with other diagnostic measures to provide a complete clinical picture of trauma patients. Ongoing development of ultrasound competency among established clinicians and nurse practitioner students is vital to maintain diagnostic accuracy and ensure quality care for trauma patients in the emergency department.

Accurate and timely identification of existing audible medical alarms is not adequate in clinical settings. New alarms that are easily heard, quickly identifiable, and discernable from one another are indicated. The "auditory icons" (brief sounds that serve as metaphors for the events they represent) have been proposed as a replacement to the current international standard. The objective was to identify the best performing icons based on audibility and performance in a simulated clinical environment.Three sets of icon alarms were designed using empirical methods. Subjects participated in a series of clinical simulation experiments that examined the audibility, identification accuracy, and response time of each of these icon alarms. A statistical model that combined the outcomes was used to rank the alarms in overall efficacy. We constructed the "best" and "worst" performing sets based on this ranking and prospectively validated these sets in a subsequent experiment with a new subject sample.Experiments were conducted in simulated ICU settings at the University of Miami.Medical trainees were recruited from a convenience sample of nursing students and anesthesia residents at the institution.In Experiment 1 (formative testing), subjects were exposed to one of the three sets of alarms; identical setting and instruments were used throughout. In Experiment 2 (summative testing), subjects were exposed to one of the two sets of alarms, assembled from the best and worst performing alarms from Experiment 1.For each alarm, we determined the minimum sound level to reach audibility threshold in the presence of background clinical noise, identification accuracy (percentage), and response time (seconds). We enrolled 123 medical trainees and professionals for participation (78 with6 yr of training). We identified the best performing icon alarms for each category, which matched or exceeded the other candidate alarms in identification accuracy and response time.We propose a set of eight auditory icon alarms that were selected through formative testing and validated through summative testing for adoption by relevant regulatory bodies and medical device manufacturers.

Introduction Ultrasound-guided central venous catheter insertion (UGCVC) is a commonly performed procedure taught through simulation. The aims of the study were to examine the utilization of an animal model and compare it with two currently used Blue Phantom central line models to determine whether an animal model provides good or better simulated conditions for the performance of UGCVC insertion. Methods Using a randomized cross-over study, 46 advanced practice nursing students were assessed using a task-specific performance tool in their performance of UGCVC insertion on both the animal model and the Blue Phantom models. The number of insertion attempts and time to performance was recorded. A preprocedure survey was used to ascertain their presimulation workshop experience, followed by a postprocedure survey. A cost comparison was completed as a secondary outcome. Results A comparison was conducted on the performance scores and the postsurvey results between the animal model and the Blue Phantom models. The number of venous access attempts was not significantly different when comparing the three models. A cost comparison showed the total cost of each animal model was US $15.66 as compared with the approximate cost for the Blue Phantom IJ model of US $1500.00 and the Gen I model of US $2700.00. Conclusions Current Blue Phantom models lack the ability to fully perform all the necessary steps critical to the performance of UGCVC insertion. At a total cost of US $15.66 per model, this study showed that training with an alternative economical model was comparable with more expensive mannequin simulators. The results of this study may serve to guide clinicians and educators who are seeking alternative simulation models to provide skill acquisition.