T he development of hospital-acquired pressure ulcers is a great concern in health care today. Pressure ulcer treatment is costly, and the development of pressure ulcers can be prevented by the use of evidence-based nursing practice. In 2008, the Centers for Medicare and Medicaid Services announced that they will not pay for additional costs incurred for hospital-acquired pressure ulcers.1 The development of a stage III or IV pressure ulcer is now considered a "never event."2 This change has resulted in an increased focus on preventive strategies and institutional scrutiny of pressure ulcers that develop in patients after hospital admission. The cost of 1 stage III or IV pressure ulcer may be between $5000 and $50000. 2The actual cost of pressure ulcers is not known because it is unclear what costs were included in estimates, such as nursing care costs, material costs, and added acute care days related to the development of a pressure ulcer. 3 In the intensive care unit (ICU), patients have multiple factors that increase the risk of pressure ulcers developing. Typically the patient has respiratory equipment, urinary catheters, sequential compression devices, multiple intravenous catheters, and the infusion of vasoactive agents for hypotension that may contribute to inability to turn patients and increase the risk of pressure ulcer development. This article discusses the multiple risk factors present in critical care for the development of pressure ulcers, current practices, and evidence for interventions aimed at preventing pressure ulcers.

Stevens-Johnson syndrome is a rare, potentially fatal drug reaction that causes necrosis of epidermal cells. Early recognition of the syndrome is essential to prevent complications. This article discusses identification, complications, and treatment of Stevens-Johnson syndrome.

Patients with heart failure and pulmonary edema are often admitted to the critical care unit. Many of these patients have severe peripheral edema, which may be associated with exudates and wounds of the lower extremities and which present a challenge to critical care nurses. Little information is available on treatment of peripheral edema in the intensive care unit or in patients with unstable hemodynamic status. Nursing care is based on available evidence, findings on chest radiographs, and hemodynamic status. Medications that contribute to peripheral edema should be evaluated and discontinued if possible. An appropriate mattress surface with an underpad that promotes wicking away of moisture should be selected. The patient’s lower extremities should be elevated according to his or her current pulmonary status, and skin-protective interventions should be instituted. Multilayer compression wraps should be avoided until the patient’s hemodynamic status is stable and the patient can get out of bed.

H eart failure is a debilitating chronic condition that affects more than 5 million patients in the United States. 1 The condition is complex and incurable, but multiple medications, procedures, and devices are available to treat it. Biventricular pacing, a therapy for some patients with heart failure, can improve quality of life and reduce the number of hospitalizations and mortality. 2,3 In this article, I discuss selection of patients and devices, the procedure used to implant the pacemaker, potential complications, and assessment of the function of biventricular pacemakers. Nurses who provide care for patients with permanent pacemakers and biventricular pacemakers should be knowledgeable in the assessment of electrocardiographic (ECG) findings related to adequate functioning of biventricular pacemakers. In addition, I provide bedside critical care or telemetry nurses the information to determine if a biventricular pacemaker is functioning and when to contact a cardiologist to determine if further interrogation of the pacemaker or correction of timing is needed. Indications for Biventricular Pacing in Heart FailureMultiple indications exist for implanting a biventricular pacemaker in patients with heart failure, and the indications are continuously being reevaluated to include a broader range of patients with the diagnosis of heart failure. According to the Heart Failure Society of America, biventricular pacing is recommended for patients with sinus rhythm, a widened QRS interval greater than 120 ms, and a left CE Continuing Nursing EducationCover Patients with heart failure may benefit from implantation of a biventricular pacemaker. This article discusses the indications for biventricular pacemaker implantation and the assessment of patients with biventricular pacemakers. Biventricular pacemakers require more assessments than do traditional single-or dualchamber pacemakers. (Critical Care Nurse. 2015;35[2]:20-28)

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