Linda Briggs

Preeclampsia increases a woman's long-term risk of vascular disease and/or death including chronic hypertension, myocardial infarction, heart failure, stroke, and venous thromboembolism. The literature suggests that maternity care providers may be unaware of this association. A database search was conducted examining the long-term effects of hypertensive disorders of pregnancy using MEDLINE, Scopus, CINAHL, ISI Web of Knowledge, and the Cochrane Database of Systematic Reviews. Inclusion criteria were: 1) English language, 2) peer-reviewed journals, 3) January 2000 to July 2015, 4) systematic reviews with or without meta-analyses, and 5) studies that addressed the relationship between hypertensive disorders of pregnancy and vascular disease such as hypertension, cardiovascular disease (CVD), and cerebrovascular diseases. Three systematic reviews with meta-analysis qualified for this review. They represented 48 unique studies from 20 countries and included a total of 3,598,601 women. Preeclampsia was associated with a 3-fold increased risk for developing chronic hypertension. Compared with normotensive women, those with preeclampsia experienced double the risk, or more, for CVD or CVD-related mortality. Preeclampsia was also associated with approximately double the risk for fatal or nonfatal stroke. Preeclampsia is associated with an increased risk for future chronic hypertension, CVD, cerebrovascular disease, and death. While evidence shows that women with cardiac risk factors may have a higher chance of developing preeclampsia, many women with preeclampsia have no CVD risk factors. Measures to prevent preeclampsia such as calcium supplementation for women with low calcium intake and low-dose aspirin for women with a history of more than one incident of preeclampsia or a preterm birth associated with preeclampsia are supported by evidence. Reduction of modifiable risks associated with CVD before, during, and after pregnancy is recommended. All care providers and women should be educated regarding these risks and the importance of pregnancy history to future health.

Recently, the Joint Commission on Accreditation of Healthcare Organizations (JCAHO) implemented new national core measures, including tobacco-cessation interventions for patients hospitalized because of pneumonia or other pulmonary-related illnesses, acute myocardial infarction, or heart failure. All interventions performed for such patients must be documented in the patient's chart. Because the JCAHO standards for tobacco cessation are implemented hospital-wide, acute and critical care nurses must take an active role in their execution. This article discusses the challenges to integrating tobacco cessation in daily acute and critical care nursing practice and makes recommendations regarding cessation approaches designed to improve health outcomes for tobacco-dependent patients.

Peer review has multiple manifestations and purposes. Two stated purposes are the demonstration of professionalism and clinical competency. The American Nurses Association (ANA) defines nursing peer-review as a process for evaluating the care provided by an individual according to accepted standards. Further, the ANA proposes that nurses with similar rank and clinical expertise should conduct these evaluations. Some local jurisdictions may also mandate that advanced practice nurses (APNs) review one another's care. Therefore, APNs should become familiar with sources for evaluation criteria and tool formats for APN peer review. The advantages and limitations of the various formats and processes of peer review should also be considered.