Critical care nursing clinics of North America
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Crit Care Nurs Clin North Am · Sep 2004
ReviewThe pragmatics of feeding the pediatric patient with acute respiratory distress syndrome.
Acute respiratory distress syndrome (ARDS) represents the ultimate pulmonary response to a wide range of injuries, from septicemia to trauma. Optimal nutrition is vital to enhancing oxygen delivery, supporting adequate cardiac contractility and respiratory musculature, eliminating fluid and electrolyte imbalances, and supporting the proinflammatory response. Research is providing a better understanding of nutrients that specifically address the complex physiologic changes in ARDS. This article highlights the pathophysiology of ARDS as it relates to nutrition, relevant nutritional assessment, and important enteral and parenteral considerations for the pediatric patient who has ARDS.
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Asthma is a chronic inflammatory disorder that results in recurrent episodes of reversible airflow obstruction. Lung hyperinflation results from obstruction or dynamic airway collapse during exhalation. ⋯ Patients who present with asthma have increased inspiratory work of breathing due to lung hyperinflation and auto-positive end-expiratory pressure (auto-PEEP). The goal of acute care treatment is to reverse bronchoconstriction and inflammation, thus reducing dynamic hyperinflation, so that breathing is restored to baseline, unlabored, quiet breathing.
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Crit Care Nurs Clin North Am · Sep 2004
The experience of four outcomes managers: an institutional approach to weaning patients from long-term mechanical ventilation.
Care of patients requiring long-term mechanical ventilation (LTMV) is the focus of many hospitals nationwide. Because the care of patients who require LTMV is complex and morbidity and mortality are high, associated costs often exceed reimbursement. This article describes a successful institutional program for the care of the patient population requiring LTMV using advanced practice nurses (APNs) in the role of outcomes managers (OMs). So that others may benefit from the experiences of the clinicians, this article describes the historical background, the selection and qualifications of APNs, the process APNs use to manage and monitor the patients, role challenges, and associated outcomes.
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Crit Care Nurs Clin North Am · Sep 2004
Review Case ReportsMonitoring carbon dioxide in critical care: the newest vital sign?
Carbon dioxide (CO(2)) monitoring can yield substantial information about cardiac and pulmonary function. Because capnography is not complicated, it is relatively easy to apply in a wide variety of clinical settings. ⋯ Although outcomes data are as yet unavailable for this technology, its ease of use makes it an attractive monitoring tool to assess severity of illness and predict patients' responses to therapy. This article describes the pathophysiology and clinical applications of the technologies and describes why they may well be "the newest vital signs."
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Crit Care Nurs Clin North Am · Sep 2004
Review Case ReportsCaring for the bariatric patient with obstructive sleep apnea.
Caring for the bariatric patient in the acute care environment poses many challenges to the team delivering care. The management of obstructive sleep apnea with noninvasive ventilation is one priority. Treatment options, including bi-level ventilation and continuous positive airway pressure, and delivery strategies are reviewed in conjunction with other aspects of care that ensure a holistic, comprehensive plan of care. The most effective plan of care for the bariatric patient is one that uses a multidisciplinary coordinated team effort.