American journal of critical care : an official publication, American Association of Critical-Care Nurses
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Few studies have documented stressors experienced by patients recovering from cardiac surgery in the intensive care unit. Furthermore, research has indicated that nurses' predictions of stressors often are not accurate. Stressors frequently experienced by cardiac surgical patients in the intensive care unit must be clearly identified to enable nurses to predict them, plan interventions to minimize them, and help patients cope. ⋯ Our results suggest that interventions reducing stressors enhance the recovery process for cardiac surgical patients.
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Although many investigators have attempted to identify weaning predictors and weaning modes for use in long-term mechanically ventilated patients, none has emerged as superior. Furthermore, few investigators have viewed the process of weaning as a dynamic continuum; thus, guidelines for care of these patients have yet to be developed. ⋯ Care delivery systems, which focus on systematic, comprehensive and coordinated care, are promising because outcomes demonstrate that they are economical, safe, and effective. This article reviews the research on weaning adult, long-term mechanically ventilated patients, suggests future research directions, and highlights the scientific basis for practice guidelines.
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Inappropriate benzodiazepine dosing in patients exhibiting signs of alcohol withdrawal cause staff and patient safety problems. Our primary goal was to develop an alcohol withdrawal protocol based on objective measures, and then to coordinate benzodiazepine dosing with those measures and improve care of the patient withdrawing from alcohol. A secondary goal was to give the primary care nurse the flexibility to administer benzodiazepine doses as needed to improve patient and staff safety. ⋯ Since implementation of the alcohol withdrawal protocol, complaints regarding patient and staff safety have decreased. Other patient care units are beginning to use the protocol. A hospital-wide task force is developing patient care plans based on the protocol for all patients withdrawing from alcohol.
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Pulmonary hypertension is seen in infants and young children who have congenital heart defects resulting in excess pulmonary blood flow. The critical care nurse can implement several interventions in the immediate postoperative period to help prevent the potentially lethal complication of pulmonary hypertensive crisis in a cardiac surgery patient. Respiratory interventions include hyperventilation, maintaining an alkalotic pH, supplemental oxygen, and low positive end-expiratory pressure. In addition, the nurse must consider the serum potassium, hematocrit, and patient temperature, and administer appropriate medications.