American journal of critical care : an official publication, American Association of Critical-Care Nurses
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Positioning of critically ill patients affects hemodynamic and cardiopulmonary outcomes. A review of clinical studies indicates that backrest elevations up to 60 degrees do not affect measurement of intracardiac pressures or cardiac output, but PaO2 may diminish in sitting positions following surgical procedures. In lateral positions, measurement of intracardiac pressures and cardiac output is not recommended, since a uniform reference point has not been identified for lateral positions. ⋯ Prone positioning may be beneficial in adult respiratory distress syndrome and in weaning of mechanically ventilated patients. When planning positioning maneuvers, critical care nurses should consider these effects in relation to the specific needs of each patient. Hemodynamic and cardiopulmonary responses to positioning should be evaluated in conjunction with other therapeutic modalities such as those designed to preserve skin integrity and improve comfort.
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To assess the beliefs and attitudes of critical care nurses about the effects of visiting on patients, staff and family. ⋯ To provide an optimal situation for visiting, its negative consequences must be minimized and nurses' attitudes and beliefs about visiting must be assessed and addressed.
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Discontinuation of mechanical ventilation because of the recognition of futility of continued treatment or because of patient or family request is an increasingly frequent occurrence in critical care. Although there is broad consensus about the patient's right to refuse life support, little has been written about the actual procedure of withdrawing mechanical ventilation. ⋯ Ethical principles supporting the position that ventilator withdrawal under these conditions can be morally justified and principles suggesting that ventilator withdrawal is morally objectionable are evaluated. Factors contributing to clinicians' ambivalence about this issue and guidelines for planning and implementing treatment withdrawal are discussed.
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Randomized Controlled Trial Comparative Study Clinical Trial
Effects of patient-controlled analgesia on postoperative anxiety in elderly men.
To determine whether the use of patient-controlled analgesia vs intramuscular injections improves postoperative psychological parameters, particularly anxiety. ⋯ The use of patient-controlled analgesia does not significantly alter the measured psychological parameters, compared with intramuscular injections. Improved analgesia is the result of pharmacologic effects, independent of psychological factors.