Enfermería intensiva
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Because of easiness and accessibility, the oral route of administration is usually the route of choice for medication delivery, as long as the oral drug form is available and the patients' circumstances allow it. In patients admitted to the intensive care unit this route is frequently altered. This provokes difficulties in swallowing and consequently an enteral feeding catheter must be inserted to supply the patient's nutritional requirements. ⋯ The aim of this study was to establish guidelines for drug administration through enteral feeding catheters. We provide a thorough review of the literature, describe oral drug forms, present a protocol for correct drug administration and provide a guide to the most commonly used drugs in our unit. For each of these drugs we include recommendations on administration and possible alternatives.
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Enfermería intensiva · Jan 2001
Review[Weaning from mechanical ventilation. The aim of nursing research].
Management of patients difficult to wean from the ventilator is a practical challenge in which professional nurses are deeply involved. The clinical research applied over the last years has tried to describe the characteristics of weaning phenomenon and the associated factors, to find predictive outcomes to guide clinical decisions, to search new strategies to conduct the protocols and to identify the most effective modes of weaning. In this paper a critical review of the current knowledge from a nursing perspective is done. The weaning conceptual model proposed by the American Association of Critical Care Nurses (AACN) group has been used as a theoretical framework.
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The aim of this study was to demonstrate the usefulness of the intraosseal route in providing emergency vascular access, especially in children, when vascular access through peripheral or central routes is difficult or impossible. A literature review revealed that the intraosseal route provides rapid, easy and effective access to the vascular system, especially in children under the age of 6 years. This route is indicated when, in emergencies, peripheral or central cannulation is too slow and the child's life is at risk. ⋯ In addition to providing an alternative route for the infusion of drugs and other substances into the bloodstream, the intraosseal route also provides access to the vascular system when samples for laboratory investigations are required. In conclusion, the intraosseal route provides rapid, safe and easy access to the vascular system. Complications are infrequent and there are few contraindications.
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Mechanical ventilation improves the symptoms and reduces complications of acute respiratory failure. Recent advances in microprocessor technology have increased the sophistication of mechanical ventilators, thus leading to new ventilation modalities. This article describes the ventilation modalities available, grouping them as conventional, alternative and new modalities. Conventional ventilation includes the most widely used modalities, alternative ventilation includes less frequently used modalities, and new ventilation modalities include recently introduced options that are available on the latest-generation mechanical ventilators.
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Toxic Epidermal Necrolysis (TEN) is a severe skin disorder characterised by separation of the dermal-epidermal junction, as it is observed in second degree superficial burns, and it may also involve any mucosal surface area (otic, buccal, conjunctival, respiratory, genital). This condition is generally induced by the ingestion of drugs, particularly certain antibiotics, nonsteroidal antiinflammatory drugs, and antiepileptic drugs. Mortality has decreased over the last decades, from 80% to about 25% in recent series. ⋯ The main nursing diagnosis include abnormalities in the skin and mucose membranes integrity, risk of infection, loss of blood volume, risk of hypothermia, acute pain, upper airway insufficiency and anxiety. We here review the nursing care of patients with TEN. We emphasize the daily skin and mucose membranes care, and the prevention of conjunctival sinequiae, including daily conjunctival cleaning and debridement of necrotic tissue and fibrin debris using a handle needle.