AACN clinical issues
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AACN clinical issues · May 1995
Review Case ReportsExtracorporeal lung assist in the adult trauma patient.
Acute respiratory distress syndrome (ARDS) is a common complication of trauma and critical illness. Despite medical advances, the mortality associated with this disease process remains consistently around 50%. ⋯ This therapy removes all or a substantial percentage of total body carbon dioxide production, allowing for much lower ventilator support and facilitating "lung rest". Although the use of ECLA is controversial, it represents a viable option for patients with severe respiratory failure.
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AACN clinical issues · May 1995
ReviewPulmonary dysfunction related to immobility in the trauma patient.
Immobility is associated with multisystem pathophysiologic sequelae, especially in the critically ill trauma patient. Pulmonary embolus from deep vein thrombosis and nosocomial pneumonia are causes of pulmonary dysfunction that are directly related to immobilization in this population. Because of the high incidence of these complications, early identification of those at risk and institution of aggressive interventions to prevent nosocomial pneumonia and pulmonary embolus are crucial responsibilities of nurses caring for severely injured patients.
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AACN clinical issues · Feb 1995
Redefining nursing according to patients' and families' needs: an evolving concept. AACN Certification Corporation.
Patients' and families' needs have been displaced from the core of today's health-care system. Nurses are positioned to serve a pivotal role during such a critical time, as health-care systems evolve. ⋯ Nurses must acknowledge that the historical conceptualization of nursing--delineating clinical practice dimensions according to a patient's diagnosis, a nurse's role, the clinical setting, and the patient's psychosocial and physiologic systems--is of limited value if we are to meet these future challenges. Redefining nursing practice according to patients' needs provides an organizing framework to examine, across all levels of nursing, the dimensions of practice most likely to meet patient needs and contribute to optimal outcomes, as well as enhance the linkages between practice, education, and research.
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AACN clinical issues · Feb 1995
Case ReportsStrategies to optimize the cardiorespiratory status of the critically ill.
The goal of cardiorespiratory monitoring is to evaluate the components of oxygen delivery and consumption. Parameters obtained from the physiologic profile are used to assess and optimize oxygen transport to meet the tissue needs of the critically ill patient. ⋯ Therapeutic interventions can be implemented to optimize the cardiorespiratory status of the critically ill patient. Intervention strategies are not directed at simply achieving normal values or even supranormal values but at identifying the relation of oxygen delivery to oxygen consumption to potentially eliminate the development of oxygen debt.
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Intubated, mechanically ventilated adult patients often require continuous sedation to alleviate anxiety and stress. Treatment decisions must balance the appropriateness and results of therapy with cost/benefit analysis. ⋯ Many staff nurses are not familiar with the use of propofol in intensive care. In this article, the author reviews current practical uses and benefits for patients.