AACN clinical issues in critical care nursing
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The forces influencing the development of outcome standards are gaining momentum. These forces are professional nursing issues, accreditation standards, and reimbursement issues. Traditionally, structure and process measures provided the means for evaluating the quality of nursing care. ⋯ This chapter describes these outcome standards and recommends ways to use them. The Joint Commission on the Accreditation of Healthcare Organizations' (JCAHO) ten-step model outlines development of unit-specific outcome standards. Methods focus throughout on a quality assurance framework.
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Traumatic injury results in major physiologic alterations that begin at the time of injury and persist until recovery is complete. The response of the body is divided into two phases--the acute phase and the flow phase. The acute phase is characterized by shock with changes in hormone concentration. ⋯ Tissues with the highest oxygen consumption are more susceptible to injury and death. Cellular function does not depend on oxygen alone but also on the ability of the cells to use available oxygen. If the body is unable to compensate through biochemical, hormonal, and metabolic activities, an irreversible state results unless appropriate interventions are instituted promptly.
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Inhalation injuries comprise three distinct clinical entities that may be classified according to the time of onset of symptoms, etiologic agents, and the anatomic location of injury. These entities are carbon monoxide toxicity, upper airway obstruction, and smoke inhalation or chemical injury. ⋯ Early aggressive treatment, including maintaining a patent airway, administering humidified oxygen and bronchodilators, and providing pulmonary toilet, is necessary to ensure the best possible outcome. Understanding the pathophysiology, clinical manifestations, diagnosis, medical management, and nursing implications of inhalation injuries can improve patient survival.
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AACN Clin Issues Crit Care Nurs · Aug 1990
New techniques for weaning difficult patients from mechanical ventilation.
This article compares the weaning of challenging patients from mechanical ventilation to an exercise training program experienced by many athletes. Physically, the importance of the correction and maintenance of chronic health issues, nutrition, and hydration are explored. Psychologically, the degree of preparedness by both the patient and the health care team is presented. ⋯ Newer modes of ventilation, including pressure support ventilation, mandatory minute ventilation, and continuous flow, decrease the work of breathing, promote ventilator/patient synchrony, and provide a more dynamic weaning process. All of these modes promote exercise, and augment the physical and psychological components of weaning. Nursing considerations for successful weaning are offered.
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AACN Clin Issues Crit Care Nurs · Aug 1990
High-frequency ventilation and extracorporeal membrane oxygenation.
Dramatic improvement in morbidity and mortality associated with neonatal respiratory failure has evolved over the last 30 years. Favorable survival statistics can be directly related to the institution and refinement of assisted ventilation techniques. ⋯ Concentrated efforts are being undertaken to find ways to safely and effectively treat these infants while decreasing the morbidity associated with therapy. Two such therapies, both experimental and controversial, which are gaining widespread recognition, are high-frequency ventilation (HFV) and extracorporeal membrane oxygenation (ECMO).