AACN clinical issues in critical care nursing
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Promoting the quiet and relaxation necessary for sleep in a busy, noisy critical care environment is a problem critical care nurses face daily. Descriptive studies have defined and increased understanding of this problem, but few interventional studies have been accomplished. Interventions that have demonstrated significant improvements in sleep quality in the critical care environment are an audiotape of the sounds of the ocean or rain, a masking signal, and a back massage.
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AACN Clin Issues Crit Care Nurs · May 1994
ReviewPain management in the critically ill: what do we know and how can we improve?
Pain management in the critically ill is a challenge and a problem of great concern for critical care nurses. The authors review research on pain in the areas of pain assessment, nurses' knowledge and attitudes, pharmacologic interventions, and nonpharmacologic interventions for the management of pain. Although the research base is not completely developed in the critically ill population, implications for practice are provided, based upon the findings in populations akin to the critically ill. Strategies are outlined for achieving improved pain control in critical care units through education, adoption of standards on pain management, and quality improvement activities.
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AACN Clin Issues Crit Care Nurs · Feb 1994
ReviewAdvances in managing increased intracranial pressure: a decade of selected research.
There have been tremendous advances in the diagnosis and treatment of increased intracranial pressure in the past decade. The author presents a review of the pathophysiology of intracranial hypertension, incorporating recent data from neuroscience research. Additional investigations that have implications for the nursing care of patients with actual or potential intracranial pressure also are described.
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Inhalation injury remains a primary determinant of patient survival, with 60% to 70% of burn center fatalities attributed to the pulmonary complications of inhalation injury. Substantial airway damage and pulmonary complications can result from the inhalation of toxic fumes and gases found in smoke. ⋯ Bronchoscopy and xenon 133 ventilation-perfusion scans are two of the newer diagnostic tools used to identify burn patients with inhalation injury. Treatment measures for patients with inhalation injury and recommendations for nursing practice are discussed.
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AACN Clin Issues Crit Care Nurs · May 1993
Review Case ReportsHypothermia and rewarming after cardiac surgery.
Ensuring adequate oxygen delivery to the tissues with respect to oxygen demand is an important operative challenge during cardiac surgery. The state of the art in myocardial preservation in the 1990s has evolved to include pretreatment of the myocardium; intraoperative use of systemic hypothermia with cardiopulmonary bypass (CPB), topical cooling of the myocardium, cold cardioplegia, and myocardial reperfusion; and postoperative oxygen transport support. ⋯ Appropriate temperature monitoring and reporting support timely medical and nursing interventions for hypothermia, such as internal and external rewarming techniques or drug administration to facilitate the rewarming process and suppress or treat shivering. This article addresses the physiologic condition of hypothermia, the elective hypothermia techniques used during cardiac surgery, and the medical or nursing rewarming and management techniques for the postoperative cardiac surgery patient.