AACN clinical issues in critical care nursing
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AACN Clin Issues Crit Care Nurs · May 1993
ReviewCare of infants with hypoplastic left heart syndrome.
Hypoplastic left heart syndrome (HLHS) is a common congenital heart defect that is universally fatal without surgical intervention. Two distinctly different surgical options, heart transplantation and reconstruction surgery, have been successful in treating infants with HLHS. ⋯ The care required by infants with HLHS after heart transplantation is the same as that required by other infants who need heart transplant and has been reported. The primary focus of this report is postoperative care after staged reconstructive surgery for infants with HLHS.
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AACN Clin Issues Crit Care Nurs · May 1993
ReviewMyocardial depression after cardiac surgery: pharmacologic and mechanical support.
Cardiovascular surgery patients may experience a low cardiac output state as a result of anesthesia, cardiopulmonary bypass, and myocardial stunning. Prompt assessment and early intervention are critical to patient survival. ⋯ A review of etiologic factors precipitating postcardiotomy failure is presented, and traditional and experimental inotropic agents are discussed. An overview of mechanical cardiac support with the IABP, centrifugal and pneumatic VAD, and the Hemopump (Johnson & Johnson Interventional Systems, New Brunswick, NJ) device is presented, all of which addresses information critical to optimal patient outcomes.
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AACN Clin Issues Crit Care Nurs · May 1992
ReviewEndocrine responses to the stress of critical illness.
The physiologic and psychologic stress of critical illness produces systemic endocrine responses that affect the body's ability to achieve and maintain homeostasis. Regardless of the nature of the stress or illness, specific hormonal changes occur in thyroid, adrenal, and posterior pituitary activity. This article describes the physiologic and pathophysiologic basis underlying endocrine responses to the stress of critical illness. The critical care nurse is challenged by the complexity of this patient and needs to be familiar with the endocrine responses to critical illness for assessment and clinical interventions to be meaningful.
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AACN Clin Issues Crit Care Nurs · Nov 1991
ReviewNeuromuscular blocking agents in the critically ill patient: neither sedating nor pain relieving.
Although neuromuscular blocking agents (NMBAs), such as pancuronium bromide and succinylcholine, are widely used in the management of critically ill patients, many misconceptions regarding the agents' clinical effects and indications persist. This article will discuss these misconceptions and review the indications for the use of NMBAs in the critically ill patient, how these potent agents work, and strategies to effectively manage critically ill patients who are receiving NMBAs as a part of their treatment regimen.
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AACN Clin Issues Crit Care Nurs · Nov 1991
ReviewEfficacy of epidural analgesia for pain management of critically ill patients and the implications for nursing care.
Management of pain for critically ill patients has been shown to be inadequately controlled and can have serious deleterious effects on a patient's recovery. Continuous epidural analgesia can be used to control pain in critical care patients. This mode of analgesia administration provides pain relief without the delays inherent in the as-needed administration of analgesics. ⋯ Evaluation of the effectiveness of the analgesia was based on the following measures: 1) pain measured at regular intervals in the 72-hour period with a visual analog; 2) pain as measured after 72 hours with the word descriptor section of the McGill pain questionnaire; 3) amount of supplemental systemic narcotic analgesic needed; 4) recovery of ambulatory and respiratory function, including ability to perform coughing and deep-breathing exercises; 5) occurrence of adverse effects, and 6) the type and distribution of nursing care problems associated with continuous epidural infusions. The results of this study showed that the level of pain relief and recovery of postoperative function was superior to that provided by the more widely used as-needed systemic administration of narcotics. Although some nursing care problems were identified, continuous epidural analgesia can be used for pain relief in critical care patients, if the analgesia is administered by accurate reliable infusion systems and carefully monitored by nursing staff who are knowledgeable about the pharmacologic considerations of epidural analgesic agents and the management of patient care.