AACN clinical issues in critical care nursing
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Initial management of minor and moderate, uncomplicated burn injury focuses on wound management and patient comfort. Initial management of patients with major burn injury requires airway support, fluid resuscitation for burn shock, treatment for associated trauma and preexisting medical conditions, management of adynamic ileus, and initial wound treatment. Fluid resuscitation, based on assessment of the extent and depth of burn injury, requires administration of intravenous fluids using resuscitation formula guidelines for the initial 24 hours after injury. ⋯ Circumferential torso burns compromise air exchange and cardiac return. Loss of skin function places patients at risk for hypothermia, fluid and electrolyte imbalances, and systemic sepsis. The first 24 hours after burn injury require aggressive medical management to assure survival and minimize complications.
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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.
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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.