Critical care nurse
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Critical care nurse · Feb 2016
Preoperative Stabilization of Infants With Hypoplastic Left Heart Syndrome Before Stage I Palliation.
Hypoplastic left heart syndrome is a severe form of congenital heart disease that results in single-ventricle physiology. Although surgical palliation in infants with this syndrome is widely agreed on in practice, variation occurs in both surgical and medical management. ⋯ The general aspects of perioperative stabilization and management are monitoring, use of vasoactive infusions, ventilatory support, and nutrition. Management strategies for balancing single-ventricle physiology are aimed at addressing the 3 major causes of desaturation: diminished pulmonary blood flow, low mixed venous oxygen saturation, and pulmonary venous desaturation.
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In the October In Our Unit article by Cooper et al, “Against All Odds: Preventing Pressure Ulcers in High-Risk Cardiac Surgery Patients” (Crit Care Nurse. 2015;35[5]:76–82), there was an error in the reference citation on page 82. At the top of that page, reference 18 cited on the second line should be reference 23, which also should be added to the References list: 23. ⋯ November 2008. https://innovations.ahrq.gov/profiles/prevention-and-treatment-program-integrates-actionable-reports-practice-significantly. Accessed November 18, 2015
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The United States has 1332 critical access hospitals. These hospitals have fewer than 25 beds each and a mean daily census of 4.2 patients. Critical access hospitals are located in rural areas and provide acute inpatient services, ambulatory care, labor and delivery services, and general surgery. ⋯ As expert generalists, rural nurses are well positioned to provide care close to home for patients of all ages and the patients' families. A case report illustrates the role that nurses and critical access hospitals play in meeting the need for high-quality palliative care in rural settings. Working together, rural nurses and their urban nursing colleagues can provide palliative care across all health care settings.
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Critical care nurse · Feb 2016
A Bedside Decision Tree for Use of Saline With Endotracheal Tube Suctioning in Children.
Endotracheal tube suctioning is necessary for patients receiving mechanical ventilation. Studies examining saline instillation before suctioning have demonstrated mixed results. ⋯ Saline instillation before endotracheal tube suctioning is associated with hemodynamic instability, bronchospasm, and transient hypoxemia. Saline should be used cautiously, especially in children with a small endotracheal tube and comorbid respiratory disease.