Critical care nurse
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Critical care nurse · Aug 2011
Case ReportsCare of the lower extremities in patients with acute decompensated heart failure.
Patients with heart failure and pulmonary edema are often admitted to the critical care unit. Many of these patients have severe peripheral edema, which may be associated with exudates and wounds of the lower extremities and which present a challenge to critical care nurses. Little information is available on treatment of peripheral edema in the intensive care unit or in patients with unstable hemodynamic status. ⋯ An appropriate mattress surface with an underpad that promotes wicking away of moisture should be selected. The patient's lower extremities should be elevated according to his or her current pulmonary status, and skin-protective interventions should be instituted. Multilayer compression wraps should be avoided until the patient's hemodynamic status is stable and the patient can get out of bed.
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Critical care nurse · Aug 2011
Case ReportsUnder pressure: pulmonary arterial hypertension . . . A mother's struggle.
Nursing grand rounds is a way for staff nurses to present an interesting case through evidence-based practice. Idiopathic pulmonary arterial hypertension is an incurable syndrome that can devastate a patient. This article describes a patient's experience with idiopathic pulmonary arterial hypertension and outlines the pathophysiology, treatment, psychosocial issues, and nursing implications that were presented in a nursing grand rounds presentation at a hospital.
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Critical care nurse · Aug 2011
Pressure ulcer prevention in high-risk postoperative cardiovascular patients.
Little has been published about how to prevent pressure ulcers in severely debilitated, immobile patients in intensive care units. ⋯ Patients spent a mean of 7.9 days on the mattress, and the cost of bed rental was approximately $18000, which was similar to the cost of treatment of 1 pressure ulcer in stage III or IV (about $40000) and was considered cost-effective.
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Esophageal cancer, although considered uncommon in the United States, continues to exhibit increased incidence. Esophageal cancer now ranks seventh among cancers in mortality for men in the United States. Even as treatment continues to advance, the mortality rate remains high, with a 5-year survival rate less than 35%. ⋯ Nursing care revolves around complex care managing multiple body systems and providing effective education and emotional support for both patients and patients' families. Even after recovery, local recurrence and distant metastases are common. Early diagnosis, surgical advancement, and improvements in postoperative care continue to improve outcomes.
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Critical care nurse · Aug 2011
Case ReportsStroke as a complication of H1N1 influenza infection: a case study.
In June 2010, the Centers for Disease Control and Prevention ended the US public health emergency for the H1N1 pandemic with estimates for total cases, hospitalizations, and deaths counted from April 2009 to April 2010. By the end of this period, the human H1N1 virus was estimated to have been responsible for 12,470 deaths in the United States. Most deaths associated with the seasonal flu or H1N1 infection are due to complications such as secondary infections. ⋯ This case study describes the clinical course of a patient who had multiple strokes due to disseminated intravascular coagulation triggered by H1N1 infection. Useful clinical information about disseminated intra-vascular coagulation is detailed for nursing practice. Implications of the possible link between H1N1 infection (and influenza A and B) and stroke resulting from disseminated intravascular coagulation are discussed.