Critical care nurse
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Critical care nurse · Jun 2011
ReviewFlexible bronchoscopy assisted by noninvasive positive pressure ventilation.
Noninvasive positive pressure ventilation is an alternative to intubation in critically ill patients with respiratory insufficiency or poor gas exchange who may require flexible bronchoscopy for diagnostic or therapeutic purposes. This ventilatory technique might help decrease the risk of bronchoscopy-related complications in patients with refractory hypoxemia, postoperative respiratory distress, severe emphysema, obstructive sleep apnea, and obesity hypoventilation syndrome and allows bronchoscopic assessment of patients with severe dyspnea from expiratory central airway collapse. In this review, the physiological rationale, indications, contraindications, techniques, and monitoring requirements for flexible bronchoscopy assisted by noninvasive positive pressure ventilation are described, with an emphasis on the role of critical care nurses in this procedure.
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Critical care nurse · Jun 2011
Nonpharmacological interventions to manage common symptoms in patients receiving mechanical ventilation.
Patients receiving mechanical ventilation can experience symptoms such as pain, anxiety, agitation, and lack of sleep while in the intensive care unit, all of which can affect healing. Nonpharmacological complementary therapies can be used as adjuncts to sedatives and analgesics. ⋯ Methods to promote sleep include relaxation techniques such as progressive muscle relaxation and massage and communication with patients' and their families to determine the patients' normal sleep patterns. Complementary therapies to relieve anxiety and agitation include music intervention, imagery, presence, and animal-assisted therapy.
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Critical care nurse · Jun 2011
Disposable vs reusable electrocardiography leads in development of and cross-contamination by resistant bacteria.
Hospital-acquired infections caused by antibacterial-resistant microorganisms are associated with high mortality and morbidity rates and markedly affect hospital economics. The expense became greater in 2008 when reimbursement for treatment of hospital-acquired infections was no longer provided by Medicare. Infections caused by cross-contamination with resistant bacteria can be eliminated by 3 methods: kill the bacteria before resistance develops, stop bacteria from communicating and acquiring resistance, and eliminate the pathway from one patient to another. ⋯ The many pathways provided by reusable wires for cross-contamination with resistant bacteria increase the risk for hospital-acquired infection when these wires are used. Disposable electrocardiography leads eliminate risk of infection through these pathways. Adoption of disposable electrocardiography leads as an adjunct to an overall infection control program can decrease infection rates in acute health care facilities.
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Critical care nurse · Apr 2011
ReviewTraumatic brain injury: advanced multimodal neuromonitoring from theory to clinical practice.
Traumatic brain injury accounts for nearly 1.4 million injuries and 52 000 deaths annually in the United States. Intensive bedside neuromonitoring is critical in preventing secondary ischemic and hypoxic injury common to patients with traumatic brain injury in the days following trauma. ⋯ The trends in and significance of metabolic, physiological, and hemodynamic factors in traumatic brain injury are reviewed, the technical aspects of the specific equipment used to monitor these parameters are described, and how multimodal monitoring may guide therapy is demonstrated. As a clinical practice, multimodal neuromonitoring shows great promise in improving bedside therapy in patients with traumatic brain injury, ultimately leading to improved neurological outcomes.