Dimensions of critical care nursing : DCCN
-
Malnutrition in the critically ill patient is associated with adverse outcomes such as increased morbidity, infectious processes, and length of stay. Alterations to the gastrointestinal system during critical illness can be devastating. Current evidence suggests that, in the presence of a functioning gut, initiating early enteral nutrition therapy (within 24-48 hours of intensive care unit admission) results in enhanced tissue repair, preservation of immune competence, and conservation of the integrity of gut flora. Recommendations for practice include development of a national nutrition support protocol for widespread use in the intensive care unit.
-
Dimens Crit Care Nurs · Sep 2012
An evidence-based oral care protocol to decrease ventilator-associated pneumonia.
The purpose of this study was to examine the impact of 0.12% chlorhexidine rinses and an oral care protocol on ventilator-associated pneumonia rates. A quasi-experimental preintervention-postintervention design was used. ⋯ Data were collected 6 months before and 12 months after intervention. Ventilator-associated pneumonia rates were reduced from 4.3 to 1.86 per 1000 ventilator-days during the study period, with an estimated cost avoidance of $700,000 to $798,000.
-
Dimens Crit Care Nurs · Jul 2012
ReviewPreoperative intra-aortic balloon pumping in high-risk cardiac surgery patients.
Intra-aortic balloon pumping increases myocardial oxygen supply and decreases myocardial oxygen demand by inflation and deflation of the balloon. This leads to increased perfusion of the coronary arteries during diastole. This technology has been used for critically ill cardiac patients for more than 30 years. ⋯ Preoperative benefits of this technology may yield positive outcomes in terms of hemodynamic effect, decreased length of stay in both the intensive care unit and the hospital, and the reduction of complications. However, the intra-aortic balloon pump must be used with a profound understanding of proper mechanism and function, monitoring, and observation for potential complications. This requires excellent critical care nursing management.
-
Dimens Crit Care Nurs · Jul 2012
Case ReportsDonation after cardiac death: ethical dilemmas and implications for advanced practice nurses.
Donation after cardiac death has always presented ethical concerns among health care providers. As advanced practice nurses and critical care nurses, it is our responsibility to ensure that health care providers and families are educated about the process and that we remain advocates for the potential donors. This article reviews the donation after cardiac death process, provides a donation after cardiac death hypothetical case report and its outcome, and addresses the ethical concerns associated with donation after cardiac death from both opponents' and proponents' points of view. It will also discuss the benefits of obtaining a palliative care consult and the roles of the advanced practice nurse in the care of the potential donor.
-
Dimens Crit Care Nurs · Jul 2012
Cultural and linguistic validation of the Italian version of the intensive care delirium screening checklist.
The purposes of this study were to identify the most suitable rating scale for the diagnosis of delirium in the Italian setting and to develop and validate an Italian version of a delirium screening checklist. The findings are reported.