Heart & lung : the journal of critical care
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The pediatric intensive care unit (PICU) hospitalization of a child is stressful for parents. Helping parents to decrease their stress is warranted so that they can function in the vital role that is therapeutic to them and their critically ill child. Many parent-supportive nursing interventions have been recommended but none has been tested in the clinical setting. ⋯ The experimental group participated in the NMPMC, designed to be supportive to and guided by the perceived individual needs of each parent. The dependent measure was the Parental Stressor Scale: Pediatric Intensive Care Unit administered within 24 to 48 hours of PICU admission, every 48 hours thereafter, and 24 hours after PICU discharge. The results indicate that the NMPMC is helpful in alleviating parental stress, specifically the stress related to interruption in the parent-child relationship, in the PICU setting.
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Patients with central nervous system trauma frequently have fevers while in the neurosurgical intensive care unit. Temperature elevations in the neurosurgical patient often cause much diagnostic confusion, and little is written that assists the critical care team in arriving at a proper etiologic diagnosis for the fever. ⋯ The recognition of central fevers, posterior fossa syndrome, and drug fevers is particularly important in neurosurgical patients to avoid inappropriate and potentially dangerous treatment with unnecessary antimicrobial therapy. Clinical and laboratory clues provide the clinician with a diagnostic approach to fever in the neurosurgical intensive care setting.
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Heparinized arterial catheters are commonly used in critically ill patients to monitor pressures and to collect blood for laboratory analysis. To remove the heparinized fluid used to keep these lines patent large volumes of blood are often withdrawn and discarded or calculations of tube volume must be made. Repeated violation of stopcocks may lead to contamination and infection of arterial lines. ⋯ The average arterial PT was 0.12 seconds less than venous control and the average arterial aPTT was 0.49 seconds greater than control. Neither of these differences was significant. We conclude that this type of high-pressure tubing allows accurate blood samples to be obtained from arterial lines without the necessity of precise calculations or blood wastage.
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The primary purpose of this study was to determine whether a modified Norton scale at admission to the hospital would predict which patients would develop pressure ulcers when hospitalized for surgery for a period of up to 3 weeks. The sample was composed of 387 adult patients admitted for elective cardiovascular surgery or neurosurgery. By regression analysis, no difference was found in the modified Norton scale scores for those who did and those who did not have pressure ulcers during hospitalization. ⋯ The knee and lateral malleolus were the sites of the most severe pressure ulcers. Subjects who were hospitalized for longer periods had more severe ulcers. Future research is needed to more precisely determine which patients in the acute care setting are at risk for the development of pressure ulcers.
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Limited data are available on the efficacy of a common endotracheal suctioning intervention to prevent postsuctioning decreases in arterial oxygenation (PaO2). This study evaluated the effect on Pao2 of five hyperinflation (tidal volume 1.5 times normal) and hyperoxygenation breaths, administered before and after each of two consecutive endotracheal suctioning passes, with use of a manual resuscitation bag (PMR-2 model). The convenience sample consisted of 32 patients with endotracheal tubes who were observed within 24 hours of coronary artery bypass surgery. ⋯ In addition, a clinical measure of alveolar-capillary gas exchange (PaO2/PAO2 ratio) was found to be a significant predictor of PaO2 after suctioning, accounting for 38% of the variance. The data from this study support the efficacy of administering five hyperinflation and hyperoxygenation breaths, with use of a manual resuscitation bag, before and after endotracheal suctioning in stable patients after coronary artery bypass surgery. Further study is necessary to determine the efficacy of this suctioning intervention in patients with other respiratory problems.