Heart & lung : the journal of critical care
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There are six herpes viruses, three of which, the varicella-zoster virus and the herpes simplex viruses types 1 and 2, are of particular concern to patients and staff in critical care units. These viruses, especially in their reactivated states, may present atypically in critically ill and immune-suppressed patients, and, by the time the diagnosis is made, exposures of other patients and clinicians may have occurred. Pregnancy and immunosuppressed states can result in severe, even life-threatening varicella-zoster virus infections in susceptible adults. ⋯ An additional problem after herpes simplex virus infection is the potential of lifelong and possibly frequent recurrences. In this article, the manifestations, modes of transmission, and treatment will be discussed. Special emphasis will be placed on describing the types of patients who are at high risk of presenting with varicella-zoster virus or herpes simplex virus infection so that physicians and nurses can use appropriate preventive measures to avert nosocomial infections in patients and staff.
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Delirium is a common, disruptive, costly, and at times lethal condition found among patients in the acute care setting. Nurses can be the first to discover its presence and thereby reduce the time to treatment. Identifying delirium requires a knowledge of its clinical features, a mastery of the bedside cognitive mental status examination, critical judgment in distinguishing delirium from other psychiatric disorders, and appropriate nursing interventions based on ongoing assessment. In this article we review elements of such an approach and illustrate common clinical challenges for nurses with case examples.
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We prospectively studied the relationship between interdisciplinary collaboration and patient outcomes in the medical intensive care unit (MICU) using nurses' and residents' reports of amount of collaboration involved in making decisions about transferring patients from the MICU to a unit with a less intense level of care. Either readmission to the MICU or death was considered a negative patient outcome. Nurses' reports of collaboration were significantly (p = 0.02) and positively associated with patient outcome, controlling for severity of illness. ⋯ When alternatives were available, collaboration was more strongly associated with patient outcome. There was no significant relationship between residents' reports of collaboration and patient outcomes. The correlation between amount of collaboration reported by nurses and residents about the same decisions was quite low (r = 0.10).
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Case Reports
Digoxin toxicity presenting as altered mental status in a patient with severe chronic obstructive lung disease.
Gastrointestinal and cardiac manifestations are the commonly considered features of digoxin toxicity. This report describes a patient with severe chronic obstructive lung disease whose primary manifestation of digoxin toxicity is acute alteration of mental status. Neurologic dysfunction may be the sole manifestation of digitalis toxicity. The diagnosis of digoxin toxicity should be considered in elderly patients with altered mental status, even when serum levels are within a therapeutic range.