Heart & lung : the journal of critical care
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The purpose of this study was to examine the differences in demographic characteristics and nursing care requirements of patients with and patients without DNR (do not resuscitate) orders in intensive care. The sample consisted of 62 patients with and 62 without DNR orders from the intensive care units of three community hospitals. ⋯ Patients with DNR orders were white (p = 0.015), older (p = 0.03), more likely to reside in nursing homes (p = 0.04), had longer intensive care stays (p = 0.0005), were more likely to be admitted from another nursing unit (p less than 0.001), and had higher mortality rates (p less than 0.001). In intensive care settings, patients with DNR orders received more nursing care than patients who did not have DNR orders.
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Case Reports Guideline
A nursing guide for patient care after percutaneous cardiopulmonary support.
Information is presented about a relatively new procedure being used in the critical care area. The percutaneous insertion technique for the initiation of cardiopulmonary bypass support (PCPS) has given new hope for patients who are considered high risk for elective coronary angioplasty and to those who suffer cardiopulmonary arrest in the cardiac catheterization laboratory or critical care unit. ⋯ Specific attention is given to the immediate postprocedural phase, where nursing responsibilities and prioritization of patient care are addressed. A nursing care guide is included.
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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).