The Journal of neuroscience nursing : journal of the American Association of Neuroscience Nurses
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Randomized Controlled Trial Clinical Trial
Effect of therapeutic hypothermia on the incidence and treatment of intracranial hypertension.
Therapeutic hypothermia initiated immediately after a severe head trauma holds promise for improving outcomes. However, the effect of hypothermia on intracranial pressure (ICP) is not yet known. ⋯ There were no significant differences in the overall incidence or treatment of intracranial hypertension between patients who were treated with therapeutic hypothermia and normal controls. Therapeutic hypothermia maintained the ICP at lower levels during the cooling phase, but once patients were rewarmed, the ICP elevated to the levels of normothermic patients.
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Comparative Study
Emotional distress in critically-injured patients three months after a potentially life-threatening accident.
A case-control study was carried out to determine why some critically-injured patients remained emotionally distressed while other critically-injured patients were found to be minimally distressed three months after a potentially life-threatening accidental injury. Cognitive processing and meaning theories suggest that psychological adjustment following a traumatizing event depends on the successful integration of the event into current or modified cognitive schema and the restoration of a sense of meaning in life. These cognitive processes may be facilitated by coping strategies that share concerns, mobilize support and reframe disturbing elements. ⋯ In contrast, minimally distressed patients evidenced a significantly greater ability to acknowledge the negative effects on the self and a higher level of psychological well-being. The potential differences between the two groups in the magnitude of the relationships of meaning, cognitive processing and coping strategies on psychological well-being were assessed by hierarchical regression equations. Psychological well-being of minimally distressed patients was characterized by a significantly higher perception of their capabilities and strengths and by an ability to acknowledge a change in their relations with family and friends.
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Effective management of brain-injured patients requires that nurses have a specialized body of knowledge relating to the pathophysiology and treatment of traumatic brain injury (TBI). Current research in this area has focused on the cascade of secondary injury which leads to the irreversible tissue damage following TBI. Such processes involve excitatory amino acids, neurotransmitters, ion changes, lipid peroxidation, oxygen free radicals, opioids, lactic acidosis and magnesium to name but a few. Given that no accepted treatment paradigm exists to attenuate these secondary processes, nurses may have to autonomously devise individual care plans based on their current understanding of brain injury pathophysiology.
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Transporting patients from the protective environment of the intensive care (ICU) unit to other areas of the hospital has become increasingly common since high technologic testing has become an integral part of health care assessment. The hazards of moving critically ill patients by ambulance or air transport are well recognized and standards of care have been developed based on delineation of these risks. Despite the existing evidence of hazards of interhospital hospital transport, less attention has been given to the potential hazards associated with the intrahospital transport of critically ill patients. ⋯ Results indicate that while the majority of patients experienced some physiologic responses as a result of transport, the responses were not of sufficient magnitude to be classified as a deleterious. Twenty-three technical mishaps, which included inadvertent ventilator and electrocardiogram disconnects, power failures, interruption of medication administration and disconnection of drainage devices were observed. Factors related to these occurrences of technical mishaps were the number of intravenous solutions and infusion pumps and the time spent outside of the ICU environment.