Critical care nursing quarterly
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A significant reduction in morbidity and mortality can be achieved by using intensive insulin therapy to achieve normoglycemia in the critically ill patient. Nurses hourly titrate insulin infusion rates using protocols, most often in chart form, to guide practice. Despite the reported development of several intensive insulin protocols, information about the accuracy, practicality, ease of calculation, and preferences of critical care nurses have not been studied. ⋯ Overall, the accuracy of the calculations improved with each revision of the nomogram. The nurses did not have a preference of one tool over another but gave extensive feedback that helped refine the nomogram. The resultant nomogram was shown to be easy to use, helpful in improving the accuracy of insulin dosage calculation, and judged to be practical by the nurses who would use the tool at the bedside.
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Cardiac disease complicates approximately 1% to 3% of pregnancies and is responsible for 10% to 15% of maternal mortality. The number of women of childbearing age with congenital disease is increasing as advances in diagnosis and treatment improve survival rates and overall health, allowing successful pregnancy. ⋯ The key component to a comprehensive and organized approach to management that ensures the best possible outcome for the woman is a multidisciplinary team that devises a plan on the basis of the most current information, communicates with each other and the patient effectively, and assumes responsibility for implementation of the plan. The purpose of this article is to review management of the woman with cardiac disease throughout pregnancy.
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When a critically ill woman is pregnant, clinical interventions for the mother can have a profound effect on fetal status. It is essential that the fetus be considered as the second patient when developing the plan of care. The most practical solution for providing comprehensive care to pregnant women in the intensive care unit (ICU) is a collaborative approach involving members of the ICU and the perinatal team, each contributing their unique knowledge and skills to the care of the mother and her unborn baby. The purpose of this article is to describe a collaborative approach to caring for a pregnant woman in the ICU along with a brief overview of fetal assessment for ICU care providers so they can become familiar with terms and methods used in assessing fetal status and common interventions that promote fetal well-being.
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A critically ill obstetric patient can present a challenging and rewarding experience for the nurse who is accustomed to caring for the typical intensive care unit patient. This patient population makes up a small percentage of the average daily census in adult critical care units across the country. ⋯ This article will describe those psychosocial needs and address the nurse's role in meeting the needs. A case study will be presented to provide specific points for focus.