Critical care nursing quarterly
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Millions of individuals in the United States and around the world are overweight or obese. Bariatric surgery is now considered an evidenced-based choice for sustainable long-term weight loss and may reduce obesity-related comorbidities such as diabetes and obstructive sleep apnea. As bariatric surgical procedures increase, it can be expected that intensive care unit (ICU) admissions will increase as well. ⋯ Massive weight loss following surgery leads to an excess of lax, overstretched skin, causing physical discomfort and psychosocial problems. It is important to understand the complex pathophysiological changes that occur in order to care for this growing population of patients. This review addresses the growing and evolving issues related to the complex nature of the postbariatric ICU patients.
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Anemia and red blood cell (RBC) transfusions are common in critically ill and injured, trauma, and surgical patients. Tolerance of anemia is highly variable, depending on the presence of cardiovascular and other comorbid diseases that may diminish the hemodynamic response to a lower hemoglobin (Hb) level. ⋯ Complications related to RBC transfusion are related to RBC storage and intrinsic properties of donor allogeneic RBCs, including bacterial contamination, transfusion-related acute lung injury, and transfusion-related immunomodulation. The best evidence related to transfusion-related outcome involves titrating transfusion requirements to parameters of severity of illness rather than arbitrarily defined Hb levels.
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Ventilator-associated pneumonia (VAP) occurs within 24 hours of intubation and mechanical ventilation. Health care costs related to increased patient mortality, extended length of stay, and patient well-being make treatment of VAP a priority in all health care settings. ⋯ A moist environment in the mouth maintains normal oropharyngeal bacteria, preventing overgrowth of pathogenic bacteria. Frequent oral care to include twice-a-day brushing of the teeth found a 69% reduction in respiratory tract infections.
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With the relentless pursuit of patient care quality and patient safety, one has to explore every possible avenue to transform and redesign care delivery to remain solvent and meet the health care needs of patients in the future. Keeping patients undergoing renal transplantation in the same room from admission to discharge positively impacts clinical care outcomes on length of stay and cost. The success of this kind of care delivery lies on 1-week didactic structured training of the transplant nurses based on critical care concepts to manage fluctuations in patients' condition. ⋯ A hybrid nurse was created who possessed both critical care and medical-surgical skills. This can be a potential trend in the professional nurse model to address the health care challenges we face today in terms of nursing shortage, abbreviated plan of care, and facility operation efficiency. Thus, the need for critical care nursing skills is invaluable to the success of an acuity-adaptable care delivery system.
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The purpose of this qualitative study was to discover why 10 nurses voluntarily left the pediatric intensive care unit (PICU) at 1 large pediatric hospital in the southwest. Critical theory provided the philosophical framework, whereas action research and Heideggerian hermeneutic phenomenology provided the methodological framework. Data analysis was conducted using the circular hermeneutic process described by Heidegger and explicated by Diekelmann. ⋯ Nurses identified the constitutive pattern of unrelieved job stress as the major reason they left the PICU. The multidimensional and interactive environmental characteristics of nature of the job, insufficient resources, and negative perceptions of managers/team leaders contributed to the development of job stress. The results of this study revealed the evidence needed to begin to focus on interventions in the areas of nursing practice, education, and research required, reducing the likelihood of losing more PICU nurses.