Critical care nursing quarterly
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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.
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Even though good communication among clinicians, patients, and family members is identified as the most important factor in end-of-life care in ICUs, it is the least accomplished. According to accumulated evidence, communication about end-of-life decisions in ICUs is difficult and flawed. Poor communication leaves clinicians and family members stressed and dissatisfied, as well as patients' wishes neglected. ⋯ Evidence suggests that improving end-of-life communication in ICUs can improve the quality of care by resulting in earlier transition to palliative care for patients who ultimately do not survive and by increasing family and clinician satisfaction. Both larger, randomized controlled trials and mixed methods designs are needed in future work. In addition, research to improve clinician communication skills and to assess the effects of organizational and unit context and culture on end-of-life outcomes is essential.