Critical care nursing quarterly
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Sleep deprivation is a significant problem for patients in critical care units. Sleep is a complex, active process that is divided into 4 stages of non-rapid eye movement (NREM) sleep, and rapid eye movement (REM) sleep. Noise, lights, discomfort, pain, medications, and stress all contribute to a patient's inability to sleep. ⋯ Education about sleep deprivation needs to be integrated into critical care courses and orientation programs. Sleep deprivation should be addressed on the multidisciplinary care plan and in health team conference, and nursing care planned accordingly. Sleep medications and their effects should be evaluated for each patient, as well as identifying medications that might be preventing or disturbing sleep.
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Integrative brain failure is often a comorbidity of critical illness, and although not uncommon, is perhaps the least understood of all the various organ failure phenomena. Factors that contribute to integrative brain failure include inadequate management of pain, stress, anxiety, and the several underlying mechanisms that create agitation in the intensive care unit patient. Delirium, a resultant organic mental syndrome, is reversible when promptly recognized and aggressively managed. The nurse who is astute in clinical assessments and skillful in the management of the environment of care can prevent and control states of anxiety, irritability, restlessness, and sleep disturbances that contribute to the development of delirium.
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This article describes the special needs of the critically ill morbidly obese, with a focus on the care of the postoperative obesity surgery patient. The technique of surgery is described elsewhere in this journal. ⋯ Pharmacokinetic factors to be considered are reviewed. A case study is presented to coalesce concepts presented.
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Intrinsic and extrinsic factors affect wound healing. High risk factors for the obese patients include infection, seromas, anastomatic leaks, and incision dehiscence. Tissue perfusion is an issue of great concern and is a key factor in most assessments. ⋯ From routine evaluations to specialized assessments with attention to bariatric equipment needs, a thorough understanding of wound healing and potential problems of obese patients, and knowledge of interventions is needed. Nonjudgmental attitudes are imperative in planning care for the obese patients. Following a review of physiological needs and nursing interventions, a case study details one woman's surgical complications.