Critical care nursing quarterly
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The management of the infant with congenital heart disease is a multidisciplinary collaborative effort that is individualized to each patient. Low cardiac output is frequently seen in the postoperative infant with arrhythmia, preload, afterload, and contractility alterations; it can be a significant complication after open heart surgery. The management of the younger patient, the higher acuity, and the high-technology environment of the cardiac intensive care unit require astute assessment and manipulation of therapies to minimize deleterious effects in caring for these patients.
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As the fields of pediatric cardiology and cardiac surgery advance in complexity and in accountability for clinical and economic outcomes, several issues traditionally associated with the operating room are becoming important to physicians, nurses, and respiratory therapists who take care of children after cardiac surgery. The article discusses the concepts of "fast track" cardiac surgery, regional anesthetic techniques, coagulopathies and bleeding after cardiopulmonary bypass, intraoperative ultrafiltration, and mechanical circulatory assist devices.
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The staff of Patient and Family Support Services oversees the developmental, psychosocial, and spiritual care of the child in the cardiac intensive care unit. Staff collaborate with medical team members, as well as the patient's family, to promote holistic care. This article describes the roles and responsibilities of the child life specialist, the social worker, and the chaplain and identifies discipline-specific assessment techniques and interventions. The article highlights identified needs of children and their families, offering tools and interventions health care clinicians can use in the cardiac intensive care unit.
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Congenital heart surgery is an evolving field. As techniques improve and procedures are modified, enhanced patient outcomes are evident. ⋯ It causes 25% of infant deaths. This article presents a staged approach for intervention in neonates with HLHS.
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The Food and Drug Administration, drug manufacturers, and critical care experts recommend using peripheral nerve stimulators (PNSs) to monitor depth of blockade when administering neuromuscular blocking agents (NMBAs). This study evaluates critical care nurses' practices regarding use of PNSs, identifies problems associated with their use, and determines other methods of assessing level of blockade to guide medication titration. ⋯ In facilities using NMBAs, 63% monitored blockade level with aPNS. Because of practice disparities and monitoring problems, further education and research are needed to ensure adequate monitoring during NMBA administration.