Critical care nursing quarterly
-
Advances in technology and development of multidrug-resistant antibiotics have increased the number of immunosuppressed patients in need of crisis care and the incidence of nosocomial infection in the nation's hospitals. Nosocomial infections are proving particularly difficult to prevent in intensive care units (ICUs), where special care must be taken to avoid transmission of any infection. The authors present an overview of this problem in the ICU, outlining basic measures to be taken in preventing nosocomial infections and ensuring the safety of the patients.
-
The critically ill patient's response to stress is to increase production of glucose; his can lead to hyperglycemia as insulin releasing factors become overloaded. Although parenteral insulin can aid in preventing complications of hyperglycemia by maintaining a euglycemic state, care must be taken to prevent hypoglycemia. ⋯ As blood glucose levels fluctuate, the critical care nurse may titrate an insulin drip without specific orders for how much to increase or decrease the amount of insulin infusing. By developing a protocol, including a formula to calculate the amount of insulin to infuse, based on blood glucose levels, the critical care nurse can safely, competently, and accurately maintain blood glucose levels under 250 mg/dL.
-
Case Reports Historical Article
The history of the Glasgow Coma Scale: implications for practice.
The Glasgow Coma Scale (GCS) has been the gold standard of neurologic assessment for trauma patients since its development by Jennett and Teasdale in the early 1970s. The GCS was found to be a simple tool to use. ⋯ Although the scale has been shown to be effective, many authors have cited weaknesses in the scale including the inability to predict outcome, variation in inter-rater reliability, and the inconsistent use by caregivers in the prehospital and hospital settings. This article outlines the components of the GCS and how practitioners can best use the scale, particularly in patients whose injuries and treatments make them difficult to assess.
-
The goal of care of the traumatic brain-injured patient is to prevent secondary injury. Technology gives the caregivers information as to the cause and severity of injury and can guide appropriate management of the patient. Use of multimodality monitoring increases the complexity of care but may allow for better targeted therapy. This article will discuss the current state of technology, the physiology and pathophysiology that it assesses, the normal and abnormal values obtained, and how care will be impacted.
-
Numerous differences exist between the pediatric and adult brain-injured patient. However, children with brain injuries are frequently cared for in adult Intensive Care Units (ICUs). ⋯ The article examines the care of the brain-injured child, including monitoring, psychosocial considerations, and supportive care with emphasis on avoiding secondary brain injury by decreasing and maintaining intracranial pressure. Differences between the pediatric patients and the adult patient are highlighted throughout.