Critical care nursing quarterly
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Critical care practice has greatly changed over the last three decades. This is partly due to the advent of the pulmonary artery catheter and subsequent advances in technologies associated with it. ⋯ Parameters that were once only available on an intermittent basis can now be obtained continuously. Addition of mixed venous oxygen saturation to the cardiorespiratory profile and other derived parameters provides the bedside clinician with important variables to assess the cardiorespiratory status of the critically ill.
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Nutritional assessment can be incorporated into the assessments performed daily by the critical care nurse for every patient. Identification of nutritional deficits will lead to timely interventions and will facilitate recovery and early discharge. The metabolic responses to starvation and stress are reviewed, and bedside techniques for nutritional assessment are outlined. General guidelines for nutritional support and parameters for monitoring the effectiveness of nutritional therapies are defined.
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Obstetric patients have long been a source of fear for nurses in the intensive care unit (ICU) setting. Several hospitals have moved toward having obstetric ICUs, but most do not have the volume to justify such units, leaving the care of these patients to nurses in traditional ICU settings. Collaboration of care may occur, but it is still imperative that ICU nurses have a basic understanding of the physiologic changes and care necessary to provide optimal outcomes for obstetric patients. Physiologic changes of pregnancy and basic care for pregnant and immediate postpartum patients are reviewed.
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Many children every year will be treated in "adult" critical care units because of the limited pediatric trauma centers currently available. Assessment is an integral part of all pain management. ⋯ In children as young as 3 years old, the self-report tool called an OUCHER can be administered to assess their pain. Easy to apply nonpharmacological approaches are discussed with recommendations for nurses to incorporate into their daily care.
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Economic, social, and technical factors are an impetus for expressing end-of-life decisions as advance directives. Despite opportunities, nurses do not appear to be widely involved in practice and research regarding advance directives. ⋯ The use of advance directives will likely increase if nurses can aggressively implement a plan on their unit. Specific methods of implementation are explored.