Critical care nursing quarterly
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Injuries from blunt trauma can occur from a variety of causes. Myocardial contusion is the most common injury resulting from blunt, nonpenetrating trauma to the chest. ⋯ Diagnosing a myocardial contusion concomitant with other traumatic injuries can often be delayed, especially in light of the fact that immediate cardiac dysfunction may be slow in manifesting symptoms. Through use of a case study approach, this article demonstrates that a myocardial contusion has many similarities in terms of pathophysiologic changes with that of a myocardial infarction, often confusing symptoms and therefore diagnosis and treatment.
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Few studies have comprehensively focused on caring as perceived by the critical care family. This study explores and describes positive types of nurses' behaviors and critical care families' perceptions of these nursing behaviors as caring. Grounded theory methodology was used to enter the world of the critical care family and to elicit the meanings of caring behaviors in nurse-family interactions in the critical care waiting room.
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Randomized Controlled Trial Clinical Trial
The effect of head covering on rewarming and shivering in cardiac surgical patients.
In hypothermic postoperative cardiac surgical patients, heat loss from the head may interfere with rewarming and cause shivering. This study investigated the effect of head covering on rewarming rate and shivering during post-operative rewarming. The sample included 19 experimental and 21 control subjects. ⋯ Shiverers were slightly colder (mean, 36.13 degrees C; t = 1.768; P = .085) on admission to the cardiac surgical intensive care unit and had significantly greater heat gain (t = -2.091, P = .043) than nonshiverers. Conclusions about the effect of head covering on shivering could not be made because of small sample size. Failure to demonstrate a significant difference in rewarming rate is due to the effects of mildly hypothermic admission UBTs on the mathematical calculation of rewarming rate and on the small sample size.
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A 1-month prospective quality improvement audit was performed to determine the incidence of self-extubation in the intensive care units (ICUs) at the Westchester County Medical Center (WCMC), a 625-bed tertiary care hospital with 92 intensive care beds in 11 ICUs. During the 1-month study period, there were seven unplanned extubations in six of 121 intubated patients, or one unplanned extubation for every 136 patient-ventilator days. Based on the initial review, a corrective action plan was initiated that consisted of education of nurses and house staff about the problem of unplanned extubation, daily assessment on rounds of patient risk of unplanned extubation, and careful documentation of any episodes of unplanned extubation. ⋯ Unplanned extubation can be a serious complication associated with mortality and therefore is a quality-of-care concern. However, the majority of patients with this complication did well and were discharged from the hospital. The incidence of unplanned extubation can be reduced but not eliminated by a program of education and attention to risk factors for unplanned extubation.
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Unintentional or accidental extubation is an undesirable complication in the mechanically ventilated patient. This is particularly dangerous in high-risk patients who are on neuromuscular blocking agents or positive end-expiratory pressure or are difficult to reintubate. ⋯ The results of a two-year study reveal a reduction of the incidence from an initial 12% to 5% and a reduction of high-risk extubations from five to an incidence of three. The investigator also assembled an airway system consisting of low pressure cuff endotracheal tube with a pressure monitoring device and several adapters along with a tube fixation system.