Critical care nursing quarterly
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Traditional treatment options for the adult with severe head injury have included hyperventilation, elevation of the head of the bed, sedation, chemical paralysis, fluid restriction, diuresis, anticonvulsant therapy, and barbiturate coma. These interventions for severe head injury are reviewed and updated with current research. Neuroprotective drugs (including glutamate antagonists, oxygen free radical scavengers, and high dose steroids) are introduced, along with monitoring of jugular venous oxygen saturation and the role of the transcranial Doppler. The role of the critical care nurse in the treatment and monitoring of the adult with severe head injury is discussed.
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Traumatic injuries are the primary cause of death in children. Nursing care that the critically injured child receives during the acute phases of resuscitation and stabilization and critical care have direct impact on potential for good long-term outcome. The nurse works in concert with other members of the trauma team to provide comprehensive assessment and interventions during both the primary and secondary surveys. Knowledge of mechanisms of injury in the pediatric population, patterns of injury unique to children, physiologic differences between adults and children and their impact on care, and developmental needs of children and families guide the trauma nurse in providing expert clinical care and caring psychosocial support to traumatized patients and families.
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Review
Clinical manifestations of blunt cardiac injury: a challenge to the critical care practitioner.
Life-threatening cardiac emergencies following blunt chest trauma demand accurate assessments and rapid interventions to prevent unnecessary complications and death. Critical care practitioners must recognize the subtle clues that indicate cardiac trauma and the decompensation that occurs if the injuries are not recognized early. ⋯ Traditional diagnostic laboratory studies such as cardiac enzymes have proven ineffective in the trauma patient population. Therefore, the role of the critical care practitioner is centered on assessing patients for the clinical manifestations of decreased myocardial performance, particularly those patients with limited cardiac reserve.
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Patients with significant abdominal trauma and polytrauma patients with less severe abdominal injuries require critical care management. The diagnostic skills used for the initial evaluation of the injured abdomen are used to determine whether celiotomy is required and to evaluate the postoperative abdomen for missed injury or early detection for complications. The critical care nurse must identify life-threatening abdominal injuries immediately and all abdominal injuries in a timely fashion through consideration of the mechanism of injury and a combination of history, physical examination, and diagnostic tests. All facets of the critical care management of abdominal trauma must be familiar to the critical care nurse in order to recognize abdominal injuries and lower the frequency of preventable death after trauma.
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Case Reports
Intensive care unit psychosis revisited: understanding and managing delirium in the critical care setting.
Delirium occurs frequently in critically ill patients, yet this syndrome is often unrecognized and poorly understood. Health professionals must recognize delirium and patients at risk because delirium can lead to higher morbidity rates and longer lengths of stay. Various disease states and pathophysiologic disorders cause delirium, as do many commonly used drugs. ⋯ Treatment of delirium focuses on finding the cause and managing the symptoms, often with the use of pharmacologic agents. Critical care nurses need to perform cognitive assessments so that deficits can be recognized and specific interventions for prevention of cognitive impairment can be used. Appropriate nursing care can lessen the severity of delirium, shorten its course, and decrease the morbidity associated with the syndrome.