Critical care nursing quarterly
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Penetrating head injuries are a significant public health problem in the United States, with an estimated 33,000 gun-related deaths and many more nonfatal shootings per year. Initial treatment for a penetrating head injury is similar to that of a closed head injury. That is, all efforts must be made to prevent any secondary insults, hypoxia, or ischemia. ⋯ Others have said that patients with a low coma score and transventricular gunshot wounds should not be treated because of the high mortality. If the patient survives a penetrating head injury, he or she generally goes on to experience a relatively good functional outcome. Only if all components of a good treatment regimen are in place will patients and their families obtain the best possible outcome.
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The critical care bedside practitioner is in a key position for early recognition of a patient at nutritional risk and is responsible for initiating collaboration with other disciplines when appropriate. An adequate knowledge-base related to the critically ill patient's nutritional needs and the recent research supporting the best techniques to provide nutritional support is essential to achieve optimal patient outcomes. This article provides the experienced practitioner with the necessary information to initiate and implement a nutritional plan of care for critically ill patients. A working model for practice will be presented to enhance bedside decision making related to nutritional support.
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This article attempts to describe the identification of high-risk characteristics of the critical care patient population that lends itself to the development of multiple organ dysfunction syndrome. A review of the literature describes the overall pathophysiology of the syndrome and the identification of a patient's risk or predisposition. ⋯ Although the studies are not conclusive, the awareness of potential predisposing factors is discussed for purposes of early recognition of symptomatology and prioritizing critical care beds when bed availability is lacking. Future studies are warranted to trend predisposing factors as well, and a discussion of developing computerized technology to incorporate predisposing factors to correlate severity of illness is presented.
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Significant biventricular cardiac dysfunction occurs early in sepsis and multiple organ dysfunction syndrome. Multiple mediators and physiologic derangements result in the characteristic hemodynamic alterations associated with sepsis. The ability of the myocardium to compensate for this failure and continue to generate adequate flow to meet tissue oxygen needs defines the difference between survivors and nonsurvivors of sepsis and multiple organ dysfunction syndrome. This article discusses the physiologic and hemodynamic differences between survivors and nonsurvivors of sepsis and describes key monitoring techniques that guide interventions.
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The intensive care unit is an area where high-technology life support systems are capable of turning around multiple organ system failure. By its nature, this care plan confers a great deal of stress on the patient and sets the stage for the phenomenon of brain failure, a syndrome where neurotransmission is disrupted by the combined forces of environmental stress and underlying disease. ⋯ Accurate recognition of brain failure and its co-morbidities can facilitate effective treatment and avoid long-term hemodynamic and metabolic consequences. Computer-interpreted cerebral function monitors can noninvasively assay cerebral function at the neuronal level under heavy sedation regimens when the visual clues of brain function disappear.