Critical care nursing clinics of North America
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The emergency nurse must anticipate the presence of SCIs. Spinal cord-injured patients should be considered acutely ill and assessed in a comprehensive manner. The occurrence of a SCI may mask symptoms of underlying pathologic conditions that, if left untreated, are life-threatening. The emergency nurse is in a pivotal role, whether functioning in a prehospital setting or in the ED, to intervene rapidly.
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A small but significant percentage of ICU patients are designated DNR at some time during their ICU stay. DNR patients in the ICU are more ill, use more resources (including nursing care) and have a higher mortality rate than non-DNR patients. In an age of a critical care nursing shortage, spiraling health costs, and an emphasis on the just allocation and use of scarce resources, the question whether DNR patients should be excluded from the ICU is appropriately raised. ⋯ In this authors' opinion, beyond point Z, only palliative treatment is justified in the ICU. DNR patients beyond point Z should not receive curative treatments in the ICU. Many DNR patients fitting this description remain in ICUs, however, perhaps because of physician reluctance to withdraw or withhold life-sustaining treatments.(ABSTRACT TRUNCATED AT 250 WORDS)
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Spinal cord injuries create alterations in ventilatory mechanics that range from complete ventilator dependence in high cervical injuries to the need for an assisted cough to clear secretions in low thoracic injuries. The initial nursing assessment should include the degree of respiratory muscle impairment, the effectiveness of the patient's inspiratory efforts, and the ability to cough. ⋯ Perhaps the greatest challenge for both the nurse and the patient is weaning from mechanical ventilation. Weaning requires a coordinated plan, based on trust between patient and nurse, in order to achieve maximum independence from ventilatory support.