Critical care nursing clinics of North America
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Clinical decision making about postoperative dysrhythmias requires the specialized skills and knowledge of the critical care nurse. During the immediate postoperative period, the critical care nurse must be aware of physiologic alterations and factors that may predispose the cardiac surgery patient to dysrhythmias. Correction of these physiologic alterations is usually the first step in postoperative dysrhythmia management. ⋯ AEGs and pacing to suppress ectopy, to augment cardiac output, or to overdrive tachydysrhythmias are some of the available options. The advent of external, temporary DDD pacing will augment these management options. The challenges presented by these options emphasize the vital role of the critical care nurse in postoperative dysrhythmia management.
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As our elderly population increases, we will be seeing more elderly heart surgery patients. Because of aging's effects on the body, the elderly have different needs from and are more prone to complications of surgery than the younger patient. Drug toxicity, pulmonary complications, unstable hemodynamics, decreased infection defense, impaired swallowing reflexes, and altered skin function are some of the critical problems seen in this group after heart surgery. The aged patient poses some unique challenges for the critical care nurse that, if met, result in a great feeling of achievement when the patient is returned to a normal and prolonged life.
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Crit Care Nurs Clin North Am · Dec 1991
Noninvasive respiratory monitoring during ventilatory support.
Noninvasive monitoring is commonly used during ventilatory support. This monitoring includes pulse oximetry, capnography, transcutaneous monitoring, monitoring of respiratory mechanics, and indirect calorimetry. There are advantages and disadvantages to each of these forms of monitoring and the technical ability to use each of them must be balanced against clinical usefulness.
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Crit Care Nurs Clin North Am · Dec 1991
Use of sedation and neuromuscular paralysis during mechanical ventilation.
Pharmacologic therapy can be a necessary adjunct with mechanical ventilation. The treatment of pain and anxiety and the suppression of the patient's respiratory drive may be necessary to facilitate effective ventilation and oxygenation. ⋯ The patient must be continually evaluated for the appropriateness and method of dosing, adequate sedation and analgesia, and adverse effects. Patient safety is one of the primary concerns of the critical care nurse during this time.
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Crit Care Nurs Clin North Am · Dec 1991
Weaning from mechanical ventilation: old and new strategies.
The strategies available for weaning patients from mechanical ventilation are many: T-piece mode, SIMV, PSV, and combinations of each. T-piece trials alternating with SIMV or AC provide periods of spontaneous breathing with rest on the ventilator. ⋯ PSV weaning alone or in combination with SIMV or T-piece trials reduces work of breathing, promotes respiratory muscle training, and improves patient-ventilator interaction. Schuster states "the specific weaning technique employed is often less important than the care with which it is applied."