Critical care nursing clinics of North America
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This article has discussed the anatomy and physiology of the neuromuscular junction and excitation-contraction coupling. The pharmacokinetics and pharmacodynamics of various depolarizing and nondepolarizing neuromuscular blocking agents were presented. ⋯ Because the recovery room nurse is relied on for continuous assessment of the postoperative patient, it is imperative that the nurse have a comprehensive knowledge of intraoperative factors that relate to the patient's recovery. The recovery room nurse should be an expert in the assessment of postoperative patients.
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Postanesthetic hypothermia is a common, significant, and costly problem in the PACU. The scope of the problem ranges from an adverse outcome for the patient to undue financial burden to the institution providing the care. All of these problems can be minimized or prevented with active warming therapy. ⋯ The problem is as ancient as surgery and anesthesia, but the implications are only beginning to be appreciated. Analysis of the problem of hypothermia in terms of clinical and financial outcome are proceeding, with new studies appearing in the literature monthly. More investigation is indicated in the area of patient temperature regulation, which is likely to identify additional situations when active warming therapy is indicated, as a mechanism to protect patients during emergence from anesthesia and to insure cost-effective use of PACU time.
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Crit Care Nurs Clin North Am · Mar 1991
Pain assessment. The problem of pain in the critically ill patient.
In the face of maintaining airways and providing circulatory support, pain assessment may be given a low priority in the critical care unit. On the contrary, given the deleterious effects pain may have for the critically ill or injured patient, pain assessment must be given a high priority to develop effective management plans. In addition to assessing the patient's pain, critical care nurses must be acutely aware of their own personal biases and how those biases might influence perceptions of the patient's suffering.
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A wide variety of agents are available to the clinician for the treatment of pain. The selection of the agent or agents is based on the severity of the pain, the expected duration of the pain, the desired method of administration, types of side effects that will or will not be tolerable, and other patient-specific factors such as pre-existing disease states.
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Understanding normal coagulation processes will allow the critical care nurse to also understand disorders of coagulation. Understanding diagnostic tests used to assess coagulation will also allow the critical care nurse to evaluate disorders of coagulation and to identify patients at risk for bleeding disorders. ⋯ Nursing interventions will include maintenance of aseptic technique; minimizing tissue trauma (avoid venipunctures, use of a soft toothbrush); guaiacing stools; monitoring oxygenation and level of consciousness; and monitoring laboratory tests, including hemoglobin and hematocrit, along with laboratory tests of coagulation. Prompt detection and intervention will help minimize the morbidity and mortality associated with bleeding and alterations in coagulation.