Critical care nursing clinics of North America
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Crit Care Nurs Clin North Am · Sep 2005
ReviewThe effects of liver and renal dysfunction on the pharmacokinetics of sedatives and analgesics in the critically ill patient.
In critically ill patients, the duration of effect and dose-response relationship of sedative and analgesic drugs can be significantly affected by the presence of renal or hepatic dysfunction. Alterations in pharmacokinetics and pharmacodynamics vary according to the degree of organ impairment and presence of comorbid illnesses. This article reviews the principals that govern the absorption, distribution, metabolism, and elimination of sedatives and analgesics during renal and hepatic impairment. By anticipating changes in pharmacokinetics, and by routinely assessing the clinical response to therapy, unintended adverse consequences of sedative and analgesic drug therapy may be avoided.
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Crit Care Nurs Clin North Am · Sep 2005
Review Case ReportsComplications of sedation and critical illness.
Critically ill patients require sedation to reduce anxiety, agitation, and achieve therapeutic goals. Over-sedation in combination with multiple causes for extreme muscle weakness, however, interferes with recovery from critical illness. This article describes contributing factors and explores methods of preventing over-sedation and related sequelae.
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People dependent on mechanical ventilation in an intensive care unit sleep poorly. Less than half of their sleep occurs at night. ⋯ Because most arousals are associated with caregiving activities or noise, caregivers should consolidate care and decrease environmental noise. More research is needed on sleep and sleep promotion in mechanically ventilated patients.
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Crit Care Nurs Clin North Am · Sep 2005
ReviewAlcohol withdrawal syndrome: assessment and treatment with the use of the Clinical Institute Withdrawal Assessment for Alcohol-revised.
Alcoholism is a chronic, complex disease and addictive disorder. Sudden cessation of alcohol consumption can lead to alcohol withdrawal, an acute process with devastating and potentially life-threatening consequences. ⋯ The higher the patient's score, the greater the risk for experiencing serious withdrawal symptoms. Pharmacotherapy may be gauged to treat the symptoms according the score.
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Crit Care Nurs Clin North Am · Sep 2005
Review Case ReportsToward solving the sedation-assessment conundrum: bi-spectral index monitoring and sedation interruption.
The sedation-assessment conundrum is defined by two diametrically opposed goals: to maintain an appropriate level of sedation, and to obtain a comprehensive neurologic examination that most accurately reflects the patient's neurologic status. A case presentation leads to a discussion of over-sedation and under-sedation issues that impact the care of critically ill patients. This information is useful in understanding the many methods of assessing sedation and interpreting individualized patient responses to sedation. The use of bi-spectral index monitoring and periods of sedation interruption are discussed within the context of addressing the sedation-assessment conundrum.