Critical care nursing clinics of North America
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Achieving pain control in critically ill patients is a challenging problem for the health care team, which becomes more challenging in morbidly obese patients. Obese patients may experience drug malabsorption and distribution, which may lead to either subtherapeutic or toxic drug levels. ⋯ In addition, nurses must be knowledgeable about physiologic pain mechanisms, types and manifestations of pain, differing patterns of drug absorption and distribution, pharmacokinetic properties of analgesic medications, and pain management strategies. This article explores factors affecting pharmacokinetics in obese patients, trends in pain management, and treatment strategies for the obese patient.
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Crit Care Nurs Clin North Am · Jun 2009
Review Case ReportsThe ten commandments of pain assessment and management in preterm neonates.
Despite advances in pain assessment and management, nonpharmacologic and pharmacologic analgesic therapies continue to be underutilized in managing both acute and procedural pain in preterm neonates. Untreated acute, recurrent, or chronic pain related to disease or medical care may have significant and lifelong physiologic and psychological consequences. Painful procedures in the NICU may be unavoidable, so it is vital that caregivers balance the painful, medically necessary care with evidence-based nonpharmacologic and pharmacologic strategies to relieve pain and stress. We present Ten Commandments of pain assessment and management in preterm neonates to promote the use of best practices and compassionate care in the NICU.
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This article briefly reviews the history of ROP followed by a discussion of the pathogenesis of this complex disorder. We describe the International Classification System for ROP and identify risk factors and screening recommendations. Finally, we discuss some of the measures that have been used in an attempt to both prevent and treat ROP.
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Crit Care Nurs Clin North Am · Jun 2009
ReviewPatient safety: effective interdisciplinary teamwork through simulation and debriefing in the neonatal ICU.
According to the Institute of Medicine, team training is necessary to promote a safe and high-quality patient care environment. The complexity of the neonatal ICU requires that interdisciplinary teams collaborate, coordinate, and communicate to achieve common goals and support families. The use of strategies from the aerospace, nuclear power, and national defense industries-simulation, and debriefing-equips health care providers with the knowledge, skills, and behaviors necessary to perform effectively and safely. Families are encouraged to participate in simulation and debriefing so interdisciplinary teams can learn how to approach and support families when disclosing errors and to communicate sensitive information in a safe and nonthreatening environment.
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Crit Care Nurs Clin North Am · Jun 2009
ReviewWhen the fetus is alive but the mother is not: critical care somatic support as an accepted model of care in the twenty-first century?
There has been an increase in cases involving the maintenance of brain dead pregnant women on life support to allow for fetal growth toward viability and birth. This article provides an ethical analysis and discusses the critical care nursing needs of the maternal patient.