Critical care nursing clinics of North America
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Crit Care Nurs Clin North Am · Sep 2004
ReviewSedation and comfort issues in the ventilated infant and child.
Intubated infants and children require optimal sedation and comfort measures. Key elements that ensure the provision of quality care for these patients include the use of pain, comfort, and sedation assessment tools; pharmacologic and nonpharmacologic strategies; and the inclusion of the patient and parents as part of the team. This article describes approaches for using sedation and ensuring comfort in these patients. Application of research and the education of team members and the patient and family are crucial aspects of care and are also discussed.
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Asthma is a chronic inflammatory disorder that results in recurrent episodes of reversible airflow obstruction. Lung hyperinflation results from obstruction or dynamic airway collapse during exhalation. ⋯ Patients who present with asthma have increased inspiratory work of breathing due to lung hyperinflation and auto-positive end-expiratory pressure (auto-PEEP). The goal of acute care treatment is to reverse bronchoconstriction and inflammation, thus reducing dynamic hyperinflation, so that breathing is restored to baseline, unlabored, quiet breathing.
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Crit Care Nurs Clin North Am · Sep 2004
Review Case ReportsMonitoring carbon dioxide in critical care: the newest vital sign?
Carbon dioxide (CO(2)) monitoring can yield substantial information about cardiac and pulmonary function. Because capnography is not complicated, it is relatively easy to apply in a wide variety of clinical settings. ⋯ Although outcomes data are as yet unavailable for this technology, its ease of use makes it an attractive monitoring tool to assess severity of illness and predict patients' responses to therapy. This article describes the pathophysiology and clinical applications of the technologies and describes why they may well be "the newest vital signs."
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Many studies have been published on weaning patients from mechanical ventilation, but few have addressed the unique needs of patients with neurologic impairment. Typically, neuroscience patients remain intubated because of concerns over airway protection or neuromuscular weakness. This article discusses special weaning considerations for this patient population. Neurologic-specific weaning trends from a comprehensive ventilator weaning program are also presented.
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Crit Care Nurs Clin North Am · Sep 2004
ReviewThe pragmatics of feeding the pediatric patient with acute respiratory distress syndrome.
Acute respiratory distress syndrome (ARDS) represents the ultimate pulmonary response to a wide range of injuries, from septicemia to trauma. Optimal nutrition is vital to enhancing oxygen delivery, supporting adequate cardiac contractility and respiratory musculature, eliminating fluid and electrolyte imbalances, and supporting the proinflammatory response. Research is providing a better understanding of nutrients that specifically address the complex physiologic changes in ARDS. This article highlights the pathophysiology of ARDS as it relates to nutrition, relevant nutritional assessment, and important enteral and parenteral considerations for the pediatric patient who has ARDS.