Critical care nursing clinics of North America
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The GI tract is an important line of defense in the body's immunologic system. Without the proper care and treatment, this defense fails, rapidly increasing critically ill patients' susceptibility to added infections and system failures. ⋯ As more research is completed, the role of the GI tract in critical illness and measures to maintain its integrity will be identified. In the meantime, the initiation of enteral nutrition is an important initiative.
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Crit Care Nurs Clin North Am · Jun 1999
Outcomes improvement following minimally invasive direct coronary artery bypass surgery.
The most progressive movement in the standardization of MIDCAB has occurred within the past 5 years. Standardization of care and continuous quality improvement are essential to improve outcomes and reduce costs for MIDCAB. At the authors' institution, perioperative clinical outcomes demonstrated no significant differences among a traditional single-vessel CABG and a MIDCAB in myocardial infarction rates, reoperations for bleeding, and cerebrovascular accidents. ⋯ The reported clinical outcomes are appropriate variables to track for continuous quality improvement. These clinical outcomes are meaningful, measurable, and appropriate for evaluating the effectiveness of care but do not address quality of life, patient satisfaction, and efficacy of pain management. Nursing care must continue to evolve as more data become available.
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Pulse oximetry is one of the most commonly applied technologies in acute and critical care. It has the potential to continuously monitor pulmonary function, avoid unnecessary blood gases, and alert clinicians to hypoxemic events that are not readily apparent by physical assessment. Due to these advantages, pulse oximetry has a firm place in health care. ⋯ In addition, oximetry has the potential to be misused owing to its widespread application. In order to obtain the maximum benefits from this technology, clinicians must be educated about the strengths and limitations of oximetry. If this education effectively changes clinicians' behavior, pulse oximetry will provide an excellent clinical advantage in patient assessment as well as moderate cost benefits.
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POCT is rapidly expanding in today's critical care areas. Nurses need to be involved in the implementation and evaluation process of POCT at every step. Each institution must determine which bedside tests are indicated based on an in-depth analysis of test accuracy, positive clinical impact, and cost-benefit ratio. ⋯ In addition, clinicians should examine the cost to patients regarding comfort and quicker discharge. These are quality indicators from the patient's perspective. POCT offers many advantages, but surrounding the implementation of this technology is a multitude of questions that each institution must answer prior to undertaking a POCT program.
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Crit Care Nurs Clin North Am · Mar 1999
Review Case ReportsCapnography. A key underutilized technology.
Based on the multiple applications and the potential cost savings, every ICU should have enough capnography for all intubations and probably for all mechanically ventilated patients. Of the multiple clinical applications of capnography, most attention should be focused on its use with intubation and resuscitation. Other applications, such as blood gas and ventilation-perfusion scan reduction, should be instituted after the primary areas have been implemented. While capnography modules may appear to be expensive at first glance, an analysis of their clinical application reveals they can save the hospital hundreds of thousands of dollars beyond the purchase price.