Critical care nursing clinics of North America
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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.
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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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The goal of fluid therapy in the PACU setting is the restoration of blood volume and tissue perfusion. Choosing the type of fluid infusion depends on the preoperative, intraoperative, and postoperative condition of the patient. An understanding of the functional fluid compartments, the composition of body fluids and commercially available fluids, and the steps to evaluate fluid depletion allow one to determine the fluid needs of the patient. ⋯ Platelets are used to treat bleeding associated with deficiencies in platelet number or function. Fresh frozen plasma is transfused to increase clotting factor levels in patients with demonstrated deficiency. A good understanding of fluid types available, of a systematic approach to evaluating fluid depletion, and of the indications for blood component therapy will allow one to make appropriate decisions when implementing fluid therapy in the PACU.
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Postoperative care of the pediatric surgical patient requires knowledge of the signs of cardiorespiratory and neurologic deterioration in the child as well as familiarity with particular postoperative complications associated with various types of surgery. This article briefly reviewed the principles of postoperative care of the critically ill child, and included references for more comprehensive sources of information.