Critical care nursing clinics of North America
-
The approach to fluid resuscitation in burn shock continues to be refined in step with improved knowledge of the complex fluid, electrolyte, and protein shifts that characterize this form of shock. Local burn tissue and generalized nonburn tissue edema occur initially after injury because of the release of histamine, which causes increased microvascular permeability. Subsequent edema formation in burned and nonburned tissue occurs according to distinctly different mechanisms. ⋯ Ringer's lactate solution is the most common fluid used in the early postburn period. The addition of colloid to resuscitation efforts should begin as microvascular permeability is restored or immediately if the patient presents in frank shock. Continuous monitoring is necessary to judge the adequacy of fluid replacement.
-
Crit Care Nurs Clin North Am · Dec 1989
Review Case ReportsFuture expectations for critical care nurses. Competence in immunotherapy.
Immunotherapy is a promising therapy for the treatment of some forms of cancer. This research therapy uses normal immune system substances such as IL-2 to stimulate the immune system to kill tumor cells while sparing normal tissues. Many side effects of IL-2 have been identified. ⋯ The critical care nurse has a major role in the monitoring and management of this patient population. Hospitals that participate in this research treatment for cancer are increasing. In the near future, competence in immunotherapy will be an expectation for many critical care nurses.
-
Crit Care Nurs Clin North Am · Dec 1989
Case ReportsAdvances in weaning from mechanical ventilation.
In all three of the previous cases, any one of the weaning modes may be successful. Although specific weaning protocols are based on individual bias, a single rigid approach to weaning may not be appropriate for all patients. ⋯ If a weaning attempt is not successful for a particular patient, it makes sense to take another approach. With T-piece trials, CPAP trials, IMV weaning, PSV, or various combinations, a successful weaning plan can usually be tailored to the individual patient.
-
The evaluation of oxygen availability, transport, and extraction at the tissue level have become critical factors in managing the acutely ill. Oximetry, both arterial and venous, has contributed to oxygenation assessments. Despite some limitations, oximetry offers immediate continuous feedback that can alert practitioners to potential oxygenation problems.
-
The burn patient is highly susceptible to infection due to the loss of the skin as a barrier to microorganisms. Immune defenses are activated in response to the burn injury; however, some of these defenses are altered. Neutrophil chemotaxis is compromised by decreased perfusion caused by hypovolemia and the formation of microthrombi. ⋯ Although burn wound sepsis is an obvious cause of death for the burn patient, it is not the primary cause. Increasing sophistication in fluid resuscitation and in intensive care therapy has resulted in patients living beyond the initial insult and the following few days. Burn patient mortality is now associated with a syndrome presenting clinically as sepsis but without any identifiable septic source.(ABSTRACT TRUNCATED AT 250 WORDS)