American journal of critical care : an official publication, American Association of Critical-Care Nurses
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Randomized Controlled Trial Comparative Study Clinical Trial
A comparison of transparent polyurethane and dry gauze dressings for peripheral i.v. catheter sites: rates of phlebitis, infiltration, and dislodgment by patients.
Before a meta-analysis by Hoffman et al was published, polyurethane dressings were used at insertion sites for peripheral i.v. catheters at our institution. On the basis of the results of the meta-analysis, we began to use gauze dressings. The change from polyurethane dressings to gauze dressings limited direct observation of the i.v. insertion site, and i.v. catheters were anecdotally reported not to be anchored as securely as before. ⋯ At our institution, given the decreased disruption of the i.v. therapy with the transparent polyurethane dressings and the lack of differences in the rates of phlebitis or infiltration with the two types of dressings, we prefer to use transparent polyurethane rather than gauze dressings at insertion sites for peripheral i.v. catheters.
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Malignant hyperthermia is a pharmacogenetic disease of skeletal muscle characterized by hypermetabolism that occurs on exposure to a triggering agent or agents. The most common agents are halogenated inhalational anesthetics and succinylcholine, a depolarizing muscle relaxant. ⋯ A thorough preoperative interview should be done to determine risk factors and susceptible patients. This article provides critical care nurses with sound information on the pathophysiology of malignant hyperthermia, the ability to assess the disease properly and treat the patient both before and after the crisis, and the ability to provide support and teaching to patients and patients' families to prevent the recurrence of malignant hyperthermia.
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To assess and compare levels of nurse-physician collaboration and satisfaction with the decision-making process as reported by critical care nurses, resident physicians (residents), and attending physicians (attendings) in making decisions to transfer individual patients out of the critical care unit, and to assess if satisfaction predicts nurse retention. ⋯ Collaboration between nurses and physicians is a more important component of satisfaction with decision making for nurses than for physicians. Any interventions to change the amount of collaboration in practice must take account of this difference.
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Comparative Study
The impact of do-not-resuscitate orders on nursing workload in an ICU.
The meaning of do-not-resuscitate orders and their impact on nursing care have been a source of confusion, and the results of the few studies that have examined nursing care of ICU patients with these orders have been conflicting. ⋯ A high level of nursing care was required for this group of critically ill patients, and the do-not-resuscitate order did not alter the number of hours of nursing care required after the order was written.
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Mucormycosis is a rare opportunistic infection caused by ubiquitous fungi typically found in soil, spoiled foods, bread, and dust. The acute infection most commonly is rhinocerebral and is associated with metabolic acidosis. ⋯ Even after aggressive and appropriate treatment with surgical debridement and IV administration of amphotericin B, the fungus invaded the central nervous system. This article discusses current methods of treating mucormycosis and important critical care nursing considerations for patients who have the infection.