American journal of critical care : an official publication, American Association of Critical-Care Nurses
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Multiple rib fractures in trauma patients are associated with significant morbidity and mortality. Delayed morbidity for patients with rib fractures is often a result of hypoventilation leading to atelectasis, pneumonia, and respiratory failure. Pain management was first recognized as an important factor in preventing complications in these patients. ⋯ It is now known that patients with multiple rib fractures benefit most from adequate pain control, rapid mobilization, and meticulous respiratory care to prevent complications. A protocol based on a synthesis of the existing literature is developed. Development of such a protocol for decisions about rapid mobilization, respiratory support, and pain management is the first step in testing the hypothesis that these interventions will decrease the length of patients' stay in intensive care units.
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Comparative Study
Comparison of outcome predictions made by physicians, by nurses, and by using the Mortality Prediction Model.
Critical care nurses must collaborate with physicians, patients, and patients' families when making decisions about aggressiveness of care. However, few studies address nurses' ability to predict outcomes. ⋯ Nurses can predict survival outcomes as accurately as physicians do. Greater sensitivity and specificity are necessary before clinical judgment or predictive tools can be considered as screens for determining aggressiveness of care.
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Comparative Study
Reliability of nurses' neurological assessments in the cardiothoracic surgical intensive care unit.
Alterations in mental status are common among patients in the cardiothoracic surgical intensive care unit. Changes in mental status can be caused by metabolic factors, medications, or brain injury. In this setting, reliable, serial neurological evaluations are critical for assessing the effectiveness of treatment and the need for additional studies. ⋯ Both scales are reliable indicators of the neurological state of patients in the cardiothoracic surgical intensive care unit. These scales measure different, although limited, aspects of cognitive function. Each test was simple to administer and did not take more time than the standard nursing neurological examination. Most of the variability in scoring was related to the different degrees of stimulation used by examiners when assessing patients, not to differences in the interpretation of patients' responses.