American journal of critical care : an official publication, American Association of Critical-Care Nurses
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The inability to speak during critical illness is a source of distress for patients, yet nurse-patient communication in the intensive care unit has not been systematically studied or measured. ⋯ Study results highlight specific areas for improvement in communication between nurses and nonspeaking patients in the intensive care unit, particularly in communication about pain and in the use of assistive communication strategies and communication materials.
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A 66-year-old woman who was a Jehovah's Witness had massive lower gastrointestinal bleeding and subsequent hypovolemic shock, necessitating a subtotal colectomy. During the postoperative period, her hemoglobin level decreased to a low of 2.6 g/dL, prolonging her dependence on mechanical ventilation. ⋯ Blood-conserving techniques are indispensable in the management of Jehovah's Witnesses who have massive blood loss. Maximizing oxygen transport, minimizing blood loss, using a cell saver when permissible, providing optimal ventilatory support, performing tracheostomy early if prolonged mechanical ventilation is expected, and augmenting hemoglobin production with administration of iron and erythropoietin are techniques that can facilitate successful outcome in patients who refuse blood transfusion.
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Caring for patients during intrahospital transport is a high-risk activity. Few data exist on the use of specialized transport teams similar to the teams used for out-of-hospital transport. ⋯ The rate of clinically significant adverse events during patient transport by a specialized team is relatively low. Further studies are needed to compare effectiveness and mortality benefits between intrahospital transport teams and traditional transport teams.