American journal of critical care : an official publication, American Association of Critical-Care Nurses
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Comparative Study
Urinary bladder/pulmonary artery temperature ratio of less than 1 and shivering in cardiac surgical patients.
Temperature gradients that normally exist between body areas may be altered as a result of heat generated by shivering. ⋯ Pulmonary artery and urinary bladder temperatures are readily available clinically. The combination of a ratio of less than 1 and an increase in rate pressure product should be considered suggestive of shivering in coronary artery bypass graft patients.
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This is a case study of a patient 32 weeks pregnant who presented with multiple endocrine neoplasia type IIa, with severe pheochromocytoma complicated by adult respiratory distress syndrome. The patient's blood pressure was labile, with systolic variations from 50 to 230 mm Hg and tachycardia ranging from 150 to 180 beats per minute. ⋯ Hemodynamic measures are compared with the clinical presentation. The importance of fluid replacement is discussed.
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Review
Gastric intramucosal pH: a noninvasive method for the indirect measurement of tissue oxygenation.
Monitoring the adequacy of tissue oxygenation is an important goal in the care of the critically ill patient. Global alterations in tissue oxygenation are inferred from changes in systemic oxygen transport (defined as the product of cardiac output and arterial oxygen content) and total oxygen consumption. These parameters, however, cannot measure the level of oxygenation of specific tissue beds, in particular those that are first affected by hypoxia, such as the gastrointestinal tract and the kidneys. ⋯ Gastrointestinal tonometry is a relatively noninvasive device that appears capable of measuring metabolic changes produced by hypoxia. Because of the sensitive nature of the gastrointestinal mucosa, these changes often occur well in advance of other, more common, indices of hypoxia. The use of the tonometer may become a routine procedure in the overall monitoring of critically ill patients.
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Comparative Study
Job stress and burnout in acute and nonacute pediatric nurses.
To identify predictors of burnout in pediatric nurses and to compare the incidence of burnout, job stress, anxiety and perceived social support in acute and nonacute care pediatric nurses. ⋯ Even though high burnout levels are more frequent in acute care pediatric nurses, burnout is a problem in both acute and nonacute care pediatric nurses. The pattern of results suggests that efforts directed toward reducing anxiety and job stress and increasing coworker support, particularly for less experienced nurses, might reduce burnout.