Resp Care
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In the 4 1/2 years beginning in January 1981, the University Hospital at the Boston University Medical Center admitted 46 ventilator-assisted individuals to its Respiratory Care Center and discharged 38 of them to their homes with ventilators. Of the 46 admitted, 23 had COPD and 23 had neuromuscular or skeletal disorders. All the latter were successfully sent home, and 15 of the 23 with COPD went home. ⋯ The hospital-based Respiratory Care Center is staffed by a team from physical therapy, occupational therapy, respiratory therapy, rehabilitation nursing, social service, psychiatry, rehabilitation medicine, and otolaryngology. A pulmonary physician directs the program and a respiratory nurse specialist is co-director and oversees its daily operation. The rehabilitation process has six stages: Stage 1 is stabilization, Stage II is evaluation, Stage III is rehabilitation planning, Stage IV is rehabilitation training, Stage V is discharge planning.(ABSTRACT TRUNCATED AT 250 WORDS)
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A respiratory care computer-charting system was developed and implemented as an addition to our hospital's computerized information system. Medical personnel charted and reviewed respiratory care procedures at nursing station computer terminals instead of using the patient's traditional paper chart. The computer automatically performed billing and provided management as well as clinical information. ⋯ Computer charting was more complete and informative. Productivity increased 18%, although it remains unclear to what degree the computer was responsible. Computer charting streamlined the process of documentation and allowed more beneficial use of clinical information.
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In the initial stage of the planning of an intensive care unit, the problems and goals should be identified, solutions to problems developed, and one solution or overall plan selected. At this point, input from all personnel who work in or contribute to care or services in the ICU should be sought and carefully considered. Once this has been done, decisions on specific design features can be made. The overall function of the unit should be kept in mind, and all design decisions should facilitate observation of the patients, surveillance of physiological monitoring, delivery of routine and emergency interventions, and recording of patient care information.
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Critically ill patients admitted to an intensive care unit (ICU) are rapidly evaluated, and aggressive management is immediately instituted. They are intubated and placed on mechanical ventilation, and invasive monitoring is begun. Many patients are successfully treated and discharged from the ICU, but unfortunately a large percentage of the critically ill do not improve and become chronically critically ill. ⋯ We present a management strategy for improving the prognosis of the chronically critically ill patient by concentrating on exercise, nutrition, fluid management, emotional support, and adequate sleep. We address issues dealing with withholding and withdrawing extraordinary life support. We conclude by demonstrating how these concepts were applied in the case of a chronically critically ill young man with the acquired immunodeficiency syndrome (AIDS).
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Ten patients with known but clinically stable chronic obstructive pulmonary disease (COPD) were studied while breathing low-flow (1-2 L/min) supplemental oxygen by nasal cannula and by biflow nasal mask. Although the increase in inspired oxygen when breathing with the cannula has been documented, the nasal mask has not been tested by measurement of PaO2 change. The mean age of the group was 64.6 years, and their mean PaO2 was 54 +/- 10.5 torr while they were at rest and breathing room air. ⋯ Differences in measured arterial saturation (SaO2) and PaCO2 also proved to be insignificant when patients breathed via the two devices. The conclude that the nasal cannula and the biflow nasal mask produce comparable PaO2 in patients who may need low-flow supplemental oxygen at rest. The mask can be considered an alternative oxygen appliance if preferred by patients because of comfort.