Aust Crit Care
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The objective of the study was to examine the impact of a discharge liaison nurse on intensive care unit (ICU) nurses' perceptions of discharge planning. The discharge liaison nurse coordinated the discharge of patients from ICU to the ward, assisted with hospital discharge, provided clinical teaching and support to both ICU and ward nurses and supported patients and families during hospitalisation. A block intervention design was used. ⋯ Self efficacy in relation to discharge planning did not change over time. Some support was found for the role of the discharge liaison nurse in promoting attitudinal change towards discharge planning in the ICU. Future research is needed to investigate the processes by which the liaison nurse fosters attitudinal change and to document the actual discharge planning practices undertaken in ICU.
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Review Case Reports
The use of activated protein C (drotrecogin alfa (activated)) in the treatment of severe sepsis.
Advances in intensive care have allowed many critically ill patients to survive their initial insult. These patients may later demonstrate multiple organ dysfunction and failure, the genesis of which appears to be the body's reaction to critical illness, manifested by an imbalance and failure of inflammatory and immune system homeostasis. The manifestation of multiple organ dysfunction in the critically ill has been termed multiple organ dysfunction syndrome (MODS). ⋯ This new agent affects both the inflammatory and coagulation dimensions of severe sepsis. The developing concepts of the pathophysiology of sepsis and the emergence of a new therapy increases the complexity of the already complex demands of providing nursing care for the patient with severe sepsis and MODS. This article reviews pathophysiological processes in sepsis, reviews clinical data on activated protein C and illustrates the utility of this therapy in a case study.
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Maintaining oral health in the critically ill patient is imperative in reducing the risk of nosocomial infections and improving patient comfort and discharge outcomes. Critically ill patients are at great risk for poor oral health as many are elderly, undernourished, dehydrated, immunosuppressed, have a smoking or alcohol history, are intubated or on high-flow oxygen, and are unable to mechanically remove dental plaque. Many modalities for delivering oral care have been reported in the literature. ⋯ Sodium bicarbonate and hydrogen peroxide are of limited use due to lack of convincing evidence regarding their safety and antimicrobial effects in the critically ill population. Saliva stimulants or substitutes including lemon and glycerine are also inappropriate for moistening the oral cavity in the critically ill patient. Regular oral assessment and individualized oral care, along with the use of a standardised protocol for oral care (incorporating proven modalities) is vital for optimal oral care in the critically ill patient.
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The ascending peripheral neuropathy and paralysis that result from Guillain-Barre Syndrome's (GBS) demyelination of peripheral nerves is a challenge to health professionals; the patient requires support during the acute disease process and during the remyelination recovery period, often lasting months to years. The staff of a major metropolitan teaching hospital's critical care unit (CCU) and physiotherapy departments developed a hydrotherapy treatment programme for a ventilated patient with GBS. ⋯ The benefits included improved range of movement due to the supportive nature of water, anecdotal increased strength, size and movement of remyelinating muscles and a psychological improvement. Although this patient has not recovered from GBS to be independent, hydrotherapy was a valuable part of the treatment regimen and it could be suggested the increase muscle strength lead to improved respiratory function and enabled weaning from ventilation, reducing intensive care length of stay and cost.