AACN clinical issues
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Although cardiopulmonary arrest rarely occurs in the pregnant woman, it is important that the health care team know the appropriate actions to take in such an event, to promote positive outcomes for both mother and fetus. Specific techniques, personnel, and equipment are required to manage this grave situation. ⋯ If the pregnant woman does not respond to treatment, a cesarean delivery must be attempted within 5 minutes of the arrest if uterine size indicates gestational age of at least 20 weeks. This article describes the adaptations of traditional cardiopulmonary arrest procedures required to treat the pregnant woman who sustains a cardiopulmonary arrest, protocols for managing the communication of the emergency code, emergency equipment that must be available, and the importance of teams in managing mother and neonate.
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AACN clinical issues · Nov 1997
Case ReportsNeutralizing ageism in critical care via outcomes research.
Ageism, as a mind-set, amplifies a belief that intensive care for the elderly is ineffectual. However, there are little data to support the notion that advanced chronological age alone predicts unfavorable outcomes in response to intensive care. A lack of outcome data, combined with ageism, may place older patients at risk for rationing of intensive care. ⋯ However, as pressure to reduce health care costs increases, critically ill elderly patients may be targeted for rationing. In this context, outcomes research involving elderly populations is crucial. The purpose of this report is to explicate the risk of ageism in the delivery of intensive care and to describe methods for implementing outcomes assessment for critically ill elderly patients as an essential element in a continuum of care.
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AACN clinical issues · Nov 1997
A collaborative approach to fetal assessment in the adult intensive care unit.
When a pregnant woman is admitted to the adult intensive care unit (ICU), responsibility for fetal assessment must be assumed by a nurse who is competent in interpreting data obtained by auscultation of the fetal heart rate or by the electronic fetal monitor. The fetus is a distinct patient requiring assessments, interventions, and evaluation, including documentation of nursing care provided, similar to any patient in the ICU setting. ⋯ Therefore, in institutions in which critically ill pregnant women are transferred to the adult ICU, a formal plan should be in place that includes care provided by nurses who are competent in fetal assessment. This article describes a collaborative approach to ensure that fetal assessments are performed by nurses who have the experience and education to do so and includes common terminology used to describe fetal status so that ICU nurses are familiar with the language and appropriate nursing intervention.