AACN clinical issues
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AACN clinical issues · May 2001
Review Case ReportsBlunt chest trauma: review of selected pulmonary injuries focusing on pulmonary contusion.
Pulmonary injuries resulting from blunt chest trauma remain a common clinical entity for critical care and emergency nurses. In this article, the epidemiology and mechanism of injury most often observed in patients with blunt chest trauma are reviewed. ⋯ Many advances and experimental therapies currently used in the management of the patient with severe lung injuries are discussed. A case study is presented highlighting a complicated case of a blunt chest injury resulting in severe pulmonary contusion.
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AACN clinical issues · May 2001
ReviewChronic critically ill dyspneic patients: mechanisms and clinical measurement.
Dyspnea is a multidimensional, subjective perception of breathing difficulty commonly seen in patients who are critically or terminally ill. Understanding the mechanisms and assessment of dyspnea will help nurses in advanced practice roles to successfully manage these patients. Major mechanisms of dyspnea include stimulation of the chemoreceptors, stimulation of chest wall and intrapulmonary receptors, and increased sense of effort (also termed increased respiratory motor command). ⋯ Assessment of dyspnea includes an accurate history of timing, precipitating factors, associated symptoms, alleviating factors, intensity and quality of the symptom. Measurement tools for dyspnea include both unidimensional and multidimensional tools, as well as tools that measure changes in the perception of dyspnea. Most tools have been tested for reliability and validity on healthy subjects or on patients with chronic obstructive pulmonary disease and, therefore, should be used with caution in critically or terminally ill patients.
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AACN clinical issues · May 2001
Review Comparative StudyAirway pressure release ventilation: theory and practice.
Airway pressure release ventilation (APRV) is a relatively new mode of ventilation, that only became commercially available in the United States in the mid-1990s. Airway pressure release ventilation produces tidal ventilation using a method that differs from any other mode. It uses a release of airway pressure from an elevated baseline to simulate expiration. ⋯ Advantages of APRV include lower airway pressures, lower minute ventilation, minimal adverse effects on cardio-circulatory function, ability to spontaneously breathe throughout the entire ventilatory cycle, decreased sedation use, and near elimination of neuromuscular blockade. Airway pressure release ventilation is consistent with lung protection strategies that strive to limit lung injury associated with mechanical ventilation. Future research will probably support the use of APRV as the primary mode of choice for patients with acute lung injury.
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AACN clinical issues · May 2001
Review Case ReportsSchool-based management of the child with an acute asthma episode.
Asthma is a chronic inflammatory disorder of the airways that affects 5 million American children. In the past decade, asthma morbidity has dramatically increased. ⋯ School-based health centers offer a conveniently located setting for the acute treatment and long-term management of childhood asthma. Treatment of asthma using the most recent management guidelines offered in a school setting should result in a decrease in the morbidity and mortality associated with pediatric asthma.
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AACN clinical issues · May 2001
ReviewCare before and after lung transplant and quality of life research.
Lung transplantation is a growing surgical option for patients with end-stage lung and pulmonary vascular diseases. After completing an extensive evaluation and meeting the selection criteria, patients are listed for either single or bilateral-sequential lung transplantation. Immediate postoperative management requires detailed attention to fluid management, monitoring for infection, reperfusion injury, pulmonary hygiene, and pain management. ⋯ Newer immunosuppressive medications offer more options for treating and preventing rejection. Advanced practice nurses, such as coordinators, case managers, nurse practitioners, and clinical nurse specialists, are uniquely positioned to play key roles in coordinating the care of transplant patients across settings and both before and after the transplant procedure. The perioperative needs of lung transplant patients and the impact of this complex procedure on the recipients' and family's quality of life merit further investigation by clinicians and researchers.