AACN clinical issues
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AACN clinical issues · Aug 2002
ReviewManagement of respiratory syncytial virus with lower respiratory tract infection in infants and children.
Respiratory syncytial virus (RSV) is the leading cause of lower respiratory tract infection in infants and children requiring pediatric hospitalizations. Infants with chronic lung, cardiac, or neuromuscular conditions are at increased risk for RSV infection. Early RSV is associated with subsequent diagnosis of reactive airway disease. ⋯ Interventions include supplemental oxygen therapy, ventilation, and fluid and nutrition therapy. Respiratory syncytial virus prophylaxis for high-risk patients includes intramuscular injections of palivizumab (Synagis) each month during RSV season, from November through April. Prevention strategies include washing hands, cleaning environment surfaces, and isolating infants and children with RSV in the emergency care area.
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AACN clinical issues · Aug 2002
Use of the injury severity score to predict nosocomial bloodstream infections among critically ill trauma patients.
Nosocomial bloodstream infections (NBSI) are associated with increased hospital length of stay (LOS), mortality, and costs. At this writing, no available reports describe the association between injury severity and NBSI among critically ill adult trauma patients. This study aimed to examine the use of the Injury Severity Score (ISS) as a predictor of NBSI among critically ill adult trauma patients. ⋯ The mean LOS until the diagnosis of NBSI was significantly lower than the total LOS of the control subjects (odds ratio [OR], 0.959; 95% confidence interval [CI], 0.93-0.99). The ISS score and age were found to be independent predictors of NBSI. The findings provide a means for using the ISS score as a predictor of NBSI in the critically ill adult trauma population.
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Coagulopathy after traumatic injury has multiple etiologies. It may result from overwhelming activation of tissue factor, consumption of circulating coagulation proteins, massive transfusion, metabolic alterations, hypothermia, or any combination of these factors. ⋯ Development of a coagulopathy has a significant impact on the morbidity and mortality of the patient with trauma. This article describes the relevant pathophysiology as it relates to the development of a coagulopathy, prevention strategies, and management principles applied in caring for the patient with trauma and a coagulopathy.
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AACN clinical issues · May 2002
ReviewSickle cell anemia in the pediatric intensive care unit: novel approaches for managing life-threatening complications.
Although the manifestations of sickle cell disease (SCD) do not typically necessitate critical care management, several life-threatening complications may require admission to the pediatric intensive care unit. Children with SCD are at risk for serious complications such as vaso-occlusive pain crises, cerebral vascular accidents, acute chest syndrome, severe anemia related to aplastic and splenic sequestration crises, infection, and multiorgan failure. Despite years of study, little progress has been made in understanding the pathophysiology of SCD. ⋯ Perhaps most exciting are the advances in bone marrow and stem cell transplantation, which offer hope of an eventual cure for this debilitating and deadly disease. Advanced practice nurses play a pivotal role in coordinating care for these critically ill children. Knowledge of both current and investigational therapies allows the advanced practice nurse to provide comprehensive, state-of-the-art care to children with life-threatening complications of SCD.
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AACN clinical issues · Feb 2002
Case ReportsObstructive sleep apnea: recognition and management considerations for the aged patient.
Sleep-disordered breathing (SDB) problems are estimated to affect between 2% to 4% of Americans with an even higher incidence occurring as one ages. This article focuses on obstructive sleep apnea (OSA) as a risk to safety and a leading contributor to interrupted sleep and disease morbidity in the aged population. Obstructive sleep apnea is caused by interruption in upper airway airflow during sleep that leads to oxygen desaturations and disruptions in sleep continuity. The symptoms, diagnosis, and initial management of OSA are discussed that provide direction for the advanced practice nurse who encounters patients with this disease.