AACN clinical issues
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Expanded roles and practice settings are evolving for the Acute Care Nurse Practitioner (ACNP). In this study, the ACNP's role is described by 384 people seeking certification. ⋯ Changes in health care will continue to give rise to new and innovative settings for ACNP practice. Communication about the ACNP remains essential to gaining acceptance of the role and enabling its expansion.
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A child's emergent admission to the pediatric intensive care unit (PICU) can strike fear and feelings of helplessness into the hearts of parents who only hours earlier had been in control of their lives. Acute critical illness seriously threatens the parents' ability to fulfill their familiar and important roles of protecting and providing for their child. ⋯ In planning interventions, these issues should be considered as well as the specific needs that parents have emphasized: accurate information, ready access to their children, and meaningful participation in their children's care. Advanced practice nurses are in an excellent position to improve delivery of psychosocial services to parents of critically ill children through direct care, acting as models of care practices and mentoring staff, staff education, policy development, and clinical research.
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AACN clinical issues · Feb 1998
ReviewNursing strategies to prevent ventilator-associated pneumonia.
Critically ill patients who require mechanical ventilation are at high risk for development of pneumonia during the course of treatment. Ventilator-associated pneumonia leads to higher rates of mortality and morbidity, increased length of hospital stay, and higher hospital costs. ⋯ Colonization and subsequent pneumonia commonly occurs from microaspiration of secretions from the oropharynx and gastrointestinal tract. In this article, the mechanism of microaspiration, diagnosis of ventilator-associated pneumonia, and nursing strategies to reduce the incidence of pneumonia are described.
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AACN clinical issues · Feb 1998
ReviewAdverse responses to analgesia, sedation, and neuromuscular blocking agents in infants and children.
Analgesics, sedation, and neuromuscular blocking agents are commonly used in treating critically ill infants and children. Although these medications are beneficial and imperative to the care of the child, their use is not risk free. Adverse responses occur in these children. With improved methods for use and monitoring, adverse responses can be minimized.
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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.