AACN clinical issues
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AACN clinical issues · Aug 1996
ReviewStress and immunity after traumatic injury: the mind-body link.
Traumatic injury poses a significant psychologic and physiologic threat, challenging a victim's perceptions of control over their environment and life outcomes. The multiple stressors presented by traumatic injury diminishes the patient's perceptions of control, resulting in a subjective stress response. ⋯ It then presents evidence suggesting that the trauma patient's subjective stress response and diminished perceptions of control may act as factors in the immune changes occurring after injury. Recent studies supporting this hypothesis are reviewed, and recommendations for interventions, nursing practice, and research are discussed.
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AACN clinical issues · Aug 1996
ReviewThe immune system: relation to sepsis and multiple organ failure.
The immune system plays a dual role in the pathogenesis of sepsis and organ failure, intended for host defense but also possessing significant cytodestructive capacity. As the understanding of the epidemiology and pathophysiology of these disorders improves, so too does the appreciation for the complexity of this system. No longer is the immune response viewed as simply cellular or humoral but rather as a network of cells, chemical mediators, and molecular elements. ⋯ Conventional therapy is limited to supportive care and has been ineffective in improving mortality. To date, efforts to modulate the inflammatory response by inhibition of specific components have been unsuccessful. In the future, better patient selection, combination therapy (perhaps using strategies of early augmentation followed by inhibition), and alternative techniques such as blood purification may prove to be more effective.
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The appropriate use of blood transfusions remains variable among health-care institutions and patient populations. Transfusion practices are discussed in this article in relation to medical practice guidelines and utilization review. ⋯ Transfusion algorithms may prove especially useful if they incorporate point-of-care testing that is both physiologic and patient-specific for transfusion decisions. Transfusion algorithms are discussed and data presented for cardiac surgical adults.
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AACN clinical issues · May 1996
ReviewNursing strategies to minimize blood loss associated with phlebotomy.
Blood loss associated with phlebotomy is significant in critically ill adults. Iatrogenic anemia may result and impose unnecessary stress on the cardiovascular and respiratory systems and may require allogeneic blood transfusions. ⋯ Implementation of these strategies are needed for all critically ill patients because allogeneic blood transfusions carry infectious risk and because complications and chronic critical illness cannot be predicted reliably. Incorporation of these strategies into daily practice as well as the development of blood conservation programs represent imminent challenges for nursing.
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Surgical patients present unique opportunities for reducing allogeneic transfusions via perioperative blood salvage. Intraoperative cell saver techniques enable the collection of autologous blood from the surgical field and cardiopulmonary bypass circuit for return to the patient. Washing and hemoconcentration creates a product with an average hematocrit of 50% that carries normal erythrocyte survival, with minimal coagulation factors of platelets. ⋯ The hematocrit of shed blood is 20-25%, with depletion of clotting factors and platelet function. Potential advantages of perioperative blood salvage include the ready availability of large volumes of patient-compatible blood, with optimal oxygen-carrying capacity, that is virtually free from the risk of viral contamination. Specific indications, contraindications, and techniques for the salvage and administration of these vital products are presented.