AACN clinical issues in critical care nursing
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AACN Clin Issues Crit Care Nurs · Feb 1991
Standards of care: integrating nursing care plans and quality assurance activities.
Traditionally, standards are used to define the level of care that a patient can expect to receive in a given institution or on a given nursing unit. These standards are the foundation of quality assurance programs. ⋯ The nursing staff at the unit level has no real knowledge or understanding of the standards. This may result in a nonfunctioning quality assurance program.
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Traumatic injury results in major physiologic alterations that begin at the time of injury and persist until recovery is complete. The response of the body is divided into two phases--the acute phase and the flow phase. The acute phase is characterized by shock with changes in hormone concentration. ⋯ Tissues with the highest oxygen consumption are more susceptible to injury and death. Cellular function does not depend on oxygen alone but also on the ability of the cells to use available oxygen. If the body is unable to compensate through biochemical, hormonal, and metabolic activities, an irreversible state results unless appropriate interventions are instituted promptly.
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Inhalation injuries comprise three distinct clinical entities that may be classified according to the time of onset of symptoms, etiologic agents, and the anatomic location of injury. These entities are carbon monoxide toxicity, upper airway obstruction, and smoke inhalation or chemical injury. ⋯ Early aggressive treatment, including maintaining a patent airway, administering humidified oxygen and bronchodilators, and providing pulmonary toilet, is necessary to ensure the best possible outcome. Understanding the pathophysiology, clinical manifestations, diagnosis, medical management, and nursing implications of inhalation injuries can improve patient survival.
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AACN Clin Issues Crit Care Nurs · Aug 1990
High-frequency ventilation and extracorporeal membrane oxygenation.
Dramatic improvement in morbidity and mortality associated with neonatal respiratory failure has evolved over the last 30 years. Favorable survival statistics can be directly related to the institution and refinement of assisted ventilation techniques. ⋯ Concentrated efforts are being undertaken to find ways to safely and effectively treat these infants while decreasing the morbidity associated with therapy. Two such therapies, both experimental and controversial, which are gaining widespread recognition, are high-frequency ventilation (HFV) and extracorporeal membrane oxygenation (ECMO).
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AACN Clin Issues Crit Care Nurs · Aug 1990
Case ReportsExtracorporeal membrane oxygenation: current use and future directions.
Extracorporeal membrane oxygenation (ECMO) is the process of using prolonged cardiopulmonary bypass to support patients with reversible respiratory and/or cardiac failure who are refractory to maximal conventional therapy. This process has been used extensively for critically ill neonates, with encouraging results. The use of ECMO in the pediatric population has been limited but is increasing. ⋯ Critical care nursing management of the pediatric or neonatal ECMO patient focuses on optimizing recovery of the pulmonary and/or cardiac system while preventing complications. A case study of a pediatric ECMO patient is presented which illustrates the complex nursing care issues related to use of this intervention. Future directions for ECMO are addressed.