AACN clinical issues in critical care nursing
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Digoxin is frequently prescribed for patients. With a narrow therapeutic window, toxicity can quickly occur. Nurses must quickly recognize dysrhythmias associated with digoxin toxicity to prevent life-threatening situations.
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Wolff-Parkinson-White (WPW) syndrome is a cardiac conduction disorder that presents with potentially life-threatening consequences. Wolff-Parkinson-White syndrome-induced dysrhythmias account for 20% of all supraventricular tachycardias that occur in the general population. ⋯ Current diagnostic modalities are accurate in identifying patients with WPW syndrome, but lack the sensitivity to predict sudden cardiac death. This article reviews the history of WPW syndrome, as well as its general characteristics, diagnostic criteria, treatment modalities, and nursing implications.
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AACN Clin Issues Crit Care Nurs · Nov 1991
ReviewEfficacy of epidural analgesia for pain management of critically ill patients and the implications for nursing care.
Management of pain for critically ill patients has been shown to be inadequately controlled and can have serious deleterious effects on a patient's recovery. Continuous epidural analgesia can be used to control pain in critical care patients. This mode of analgesia administration provides pain relief without the delays inherent in the as-needed administration of analgesics. ⋯ Evaluation of the effectiveness of the analgesia was based on the following measures: 1) pain measured at regular intervals in the 72-hour period with a visual analog; 2) pain as measured after 72 hours with the word descriptor section of the McGill pain questionnaire; 3) amount of supplemental systemic narcotic analgesic needed; 4) recovery of ambulatory and respiratory function, including ability to perform coughing and deep-breathing exercises; 5) occurrence of adverse effects, and 6) the type and distribution of nursing care problems associated with continuous epidural infusions. The results of this study showed that the level of pain relief and recovery of postoperative function was superior to that provided by the more widely used as-needed systemic administration of narcotics. Although some nursing care problems were identified, continuous epidural analgesia can be used for pain relief in critical care patients, if the analgesia is administered by accurate reliable infusion systems and carefully monitored by nursing staff who are knowledgeable about the pharmacologic considerations of epidural analgesic agents and the management of patient care.
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AACN Clin Issues Crit Care Nurs · Nov 1991
ReviewNeuromuscular blocking agents in the critically ill patient: neither sedating nor pain relieving.
Although neuromuscular blocking agents (NMBAs), such as pancuronium bromide and succinylcholine, are widely used in the management of critically ill patients, many misconceptions regarding the agents' clinical effects and indications persist. This article will discuss these misconceptions and review the indications for the use of NMBAs in the critically ill patient, how these potent agents work, and strategies to effectively manage critically ill patients who are receiving NMBAs as a part of their treatment regimen.
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AACN Clin Issues Crit Care Nurs · Nov 1991
ReviewIntracranial pressure monitoring: technical imperatives.
Intracranial pressure (ICP) monitoring provides extremely important information that is helpful in detecting intracranial hypertension and guiding therapeutic interventions that attempt to control this pathologic condition. This article reviews the purpose and rationale for monitoring ICP. ⋯ This article also explains how to interpret ICP, ICP waveforms, and cerebral perfusion pressure. In addition, it addresses the application of data retrieved from ICP monitoring to clinical nursing practice and implications for nursing research.