Focus on critical care / American Association of Critical-Care Nurses
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The issue of do not resuscitate (DNR) decisions has been the subject of much discussion in the medical literature. To try to understand the factors that may be determinants of the timing of DNR decisions, we reviewed the charts of 70 consecutive burned patients who died between 1986 and 1988. ⋯ Physicians, nurses, social workers, the hospital attorney, the district attorney, and the coroner of our county were interviewed. The uncertainty of legal guidelines and practical considerations of family expectations preclude a uniform approach to this problem.
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Those caring for patients who undergo cardiac surgery share a dilemma. Complications associated with hypothermia encourage the care giver to rewarm the patient quickly, but complications associated with rapid temperature changes and hyperthermia can threaten the patient's hemodynamic stability. ⋯ Continued nursing research will expand the science of nursing and provide care givers with knowledge for expert care. As the turn of the century approaches and surgical techniques advance, high-risk patients who undergo reoperation and multi-valve cardiac surgery require expert nursing care.