Articles: cations.
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Critical care nurse · Jun 2022
Implementation of a Pediatric Delirium Screening Program in a Pediatric Intensive Care Unit.
Knowledge of and screening for delirium are important to patient care. As bedside caregivers, nurses are in a strategic position to observe changes that may indicate delirium. ⋯ Although unit-wide compliance with the screening protocol decreased without regular monitoring, it subsequently improved after the institution of reminders and reeducation of nursing staff. Nursing perceptions evolved to view screening as an important component of patient care that did not disrupt daily workflow.
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Ventilator-associated pneumonia (VAP) is a common complication occurring in critically ill patients who are mechanically ventilated and is the leading cause of nosocomial infection-related death. Etiologic agents for VAP widely differ based on the population of intensive care unit patients, duration of hospital stay, and prior antimicrobial therapy. VAP due to multidrug-resistant pathogens is associated with the highest morbidity and mortality, likely due to delays in appropriate antimicrobial treatment. ⋯ Empirical treatment should be based on the most likely etiologic microorganisms and antibiotics likely to be active against these microorganisms. Response to therapy should be reassessed after 3 to 5 days and antimicrobials adjusted or de-escalated to reduce the burden of the disease. Finally, considering that drug resistance is increasing worldwide, several novel antibiotics are being tested to efficiently treat VAP in the coming decades.
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Eur. J. Intern. Med. · Jun 2022
Reconsidering the Edelman equation: impact of plasma sodium concentration, edema and body weight.
Guidelines recommend treatment of dysnatremias to be guided by formulas based on the Edelman equation. This equation describes the relation between plasma sodium concentration and exchangeable cations. However, this formula does not take into account clinical parameters that have recently been associated with local tissue sodium accumulation, which occurs without concurrent water retention. We investigated to what extent such clinical factors affect the Edelman equation and dysnatremia treatment. ⋯ Edelman's equation's coefficients are significantly affected by weight, edema and plasma sodium, possibly reflecting differences in tissue sodium accumulation capacity. The performance of Edelman-based formulas in clinical settings may be improved by taking these clinical characteristics into account.
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To investigate the application skills and importance of ultrasonic bone osteotome in anterior cervical discectomy and fusion surgery. ⋯ This study shows that in ACDF surgery, UBS is more efficient than HSD and can effectively shorten the operation time and reduce the amount of bleeding and the incidence of complications.