Articles: critical-care.
-
The high cost and scarcity of intensive care unit (ICU) beds has resulted in a need for improved utilization. This study describes the characteristics of patients who are admitted to the ICU for neurosurgical and neurological care, identifies patients who might receive all or most of their care in an intermediate care unit, and describes the services the patients would receive in an intermediate care unit. ⋯ Patients receiving neurological care at an ICU who receive only monitoring during their 1st ICU day and have a less than 10% predicted risk of active treatment can be safely transferred to an intermediate care unit. Some of these patients may not require ICU admission. We suggest guidelines for equipping and staffing neurological intermediate care units based on the type and amount of therapy received by these patients.
-
We describe the successful use of methadone in the restoration of sedation and provision of analgesia in two morphine-tolerant, paediatric patients who had suffered significant thermal injuries and were undergoing mechanical ventilation. Both patients had exhibited escalating requirements for sedative drugs while undergoing ventilation yet remained inadequately sedated. ⋯ Hyperalgesia and morphine tolerance appear to be associated; it is proposed that methadone acts primarily, under these circumstances, by re-establishing the analgesic state. Such use of methadone in the morphine-tolerant patient also afforded a concomitant sedative-sparing effect.
-
Off J Can Assoc Crit Care Nurs · Jan 1998
Determining the potential need for a bereavement follow-up program: how well are family and health care workers' needs currently being met?
The purpose of the study was to determine the need for a bereavement follow-up program for either the families of patients dying in a critical care unit or the health care workers who care for these patients. Two questionnaires, the first a telephone administered questionnaire to all consenting family members of patients dying in the critical care unit, and the second a self-administered questionnaire administered to all health care workers in the critical care unit, were developed and piloted for content validity and clarity. The data was analyzed using descriptive statistics. ⋯ After a family member had died, 40% of those interviewed did not identify a specific source for support and 48% were interested in obtaining information on community resources available for aid in the bereavement process. The results from 117 (79% response rate) health care workers revealed that 30% were either uncomfortable or only somewhat comfortable with the dying process and the support available for them to deal with the death of their patients. The authors identified a need for bereavement follow-up programs for both the families of patients who die in the critical care unit and for the health care workers who care for these patients.
-
Dimens Crit Care Nurs · Jan 1998
Comparative StudyExperiences of critical care nurses in telephone triage positions.
Critical care nurses have valuable experience making critical judgments, using protocols, and working autonomously. These and other skills make critical care nurses good candidates for the new nursing positions in telephone triage being generated as managed-care systems expand. This investigator describes the experiences of critical care and medical/surgical nurses who make the transition to telephone triage nurse roles.
-
Fever in the critical care unit (CCU) may be on an infectious or noninfectious basis. Many noninfectious disorders have clinical and laboratory features mimicking infections. ⋯ Selection of appropriate antibiotic therapy is straightforward once the likely source of sepsis is determined. This article provides a clinical diagnostic approach.