ISSN:1079-0713    

出版商:OVID    

年代:2002

数据来源: OVID

ISSN:1079-0713    

出版商:OVID    

年代:2002

数据来源: OVID

摘要:

Although the manifestations of sickle cell disease (SCD) do not typically necessitate critical care management, several life-threatening complications may require admission to the pediatric intensive care unit. Children with SCD are at risk for serious complications such as vaso-occlusive pain crises, cerebral vascular accidents, acute chest syndrome, severe anemia related to aplastic and splenic sequestration crises, infection, and multiorgan failure. Despite years of study, little progress has been made in understanding the pathophysiology of SCD. For this reason, management has been primarily focused on treating the negative sequelae of the disease. However, exciting ongoing research has led to great improvements not only in the understanding of the disease, but also in what was once considered routine therapy for SCD. Research on the use of modalities such as inhaled nitric oxide, L-arginine therapy, and transcranial Doppler ultrasound, and the development of blood transfusion programs are making strides in reducing morbidity and mortality, and in improving the quality of life for children with SCD. Perhaps most exciting are the advances in bone marrow and stem cell transplantation, which offer hope of an eventual cure for this debilitating and deadly disease. Advanced practice nurses play a pivotal role in coordinating care for these critically ill children. Knowledge of both current and investigational therapies allows the advanced practice nurse to provide comprehensive, state-of-the-art care to children with life-threatening complications of SCD.

ISSN:1079-0713    

出版商:OVID    

年代:2002

数据来源: OVID

摘要:

Aplastic anemia is a form of bone marrow failure that ranges in severity from mild to severe. In all cases, some degree of pancytopenia is present. The cause usually is unknown, although many drugs and viruses are associated with the disease. The pathophysiology of aplastic anemia involves either a stem cell defect or injury or an immunologically mediated hematopoietic cell destruction, which may operate in concert with abnormalities in programmed cell death. Excellent clinical care and research have dramatically improved patient survival, with 70% to 90% of sibling hematopoietic stem cell transplant recipients surviving long term. Patients with mild or moderate disease may not require immediate treatment. If and when these patients require treatment, the mainstay of therapy is immunosuppression. The initial drug regimen includes antithymocyte globulin, often in combination with cyclosporine A, followed by moderate-dose steroids and cyclophosphamide. Nurses assess and monitor patients and their progress, recognizing medication adverse effects. Nurses educate patients about their disease and its treatment, and provide necessary emotional support. Severe aplastic anemia is treated with allogeneic hematopoietic stem cell transplantation. This therapy involves complex nursing challenges. The patient goes through an extensive pretransplantation workup. Donor selection and harvesting of hematopoietic stem cells are preludes to an intensive preparative regimen. This preparative or conditioning regimen and the need for long-term immunosuppression are the reasons for many of the acute complications and adverse events that may follow the hematopoietic stem cell transplantation. Nurses must be vigilant in assessing and monitoring patients for toxicities and long-term complications that may affect almost any organ system.

ISSN:1079-0713    

出版商:OVID    

年代:2002

数据来源: OVID

摘要:

Coagulopathy after traumatic injury has multiple etiologies. It may result from overwhelming activation of tissue factor, consumption of circulating coagulation proteins, massive transfusion, metabolic alterations, hypothermia, or any combination of these factors. Despite advances in trauma resuscitation, the problem of persistent, life-threatening coagulopathy continues to pose a significant challenge for the healthcare team, and sometimes is an insurmountable obstacle in the path to recovery of the patient with trauma. Development of a coagulopathy has a significant impact on the morbidity and mortality of the patient with trauma. This article describes the relevant pathophysiology as it relates to the development of a coagulopathy, prevention strategies, and management principles applied in caring for the patient with trauma and a coagulopathy.

ISSN:1079-0713    

出版商:OVID    

年代:2002

数据来源: OVID

摘要:

Major changes in the healthcare environment have increasingly forced hospitals to reconsider their operative structures to maintain cost competitiveness. These changes have included restructuring and numerous hospital mergers, and they have forced hospitals to examine ways to improve operational efficiency. Nowhere in the hospital is this truer than in the critical care areas, where costs are highest, and one of the places where process improvements can be made is in the laboratory analysis. Data indicate that laboratory analysis comprises about 43% of the data used by critical care clinicians to make clinical decisions. The more quickly these data can be provided to the clinicians, the more likely they are to have an impact on the patient’s care.Point-of-care testing (POCT) in critical care is one way of simplifying the laboratory analysis process so that laboratory data are more readily available to clinicians. A close collaborative relationship with the clinical laboratory can allow a robust POCT to be implemented in critical care that meets the needs of both the clinical laboratory and the critical care areas. When implemented appropriately, a POCT program in critical care can provide rapid and accurate test results, can be fairly simple to maintain, and can be cost effective. However, successful implementation requires a new set of skills for critical care nurses including knowledge of the laboratory regulatory issues, a commitment to training, recertification, and a quality improvement program related specifically to POCT.Several studies have shown that laboratory turnaround time can be reduced through the implementation of a POCT program. However, at this writing, no studies have linked this decrease in turnaround time to improved patient outcomes, although there are some data to support a decrease in iatrogenic blood loss with the use of POCT. Although the use of POCT in critical care has some distinct benefits, clearly, outcome studies need to be conducted to assess the true impact of POCT on the care of patients who are critically ill.

ISSN:1079-0713    

出版商:OVID    

年代:2002

数据来源: OVID

摘要:

The advanced practice nurse is uniquely qualified to act as a consultant and specialist in the field of anticoagulation at an acute care hospital. The advanced practice nurse acts at both a system level and a patient care level to improve anticoagulation with low-molecular-weight heparins, heparin, and warfarin through education, research, quality improvement initiatives, and patient care management.

ISSN:1079-0713    

出版商:OVID    

年代:2002

数据来源: OVID

ISSN:1079-0713    

出版商:OVID    

年代:2002

数据来源: OVID

摘要:

Muscular strength is essential for recovery after an acute illness. Disuse atrophy of muscle begins within 4 hours of the start of bed rest resulting in decreases in muscle mass, muscle cell diameter, and the number of muscle fibers. Strenuous exercise of atrophic muscle can lead to muscle damage including sarcolemmal disruption, distortion of the myofibrils’ contractile components, and cytoskeletal damage. Assessment of skeletal muscle for disuse atrophy is done clinically at the bedside through strength assessment. Examination of the muscle itself can be conducted through the use of nuclear magnetic resonance imaging, whereas muscle strength can be quantified with a computerized dynamometer. Biochemical markers, including creatine kinase and troponin, also are available for the assessment of skeletal muscle damage. Activity management in the critical care environment focuses on an individualized plan, developed in cooperation with the recovering patient, with the goal of preserving and improving atrophic skeletal muscle.

ISSN:1079-0713    

出版商:OVID    

年代:2002

数据来源: OVID

摘要:

This longitudinal study assessed change in gastrocnemius muscle metabolism across antepartum bed rest and recovery during the first 6 weeks postpartum as well as symptoms during recovery. The convenience sample consisted of 65 pregnant women, hospitalized on bed rest for a mean of 24.8 days (range 5–70 days). A dual wavelength hemoglobin/ myoglobin spectrophotometer and ergometer assessed muscle reoxygenation times after plantar flexion exercise from hospital admission through 6 weeks postpartum. The Postpartum Symptom Checklist assessed symptoms of muscle deconditioning. The time for gastrocnemius muscle reoxygenation after exercise significantly increased across antepartum bed rest (t = −2.1,P< .05) and significantly decreased during the 6-week postpartum period (t = 1.83,P< .05). Women who were on bed rest prior to hospital admission had significantly higher reoxygenation scores upon enrollment (t = −8.6,P< .05). Symptoms of postpartum muscle soreness, deconditioning, and difficulty with mobility were reported. Postpartum assessment and rehabilitation are needed to facilitate recovery and prevent long-term injury.

ISSN:1079-0713    

出版商:OVID    

年代:2002

数据来源: OVID