Management of Increased Intracranial Pressure

Brain edema and the resulting increase in intracranial pressure may be the result of several conditions: head trauma, intracranial hemorrhage, embolic stroke, infections, tumors, and alterations in cerebral spinal fluid production or absorption. At times, these patients may be treated outside of the neurological intensive care unit (ICU) for a variety of reasons. Therefore, general critical care nurses may find themselves in the position of caring for these patients. Maintaining expertise outside of one's area of focus is increasingly difficult to do, and the non-neuro critical care nurse may be unfamiliar with some of the newer research findings and trends in treating these patients. The purpose of this article is to review several of the concepts of neurological care and to update critical care nurses in various newer approaches to caring for patients with increased intracranial pressure.

The process of devising and undertaking a trial to evaluate oxygen therapy products

Streamlining the use of oxygen therapy products across a single trust has the merits of removing the need to switch equipment as patients are moved from one area to another and reducing the confusion faced by staff having to use similar, but different, products; it also improves patient care. The trial described incorporated all these strands.

The use of technology at home: what patient manuals say and sell vs. what patients face and fear

Over the past 15 years, the use of specialised medical equipment by patients at home has increased in most industrialised countries. Adopting a conceptual framework that brings together two research perspectives, i.e. the sociology of technology and the sociology of illness, this paper empirically examines why and how patients use health technology at home and in the broader social world. Our study compares and contrasts the use of four interventions: antibiotic intravenous therapy, parenteral nutrition, peritoneal dialysis and oxygen therapy. We conducted interviews with patients (n = 16) and caregivers (n = 6), and made direct observations of home visits by nurses (n = 16). The content and structure of patient manuals distributed by major manufacturers and hospitals were analysed (n = 26). The aim of our study was to determine how technology was supposed to be used versus how it was actually used. This study shows that patients are deeply ambivalent about the benefits and drawbacks of technology, and that these advantages and disadvantages are shaped by the various places in which the technology is used. While technology can be pivotal in making patients autonomous and able to participate in the social world, it also imposes heavy restrictions that are intimately interwoven with the nature of the particular disease and with the patient's personal life trajectory.

Informed nursing practice: the administration of oxygen to patients with COPD

Although the Hypoxic Drive Theory has been a long-time influence on the care of patients with chronic obstructive pulmonary disease (COPD), in reality a relatively fine line exists between optimal and excessive oxygen therapy. Medical-surgical nurses need a clear understanding of the benefits and the possible complications of oxygen therapy in patients with COPD.

A Model of Nurse Assistant Care to Promote Functional Status in Hospitalized Elders

After completing 20 hours of classes on promoting the functional status of hospitalized elders, the certified nursing assistants on this medical unit participated in developing a new model of care delivery. Discharge destination (home or nursing home) and length of stay were compared for patients pre- and post-implementation. Length of stay decreased by 2.4 days (p =.0007), and there was a significant increase in the number of elders who were able to return home (p =.024).

The changing face of bronchopulmonary dysplasia: Part 2. Discharging an infant home on oxygen

Transitioning an infant with bronchopulmonary dysplasia (BPD) home on oxygen is a complex process. It requires an interdisciplinary team, with clear but flexible discharge criteria, and a coordinated process to manage the complexity. In "The Changing Face of Bronchopulmonary Dysplasia: Part I" (Advances in Neonatal Care, December 2002, pp 327-338), the evolving nature of BPD was presented, along with new diagnostic criteria, a description of the risk factors and clinical profile of this condition, and a discussion of preventative strategies as well as the medical and neurodevelopmental outcomes. "The Changing Face of Bronchopulmonary Dysplasia: Part 2. Discharging an Infant Home on Oxygen" provides strategies to support families during the pivotal transition home on oxygen and other related technologies. The use of a systematic interdisciplinary discharge planning process, guided by clear criteria for discharge, is presented. An outline of the comprehensive discharge teaching, home care, and multispecialty follow-up that are necessary to ensure a safe and smooth transition into the community to avoid repeat or unnecessary rehospitalizations and to enhance outcomes is provided. Medical fragility persists in infants with BPD, placing additional stress on families. Pragmatic strategies to provide intensive parent support throughout the process are offered.

Managing hypoxia and hypercapnia

The main objective when treating hypoxia (a deficiency of oxygen in the tissues) and hypercapnia (a high concentration of carbon dioxide in the blood) is to give sufficient oxygen to ensure that the patient is safe and his or her condition does not deteriorate. However, while giving too little oxygen can result in hypoxia, which can result in death, excessive oxygen therapy can also be dangerous for some patients.

Nursing the breathless patient

In this article, Clare Bennett provides an overview and update of respiratory assessment and symptom management. The causes and symptoms of breathlessness are discussed, along with assessment methods and nursing interventions.

Minimizing fire risk during eye surgery

Supplemental oxygen under the drapes in high concentrations can lead to fires in ophthalmic theaters. This study attempted to eliminate the fire risk while maintaining the required therapeutic effect. The sample consisted of 201 patients undergoing ophthalmic surgery, with 104 subjects in the control group and 97 in the experimental group. A quasi-experimental design compared the existing method of oxygen administration (100% supply) with a new method (experimental) providing 24% oxygen supply. Measurements of the oxygen concentration were taken along with the fractional inspiratory carbon dioxide (FiCO2), the peripheral oxygen saturation (SpO2), the end tidal carbon dioxide (ETCO2), and the respiratory rate (RR). There was a significant difference in oxygen and carbon dioxide concentrations under the drapes (p <.05). The fractional inspiratory carbon dioxide was reduced in the experimental group. The new method was adopted to reduce the risk of fire in ophthalmic operating theaters.

Home oxygen therapy for children

The number of children who need home oxygen therapy is increasing, and there is a growing need to support both them and their parents. Families must also understand the practical and safety issues surrounding the supply of oxygen cylinders. A best practice statement was developed to ensure consistency and high standards of practice. It covers a range of areas including risk assessment, information for parents and carers, discharge planning, the provision of equipment and the use of oxygen therapy outside the home.

An audit of oxygen prescribing in acute general medical wards

Oxygen therapy is highly specialised and must be tailored to the individual. In an audit in one hospital, less than a fifth of the patients receiving this therapy had the prescription written in their medical notes. This problem could have possible legal implications and requires nurses to be vigilant in ensuring oxygen is properly prescribed and administered.

Supplemental oxygen delivery to the nonventilated neonate

Oxygen is one of the most commonly administered drugs in the neonatal intensive care unit. A variety of techniques exists to deliver oxygen to infants who are not on a ventilator or who are not receiving positive pressure. These techniques include oxygen hood, nasal cannula, face mask delivery or "free flow," and "flooding" the incubator with oxygen. Because each technique has unique advantages and disadvantages, the choice is frequently dependent on style. Recent advances in incubator technology have improved the delivery of supplcmental oxygen by incubator flooding. This technique is generally underutilized, but it has some advantages over thc other modalities in certain clinical scenarios. The neonatal nurse needs to be aware of the characteristics of the various oxygen delivery technologies and the tools needed to optimally care for infants who are dependent on supplemental oxygen.