Category: Critical Care Nursing Factors that decrease glomerular filtration rate in ICU patients include hypovolemia related to fluid losses, hemorrhage, third-spacing, low cardiac output states and vasodilatation, as seen commonly in patients with sepsis or secondary to sedatives.
Category: Critical Care Nursing The most common nonelectrolyte solutes causing excessive diuresis is glucose and urea. Management usually involves treatment of the underlying disorder and repletion of extracellular volume by hydration.
Category: Critical Care Nursing Total daily urinary solute excretion varies. The average urinary solute excretion in a healthy adult is between 500 and 1000 mOsm/d. Solute or osmotic diuresis causing polyuria is due to solute excretion in excess of the usual excretory rate.
Category: Critical Care Nursing Polyuria is classified into solute or water diuresis. When increased solute excretion drives the polyuria, it is termed solute diuresis. Increased urine output secondary to increased water intake or impaired water reabsorption is termed water diuresis.
Category: Critical Care Nursing Management of pleural fluid collections is targeted at the specific cause. Transudative effusions from congestive heart failure will resolve with diuresis, whereas moderate to large hemothoraces will require tube thoracostomy drainage.
Category: Critical Care Nursing Administration of supplemental oxygen is the cornerstone of treatment for carbon monoxide poisoning. Oxygen inhalation will hasten the dissociation of carbon monoxide from hemoglobin and provide enhanced tissue oxygenation.
Category: Critical Care Nursing Survivors of acute carbon monoxide poisoning are at risk for developing delayed neurologic sequelae that include cognitive deficits, memory loss, dementia, paralysis, chorea, cortical blindness, psychosis and peripheral neuropathy.
Category: Critical Care Nursing Carbon monoxide poisoning is one of the leading causes of injury and death by poisoning in the world. The affinity of carbon monoxide for hemoglobin to form carboxyhemoglobin, is more than 200-fold greater than that of O2.
Category: Critical Care Nursing Prone positioning is adjunctive therapy used in the treatment of hypoxic respiratory failure. Prone positioning recruits dependent lung regions, which helps improve ventilation-perfusion matching and may help gas exchange.
Category: Critical Care Nursing An alternative to noninvasive ventilation and perhaps to mechanical ventilation is the use of high-flow nasal cannula. This system provides heated and humidified air at 21%-100% of FiO2 with flow rates of up to 60 liters per minute (L/min).
Category: Critical Care Nursing A depressed mental status with an inability to protect the airway, copious secretions, hemoptysis or hematemesis, recent upper gastrointestinal surgery, facial deformity or trauma are some contraindications to noninvasive ventilation.
Category: Critical Care Nursing Noninvasive ventilation is not always prudent as the first step in advanced hypoxemic respiratory failure, as it may lead to a more difficult transition to mechanical ventilation in cases of noninvasive ventilation failure.
Category: Critical Care Nursing Acute pulmonary edema is an emergency that demands immediate medical attention. It is broadly classified into cardiogenic (increased hydrostatic pressure) or noncardiogenic (increased microvascular permeability) causes.
Category: Critical Care Nursing Noninvasive ventilation requires the patient’s cooperation and an anatomically preserved, functional upper airway. It is not a replacement for invasive mechanical ventilation, nor is it suitable for all patients with acute respiratory failure.
Category: Critical Care Nursing The purpose of mechanical ventilation is to improve oxygenation and ventilation to correct respiratory acidosis and hypoxemia, meet metabolic demands, rest respiratory muscles and optimize cardiac function and blood circulation.
