Autonomic nervous system function analysis
Autonomic nervous system function and depth of sedation in adults receiving mechanical ventilation.
The authors of the article were attempting to discover how the autonomic nervous system affected the depth of sedation which occurred when a patient was placed on mechanical ventilation. The reason for this concern was that patients have been known to have adverse effects due to changes in the autonomic functions during critical illness. The stated thesis of the article is to understand autonomic responses better.
This study was part of a larger study which monitored patients for a 24-hour period “in the medical respiratory and coronary care ICUs at Virginia Commonwealth University.” The study chose patients who were not compromised by receiving neuromuscular blocking agents and had no scalp lacerations or skull abnormalities. The patients had to be more than 18 years old at the time of the trial. Patients heart rate variability and sedative state were constantly monitored during the research.
The main finding from the study was that “deep sedation was associated with depressed parasympathetic nervous activity and that measures of sympathetic nervous activity and heart rate did not change with changes in the depth of sedation.” From this finding the researchers believe that measuring heart rate variance in the ICU is justified in some situations. The specific situation would be when the patients with cardiac disease because there can be related cardiac complications as a result of the depressed heart rate variability. However, the authors suggest that further study which was targeted specifically at this issue may be warranted. Their study was based on secondary data.
2. Clorhexedine, toothbrushing, and preventing ventilator-associated pneumonia in critically all adults.
The main thrust of the article was to determine if there is a specific measure that can be taken to reduce the amount of patients who contract pneumonia when they are placed in a ventilator. The hypothesis was that regular cleaning of the mouth and teeth could defeat the bacteria which cause pneumonia and thus reduce its occurrence. The two treatments used to determine the effectiveness of this hypothesis were tooth brushing and chlorhexidine either together as a treatment or separate.
Since it is noted that there are many factors associated with ventilation that increase the possibility that a patient will get pneumonia, it was theorized that inadequate dental care could also be a factor. The authors of the study noted that “Dental plaque can provide a habitat for microorganisms responsible for ventilator-associated pneumonia.” Thus, researchers found 547 patients who met the criteria of having been intubated at least 24 hours prior to intervention, and they could not already have been infected with pneumonia. The patients were put into one of four groups — tooth brushing only, chlorhexidine only, tooth brushing and chlorhexidine, or a control group which received normal care — for the study.
It was found that tooth brushing by itself did not reduce the occurrence of ventilator-associated pneumonia, however when a chlorhexidine swab was used the patients were less likely to contract pneumonia. The researchers believe that, along with other measures to prevent VAP, chlorhexidine sabs should be employed since VAP is a significant issue among intubated patients.
3. Chronic critical illness: Prevalence, profile, and pathophysiology.
The authors of this study attempt to give physicians and nurse who work in the intensive care unit further understanding of chronic critical illness. All patients in an ICU are undergoing some form of acute critical illness or they would not be in the ICU. But that can turn into chronic status which makes it more difficult for the patient to recover. Chronic critical illness is marked by “recurrent episodes of instability, need for prolonged medical and nursing care, multiple organ dysfunction or failure, ongoing need for life-sustaining interventions, and uncertain trajectory for recovery.” The reason for acute status changing into chronic is unknown, but the purpose of the study is to inform caregivers “essential information about the prevalence and profile of the chronically critically ill patient.”
The authors of the study did not conduct their own investigation of the phenomenon with their own critically ill patients, but rater they looked at research that had been conducted already to determine the signs and effective treatments for a person with CCI. First, only approximately 6% to 10% of critically ill patients reach this threshold, but these patients account for a very large portion of ICU care costs. There was found to be no exact definition of this group of patients (historically it was associated with prolonged stays on mechanical ventilators, but that definition has changed. The authors determine a more comprehensive diagnosis. Patients who have been on a mechanical ventilator for a prolonged amount of time, have been in the ICU for a long period and who have had a prolonged need for life-sustaining technologies. The authors also found that age, early tracheotomy, readmission rate, and multiple organ dysfunction were factors associated with CCI.
4. Induced moderate hypothermia after cardiac arrest.
Research and practice has shown that inducing moderate hypothermia after a patient experiences cardiac arrest is considered a best practice. It has been found that “Ten percent to 30% of patients who survive an out-of-hospital cardiac arrest will have permanent brain damage.” The preferred treatment for this for the past ten years has been to induce a moderate hypothermia following the incident. The authors say that “The purpose of this article is to provide an overview of the pathophysiology and research that supports the use of induced mild hypothermia following cardiac arrest along with nursing considerations for this patient population.”
Research has shown that inducing moderate hypothermia increases the number of patients who will survive a cardiac arrest event. In a clinical study of the effects, 49% of patients who had the treatment versus 26% who did not were able to go home. The reason for this was found to be that patients who were allowed to undergo the moderate hypothermia were able to survive the loss of oxygen to the brain inherent patients who have a cardiac arrest.
The researchers found that there were two methods of hypothermia inducement — noninvasive and invasive. Noninvasive inducement is characterized by using manual control of temperature such as ice packs, fans, alcohol baths and cooling blankets. This method was not recognized as effective because the nurse must maintain control of the patients temperature constantly. “Invasive methods include use of iced (4Â°C) intravenous fluids and the use of intravascular catheters.” These methods were supported by research and found to be effective.
5. Intra-abdominal hypertension: Detecting and managing a lethal complication of critical illness.
Patients in the ICU are subject to a long list of complications which can severely diminish their prospects of survival or, at the very least, artificially prolong their stay in the ICU. One issue, which plagues as many as 50% of patients treated in the ICU, is intra-abdominal hypertension. “Patients at risk for intra-abdominal hypertension include those with major traumatic injury, major surgery, sepsis, burns, pancreatitis, ileus, and massive fluid resuscitation.” This occurrence generally causes a prolonged stay, but it can also lead to further complications as well. Researchers found that certain patients were predisposed to IAH, those who were obese or had undergone certain procedures.
The danger of the occurrence is that it is detrimental to organ function. Because the abdominal region contains so many organs which are vital to sustained life, this can be an extremely life threatening condition. One of the primary purposes of the article is to make sure that caretakers can detect when IAH is occurring. Mostly the difference between hypertension and simple pressure is in the matter of the whether the organs in the abdominal cavity are compromised or not. Of course, testing to understand whether organ function has been affected is crucial.
The article also talks about risk factors for IAH. There are four such factors — diminished abdominal wall compliance, increased intraluminal contents, increased peritoneal cavity contents, and capillary leak/fluid resuscitation — that occur to warn clinicians when it is possible to have an IAH episode. To thwart this occurrence there are several measuring techniques that can be used. The caregiver can do a bladder pressure measurement, or a measurement of the abdominal pressure itself.
6. Long-term survival in the intensive care unit after erythrocyte blood transfusion.
Erythrocyte transfusion are commonly done in the ICU to “treat anemia, support hemodynamic status, minimize ischemic organ damage, and prevent mortality.” Because it is anecdotally supported as an effective treatment, and has some efficacy in studies, there is an increasing wish to understand what the long-term effects are. The study under consideration looks at other studies which have given contradictory evidence when short-term mortality was the subject, and conduct there own study to see the effects of long-term mortality rates.
The study was conducted using data from a database of several different hospitals ICUs over an extended period of time. The authors also had a smaller control group which was compared to the study groups. The number of patients studied during this time period was 2213 patients in the database and 554 in the control group. The researchers were looking for evidence that the transfusion significantly increased the mortality rate of these patients.
The authors found that in a univariable analysis the transfusion did increase he risk of death in all three time periods studied (0-30, 31-180, an >180 days). However, when a multivariate analysis was conducted they found that patients did not have a higher risk of death in the two shorter time periods and that they had between a 25% and 29% better chance of survival if they reached the >180 day limit. The authors of the study reported that “We found that administration of a blood transfusion to patients in the ICU was associated with improved survival in those patients who survived at least 180 days after admission to the ICU.” This bodes well for all patients in the ICU .
7. Transcatheter and transapical aortic valve replacement.
This is an article which discusses the use of minimally invasive aortic valve replacement for patients which are at a higher risk of complications and mortality as a result of a traditional procedure which is more invasive and therefore dangerous. The study found that several factors increased risk to patients, the greatest of which was advanced age. The two procedures studied, transcatheter and transapical, are looked at from the perspective of care required and efficacy for patients who are at a higher risk of complications from a traditional procedure.
First, the article looks at the procedure itself and details how it is conducted. The transcatheter procedure involves not removing the entire defective valve, as is the case in traditional valve replacement, but the new valve is loaded onto a “stent or frame.” The stent is then inflated to anchor the valve. This procedure is said to last as long as the typical procedure with the same type of valve. These procedures are typically less invasive because they are not as invasive as a typical heart valve replacement. The article also makes the statement that both of these procedures are still in the trial stages, and the article is concerned with the results of those studies.
The issues that they have had so far in the trials is that there is a greater chance that this procedure will result kin death because there is some danger that “perivalvular regurgitation will occur.” This is because the stent or structure is not secured to the same extent as a typical valve in a valve replacement. The valve in the case of transcatheter and transapical replacement may become dislodged, whereas, in the traditional method, that is much less common.
8. Transparent film dressing vs. pressure dressing after percutaneous transluminal coronary angiography.
The focus of the study is to asses three different types of dressing that can be used after an angiography “with respect to effect on bleeding, discomfort voiced by patients, and ease of groin assessment in patients after percutaneous transluminal coronary angiography.” The reason for this concern is that patients complain of pain when they receive the traditional pressure dressing when the dressing is applied, during the time when the dressing is in place and of skin irritation after it is removed.
Patients in the study received one of three types of dressing after the procedure. Either they were given pressure dressing, transparent film dressing or they were given an adhesive bandage. 100 patients were chosen for the study who had undergone the specific procedure and they were assessed for the comfort and issues that they complained of from the type of dressing they were given.
Among the patients who received one of the three dressing types, almost two-thirds had previously undergone the same procedure, and could more accurately assess the difference in the types of dressing. The pressure dressing was deemed by both nurses and patients to cause the most difficulties. The nurses were less able to assess the groin when the pressure dressing was used, and the patients had more pain and general discomfort with the pressure dressing. Both the transparent film dressing and the adhesive bandage were seen as superior for both patients and nurses. Nurses liked the transparent film the best.
Engoren, M., & Arslanian-Engoren, C. (2009). Long-term survival in the intensive care unit after erythrocyte blood transfusion. American Journal of Critical Care, 18(2), 124-131.
Gallagher, J.J. (2010). Intra=abdominal hypertension: Detecting and managing a lethal complication of critical illness. AACN Advanced Critical Care, 21(2), 205-217.
McIe, S. Pettite, T., Pride, L., Leeper, D., & Ostrow, C.L. (2009). Transparent film dressing vs. pressure dressing after percutaneous transluminal coronary angiography. American Journal of Critical Care, 18(1), 14-19.
McKean, S. (2009). Induced moderate hypothermia after cardiac arrest. AACN Advanced Critical Care, 20(4), 343-352.
McRae, M.E., Rodger, M., & B.A. (2009). Transcatheter and transapical aortic valve replacement. Critical Care Nurse, 29(1), 22-36.
Munro, C.L., Grap, M.J., Jones, D.J., McClish, D.K., & Sessler, C.N. (2009). Chlohexidine, toothbrushing, and preventing ventilator-associated pneumonia in critically ill adults. American Journal of Critical Care, 18(5), 428-437.
Unoki, T., Grap, M.J., Sessler, C.N., Best, A.M., Wetzel, P., Hamilton, A., Mellott, K.G., & Munro, C.L. (2009). Autonomic nervous system function and depth of sedation in adults receiving mechanical ventilation. American Journal of Critical Care, 18(1), 42-50.
Wiencek, C., & Winkleman, C. (2010). Chronic critical illness: Prevalence, profile, and pathophysiology. AACN Advanced Critical Care, 21(1), 44-61.
Get Professional Assignment Help Cheaply
Are you busy and do not have time to handle your assignment? Are you scared that your paper will not make the grade? Do you have responsibilities that may hinder you from turning in your assignment on time? Are you tired and can barely handle your assignment? Are your grades inconsistent?
Whichever your reason is, it is valid! You can get professional academic help from our service at affordable rates. We have a team of professional academic writers who can handle all your assignments.
Why Choose Our Academic Writing Service?
- Plagiarism free papers
- Timely delivery
- Any deadline
- Skilled, Experienced Native English Writers
- Subject-relevant academic writer
- Adherence to paper instructions
- Ability to tackle bulk assignments
- Reasonable prices
- 24/7 Customer Support
- Get superb grades consistently
Online Academic Help With Different Subjects
Students barely have time to read. We got you! Have your literature essay or book review written without having the hassle of reading the book. You can get your literature paper custom-written for you by our literature specialists.
Do you struggle with finance? No need to torture yourself if finance is not your cup of tea. You can order your finance paper from our academic writing service and get 100% original work from competent finance experts.
While psychology may be an interesting subject, you may lack sufficient time to handle your assignments. Don’t despair; by using our academic writing service, you can be assured of perfect grades. Moreover, your grades will be consistent.
Engineering is quite a demanding subject. Students face a lot of pressure and barely have enough time to do what they love to do. Our academic writing service got you covered! Our engineering specialists follow the paper instructions and ensure timely delivery of the paper.
In the nursing course, you may have difficulties with literature reviews, annotated bibliographies, critical essays, and other assignments. Our nursing assignment writers will offer you professional nursing paper help at low prices.
Truth be told, sociology papers can be quite exhausting. Our academic writing service relieves you of fatigue, pressure, and stress. You can relax and have peace of mind as our academic writers handle your sociology assignment.
We take pride in having some of the best business writers in the industry. Our business writers have a lot of experience in the field. They are reliable, and you can be assured of a high-grade paper. They are able to handle business papers of any subject, length, deadline, and difficulty!
We boast of having some of the most experienced statistics experts in the industry. Our statistics experts have diverse skills, expertise, and knowledge to handle any kind of assignment. They have access to all kinds of software to get your assignment done.
Writing a law essay may prove to be an insurmountable obstacle, especially when you need to know the peculiarities of the legislative framework. Take advantage of our top-notch law specialists and get superb grades and 100% satisfaction.
What discipline/subjects do you deal in?
We have highlighted some of the most popular subjects we handle above. Those are just a tip of the iceberg. We deal in all academic disciplines since our writers are as diverse. They have been drawn from across all disciplines, and orders are assigned to those writers believed to be the best in the field. In a nutshell, there is no task we cannot handle; all you need to do is place your order with us. As long as your instructions are clear, just trust we shall deliver irrespective of the discipline.
Are your writers competent enough to handle my paper?
Our essay writers are graduates with bachelor's, masters, Ph.D., and doctorate degrees in various subjects. The minimum requirement to be an essay writer with our essay writing service is to have a college degree. All our academic writers have a minimum of two years of academic writing. We have a stringent recruitment process to ensure that we get only the most competent essay writers in the industry. We also ensure that the writers are handsomely compensated for their value. The majority of our writers are native English speakers. As such, the fluency of language and grammar is impeccable.
What if I don’t like the paper?
There is a very low likelihood that you won’t like the paper.
- When assigning your order, we match the paper’s discipline with the writer’s field/specialization. Since all our writers are graduates, we match the paper’s subject with the field the writer studied. For instance, if it’s a nursing paper, only a nursing graduate and writer will handle it. Furthermore, all our writers have academic writing experience and top-notch research skills.
- We have a quality assurance that reviews the paper before it gets to you. As such, we ensure that you get a paper that meets the required standard and will most definitely make the grade.
In the event that you don’t like your paper:
- The writer will revise the paper up to your pleasing. You have unlimited revisions. You simply need to highlight what specifically you don’t like about the paper, and the writer will make the amendments. The paper will be revised until you are satisfied. Revisions are free of charge
- We will have a different writer write the paper from scratch.
- Last resort, if the above does not work, we will refund your money.
Will the professor find out I didn’t write the paper myself?
Not at all. All papers are written from scratch. There is no way your tutor or instructor will realize that you did not write the paper yourself. In fact, we recommend using our assignment help services for consistent results.
What if the paper is plagiarized?
We check all papers for plagiarism before we submit them. We use powerful plagiarism checking software such as SafeAssign, LopesWrite, and Turnitin. We also upload the plagiarism report so that you can review it. We understand that plagiarism is academic suicide. We would not take the risk of submitting plagiarized work and jeopardize your academic journey. Furthermore, we do not sell or use prewritten papers, and each paper is written from scratch.
When will I get my paper?
You determine when you get the paper by setting the deadline when placing the order. All papers are delivered within the deadline. We are well aware that we operate in a time-sensitive industry. As such, we have laid out strategies to ensure that the client receives the paper on time and they never miss the deadline. We understand that papers that are submitted late have some points deducted. We do not want you to miss any points due to late submission. We work on beating deadlines by huge margins in order to ensure that you have ample time to review the paper before you submit it.
Will anyone find out that I used your services?
We have a privacy and confidentiality policy that guides our work. We NEVER share any customer information with third parties. Noone will ever know that you used our assignment help services. It’s only between you and us. We are bound by our policies to protect the customer’s identity and information. All your information, such as your names, phone number, email, order information, and so on, are protected. We have robust security systems that ensure that your data is protected. Hacking our systems is close to impossible, and it has never happened.
How our Assignment Help Service Works
1. Place an order
You fill all the paper instructions in the order form. Make sure you include all the helpful materials so that our academic writers can deliver the perfect paper. It will also help to eliminate unnecessary revisions.
2. Pay for the order
Proceed to pay for the paper so that it can be assigned to one of our expert academic writers. The paper subject is matched with the writer’s area of specialization.
3. Track the progress
You communicate with the writer and know about the progress of the paper. The client can ask the writer for drafts of the paper. The client can upload extra material and include additional instructions from the lecturer. Receive a paper.
4. Download the paper
The paper is sent to your email and uploaded to your personal account. You also get a plagiarism report attached to your paper.
PLACE THIS ORDER OR A SIMILAR ORDER WITH US TODAY AND GET A PERFECT SCORE!!!