This issue is a collection of unsolicited manuscripts that deal with special assessment problems in the intensive care unit (ICU). Although the articles represent a range of clinical issues, they all reinforce the value of astute observations as a complement to biomedical technology and laboratory testing.
Innerarity is a must read for every critical care nurse. It covers a wide range of issues and special problems in which detection and management of magnesium imbalances are central to the patient's stability and recovery.
Capovilla et al, discusses the use of noninvasive blood gas analyzers that have become the standard of care for judging the patient's response to pulmonary therapies. In addition to their use within the critically ill population, the gas analyzers are also being regularly employed for other patients in subacute and rehabilitative settings who need either intermittent or continuous monitoring of arterial oxygen and carbon dioxide. Emphasis of the article is on interpreting data from the analyzers and trouble-shooting problems that occur during monitoring.
Angerio outlines an unusual problem in his paper "Endothelin-Mediated Preeclampsia at High Altitude." It is not uncommon for even the most highly experienced nurse to be intimidated by pregnant patients and the special challenges they bring to the caregiver team. The role of endothelin and its antagonists in the genesis and management of pregnancy-associated hypertension is intriguing reading.
The three articles by Fulton will be especially useful to help in the understanding of difficult problems of Munchausen Syndrome by Proxy (MSBP), Shaken Baby Syndrome (SBS), and injuries associated with domestic violence. These problems that have intriguing etiologies and manifestations may easily go undetected if the nurse is not aware of both typical and atypical presentations. The failure of a nurse to recognize vulnerable patients who have been victimized by abuse may permit them to return to a setting in which the battery and injuries may continue.
As the average age of ICU patients continues to escalate, older patients comprise a significant part of the typical caseload. In addition to the physical and physiological challenges they bring to the nursing staff, there is growing awareness that an unfortunate number of these older clients may have been abused or neglected by their caretakers. It is vital that critical care nurses assess all older patients for signs and symptoms of abuse, and White offers helpful assessment guides to use when admitting and caring for the older patient.
Ptacek and Ellison report their study on transactions between patients and physicians when bad news is delivered. Perhaps the most important findings relate to the specific factors that influence participants' perceptions since the nurse is in the ideal position to influence at least some of these. Those who work in critical care face the unenviable role of conveying bad news as well as good news to patients and their loved ones, almost daily. Any information that can sharpen their skills for this task is certain to be useful.
Finally, Kosco and Warren's study, like the one just discussed, continues to illustrate how subtleties in interactions among the staff, patients and their significant others influence the overall satisfaction of the ICU stay.
Upcoming issues of Critical Care Nursing Quarterly will address clinical topics including Head Trauma, Point of Care Testing, and Infection Control in Critical Care. In the meantime, this issue is certain to redirect and sharpen your assessment skills to include some uncommon problems. It hopefully will also encourage you and your colleagues to think more critically about the potential long-term impact of your routine interactions with the patient's family.