Bedside patients

A multidisciplinary effort is required to design and build instruments with previously unavailable capabilities for demanding new applications. Instruments with more sensitivity are required today to analyze ultra-trace levels of environmental pollutants, pathogens in water, and low vapor pressure energetic materials in air. Sensor systems with faster response times are desired to monitor transient in-vivo events and bedside patients. More selective instruments are sought to analyze... 

Volume measurements by impedance were proposed early and became one of the first widespread impedance applications in hospital instrumentation. It is a part of the usual bedside patient monitor present in all intensive-care units impedance adds respiration to the ECG and blood pressure channels. It is embedded in the monitors rather anonymously, uses the ECG electrodes already there, and passes unnoticed as a clinical bioimpedance method by most users. 

Ward rounds are usually once or twice a week, and take a few hours. They re the place where team decisions are made, thus a good place to learn about management (Box 35.1). Rather than beii visited at their bedside, patients usually attend a conference room, and can feel understandably overvdielmed by the crowd of MDT representatives. Some consultants use ward rounds to gain updates, before reviewii patients in a more relaxed manner, one-to-one. 

The first thing they usually mention is time pressure. Nurses complain that they have more patients than they can manage, that teamwork is poor, morale low, and burnout high. They feel their availability for bedside patient care is compromised by a growing body of administrative tasks. 

Leuko-reduction can be performed at the time of collection by apheresis in the blood lab or at the patient s bedside. Economic, quaUty assurance. 

Never leave a drug at the patient s bedside to be taken later unless there is a specific order by the... 

DIARRHEA. When these dragp are used orally they occasionally result in excessive salivation, abdominal cramping, flatus, and sometimes diarrhea The patient is informed that these reactions will continue until tolerance develops, usually within a few weeks. Until tolerance develops, the nurse ensures that proper facilities, such as a bedside commode, bedpan, or bathroom, are readily available. The patient is encouraged to ambulate to assist the passing of flatus. If needed, a rectal tube may be used to assist in the passing of flatus. The nurse keeps a record of the fluid intake and output and tlie number, consistency, and frequency of stools if diarrhea is present. The primary health care provider is informed if diarrhea is excessive because this may be an indication of toxicity. 

The primary care provider allows the patient to keep pilocarpine eye drops at the bedside and to self-administer the eye drops 4 times daily. The nurse... 

The nurse never leaves hypnotics and sedatives at the patient s bedside to be taken at a later hour hypnotics and sedatives are controlled substances (see Chap. 1). hi addition, the nurse never leaves these dru unattended in the nurses station, hallway, or other areas to which patients, visitors, or hospital personnel have direct access. If these dragp are prepared in advance, it is important to place them in a locked cupboard until the time of administration. 

Antiseptic and germicidal drugp kept at die patient s bedside must be clearly labeled with die name of die product, die strengtii, and when applicable die date of preparation of die solution. The nurse replaces hard-to-read or soiled, stained labels as needed. These solutions... 

The use of wireless computer systems has gain popularity in data collection for clinical trials. They have been used as a substitute for normal paper-based patient diaries (Koop et al. [19]) to increase data quality and shorten the time needed to close the database. They have also been used for mobile interviewing [20] and for bedside data collection [21]. In patient-directed data entry, subjects are given handheld computers to answer the trial s questions (Clarke et al. [22]). 

Shafqat et al. ° previously validated the National Institutes of Health Stroke Scale (NIHSS) assessment as a reliable method of evaluating patients with stroke symptoms at a bandwidth of 384 kbit/s comparing a bedside neurologist to a telemedicine-enabled neurologist teamed with a bedside nurse in patients with ischemic stroke and NIHSS scores ranging from 1 to 24. There was an excellent correlation between bedside and remote scores (inter-rater correlation coefficient... 

Respiratory alkalosis is associated with low partial pressure of02 (25 to 35 mm Hg) and alkaline pH, but normal bicarbonate. The first two values are measured by arterial blood gas, which also yields partial pressure of carbon dioxide and arterial oxygen saturation. Circulating arterial oxygen saturation can also be measured by an oximeter, which is a noninvasive method that is fairly accurate and useful at the patient s bedside. 

Suxamethonium sensitivity," prolonged paralysis of respiratory muscle function caused by failure to cleave the short-acting muscle relaxant succinylcholine widely used in anesthesia, was made testable with a simple bedside assay in 1968 (Motulsky and Morrow). However, that test was not incorporated widely into practice. Most anesthesiologists felt they could simply monitor all patients and "bag" those not resuming respiratory action, without testing for a trait that would be found in only one of 2000 patients. 

How can phase-modulation fluorometry contribute to this health-care need It now seems possible to construct a lifetime-based blood gas catheter (Figure 1.3), or alternatively, an apparatus to read the blood gas in the freshly drawn blood at the patient s bedside. To be specific, fluorophores are presently known to accomplish the task using a 543-nm Green Helium-Neon laser,(18 19) and it seems likely that the chemistries will be identified for a laser diode source. The use of longer wavelengths should minimize the problems of light absorption and autofluorescence of the samples, and the use of phase or modulation sensing should provide the robustness needed in a clinical environment. For the more technically oriented researcher, we note that the... 

Optical measurements of blood gases Available at bedside in the CCU Continuous readout of p02, pC02, and pH Rapid response and improved patient care No handling of blood by health care workers... 

Stahl N, Mellergard P, Hallstrom A, Ungerstedt U, Nordstrom CH. 2001a. Intracerebral microdialysis and bedside biochemical analysis in patients with fatal traumatic brain lesions. Acta Anaesthesiol Scand 45(8) 977-985. 

Analysers for clinical purposes have been designed [129-131] and even a bedside analyser for monitoring Na, K, Cs and jJ-D-glucose in patients blood [127] or a blood potassium analyser for use during open-heart surgery [109]. A computer-controlled interference correction has been proposed [44], in which the standards are mixed to match the electrode potential obtained in the test solution. A simple caUbration in flow systems [61] involves dilution of the standard solution and monitoring of the ISE potential as a function of the diluent volume and dilution time. 

Ultrasound equipment is the most portable of all the imaging modalities. It can be brought to the patient bedside and emergency room. Recently, ultrasound laptop/handheld portable imaging systems have become available and these can facilitate use in ambulances and field hospitals). 

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