• 제목/요약/키워드: Critically ill patient

검색결과 72건 처리시간 0.028초

수면 무호흡증이 있는 양극성 장애 환자에서 급속 정온요법으로 인해 발생한 급성 호흡 장애 (Acute Respiratory Distress due to Rapid Tranquilization in a Bipolar Patient with Sleep Apnea)

  • 함병주;서용진;김린
    • 수면정신생리
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    • 제8권2호
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    • pp.144-147
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    • 2001
  • Chemical restraint or "rapid tranquilization" is another option in treating patients who are a danger to themselves or others and struggle violently once physically restrained. The most commonly used drugs are benzodiazepines and antipsychotics. The use of benzodiazepines, either alone or in combination with high potency neuroleptics, has increased in recent years. Benzodiazepines are extremely safe but may cause respiratory depression and hypotension. Respiratory depression is more likely with intravenous administration, therefore these medications should be given slowly and titrated to the desired effect. Special care should be taken when sedating patients who are under the influence of alcohol or narcotics and are sleep apneic patients. This report deals with a case of respiratory distress in a patient with sleep apnea syndrome after the rapid tranqulization. All patients receiving chemical restraint must be carefully monitored. For critically ill patients who require sedation or chemical restraint, the constant attendance of a physician may be warranted.

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일 대학병원 호스피스 병동 입원 환자의 간호활동시간 측정과 원가산정 (Determination of Cost and Measurement of nursing Care Hours for Hospice Patients Hospitalized in one University Hospital)

  • 김경운
    • 간호행정학회지
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    • 제6권3호
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    • pp.389-404
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    • 2000
  • This study was designed to determine the cost and measurement of nursing care hours for hospice patients hostpitalized in one university hospital. 314 inpatients in the hospice unit 11 nursing manpower were enrolled. Study was taken place in C University Hospital from 8th to 28th, Nov, 1999. Researcher and investigator did pilot study for selecting compatible hospice patient classification indicators. After modifying patient classification indicators and nursing care details for general ward, approved of content validity by specialist. Using hospice patient classification indicators and per 5 min continuing observation method, researcher and investigator recorded direct nursing care hours, indirect nursing care hours, and personnel time on hospice nursing care hours, and personnel time on hospice nursing care activities sheet. All of the patients were classified into Class I(mildly ill), Class II (moderately ill), Class III (acutely ill), and Class IV (critically ill) by patient classification system (PCS) which had been carefully developed to be suitable for the Korean hospice ward. And then the elements of the nursing care cost was investigated. Based on the data from an accounting section (Riccolo, 1988), nursing care hours per patient per day in each class and nursing care cost per patient per hour were multiplied. And then the mean of the nursing care cost per patient per day in each class was calculated. Using SAS, The number of patients in class and nursing activities in duty for nursing care hours were calculated the percent, the mean, the standard deviation respectively. According to the ANOVA and the $Scheff{\'{e}$ test, direct nursing care hours per patient per day for the each class were analyzed. The results of this study were summarized as follows : 1. Distribution of patient class : class IN(33.5%) was the largest class the rest were class II(26.1%) class III(22.6%), class I(17.8%). Nursing care requirements of the inpatients in hospice ward were greater than that of the inpatients in general ward. 2. Direct nursing care activities : Measurement ${\cdot}$ observation 41.7%, medication 16.6%, exercise ${\cdot}$ safety 12.5%, education ${\cdot}$ communication 7.2% etc. The mean hours of direct nursing care per patient per day per duty were needed ; 69.3 min for day duty, 64.7 min for evening duty, 88.2 min for night duty, 38.7 min for shift duty. The mean hours of direct nursing care of night duty was longer than that of the other duty. Direct nursing care hours per patient per day in each class were needed ; 3.1 hrs for class I, 3.9 hrs for class II, 4.7 hrs for class III, and 5.2 hrs for class IV. The mean hours of direct nursing care per patient per day without the PCS was 4.1 hours. The mean hours of direct nursing care per patient per day in class was increased significantly according to increasing nursing care requirements of the inpatients(F=49.04, p=.0001). The each class was significantly different(p<0.05). The mean hours of direct nursing care of several direct nursing care activities in each class were increased according to increasing nursing care requirements of the inpatients(p<0.05) ; class III and class IV for medication and education ${\cdot}$ communication, class I, class III and class IV for measurement ${\cdot}$ observation, class I, class II and class IV for elimination ${\cdot}$ irrigation, all of class for exercise ${\cdot}$ safety. 3. Indirect nursing care activities and personnel time : Recognization 24.2%, house keeping activity 22.7%, charting 17.2%, personnel time 11.8% etc. The mean hours of indirect nursing care and personnel time per nursing manpower was 4.7 hrs. The mean hours of indirect nursing care and personnel time per duty were 294.8 min for day duty, 212.3 min for evening duty, 387.9 min for night duty, 143.3 min for shift duty. The mean of indirect nursing care hours and personnel time of night duty was longer than that of the other duty. 4. The mean hours of indirect nursing care and personnel time per patient per day was 2.5 hrs. 5. The mean hours of nursing care per patient per day in each class were class I 5.6 hrs, class II 6.4 hrs, class III 7.2 hrs, class IV 7.7 hrs. 6. The elements of the nursing care cost were composed of 2,212 won for direct nursing care cost, 267 won for direct material cost and 307 won for indirect cost. Sum of the elements of the nursing care cost was 2,786 won. 7. The mean cost of the nursing care per patient per day in each class were 15,601.6 won for class I, 17,830.4 won for class II, 20,259.2 won for class III, 21,452.2 won for class IV. As above, using modified hospice patient classification indicators and nursing care activity details, many critical ill patients were hospitalized in the hospice unit and it reflected that the more nursing care requirements of the patients, the more direct nursing care hours. Emotional ${\cdot}$ spiritual care, pain ${\cdot}$ symptom control, terminal care, education ${\cdot}$ communication, narcotics management and delivery, attending funeral ceremony, the major nursing care activities, were also the independent hospice service. But it is not compensated by the present medical insurance system. Exercise ${\cdot}$ safety, elimination ${\cdot}$ irrigation needed more nursing care hours as equal to that of intensive care units. The present nursing management fee in the medical insurance system compensated only a part of nursing car service in hospice unit, which rewarded lower cost that that of nursing care.

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환자분류에 의한 일개 2차 의료기관의 간호업무량 조사;전산화를 위한 기초작업으로서 (Measurement of the Nursing Workload by Patient Classification System in a Secondary Hospital;As a Preliminary Step for Computerization of Nursing Staffing and Scheduling)

  • 박정호;조현;박현애;한혜라
    • 간호행정학회지
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    • 제1권1호
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    • pp.132-146
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    • 1995
  • Even though Korean medical law stipulates that number of patients attended by a nurse is 2.5 for hospitalization and 30 for ambulatory care, the number of patients cared by a nurse per day is much greater than the standard prescribed by the medical law. Current productivity of nurses is not desirable unless the quality of care is considered. And nursing manpower staffing based on neither current nurses' productivity nor standard of medical law cannot respond properly to dynamic situation of the medical services. Under this background, the necessity of more efficient management of nursing manpower occupying 1/3 of total hospital workers has been recognized by many nursing administrators. Many nursing researchers have studied to foretell the nursing manpower objectively on the basis of measured nursing workload according to patient classification as well. Most of These researches, however, have been conducted in the tertiary hospitals, so it is imperative to conduct other researches to predict necessary nursing manpower in the secondary and the primary hospitals. The study was performed to measure nursing workload and predict pertinent nursing manpower to a secondary hospital with 400beds. Nursing workload was surveyed using measuring tool for direct and indirect care hours in a surgical unit and a medical unit. Survey was conducted from Sep.10 to Sep.16 and from Oct.5 to Oct.11, 1994 respectively by two skilled nurses, Subjects were patients, patients' family members and nursing personnels. Results are follows : 1. Patient classification distributed as 22% of class I (mildly ill patient), 57% of class II (moderately ill patient), and 21% of class III (acutely ill patient) in the medical nursing unit, while 23% of class I, 29% of class II, 12% of class III, and 36% of classIV (critically ill patient) in the surgical nursing unit. There was no difference of inpatient number between weekday and weekend. Bed circulation rate was 89% in both units and average patients number per day was 37.4 (total 42beds) in the medical nursing unit, 32.9 (total 37beds) in the medical nursing unit. 2. Direct care hours per day measured as 2.8hrs for class I, 3.3hrs for class II, and 3.5hrs for class III in the medical nursing unit, while 3.1hrs for class I, 3hrs for class II, 2.7hrs for class III, and 2.2hrs for classIV in the surgical nursing unit. Meanwhile, hours for nursing assistant activities per patient by patients' family members were 11mins and 200mins respectively. Direct care hour rate by shift was day 36%, evening 25%, and night 39% in the medical nursing unit, while 40%, 29%, and and 31% respectively in the surgical nursing unit. 3. Measurement and observation activity held 44.2% of direct care activities of nurses and medication 36.7%, communication 11.7%, exercise 1.8%, treatment 1.3%, hygiene 1.3%, elimination and irrigation 1.1%, suction 1%, nutrition 0.5%, thermotherapy 0.3%, oxygen therapy 0.1% in order. 4. Indirect care hours per day were 294.2mins in the medical nursing unit, and 273.9mins in the surgical nursing unit. By shift, evening was the highest in both units. Indirect care hours for each patient were 44.5mins in the medical nursing unit and 46mins in the surgical nursing unit. 5. checking activities including doctor's order, medication, and delivering patients to the next shift occupied 39.7% of indirect care activities, and preparation 26%, recording 23.8%, communication and conference 6.7%, managing equipments 2.1%, messenger activity 1.7% in order. 6. On the ground of these results, nursing manpower needed in a secondary hospital was estimated ; 27 nursing personnels for the medical nursing unit of 37beds, and 20 nursing personnels for the surgical nursing unit of 33beds.

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소아심장외과 중환자실에서의 실무의사소통 프로토콜이 수술 후 성과에 미치는 영향 (Practical Communication Strategies to Improve the Surgical Outcomes in a Pediatric Cardiac Intensive Care Unit)

  • 엄주연;이월숙
    • 간호행정학회지
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    • 제21권3호
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    • pp.243-253
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    • 2015
  • Purpose: The purpose of this study was to identify the impact of practical communication strategies (PCS) on the reduction of AEs (Adverse Events) in pediatric cardiac ICU (PCICU). Methods: Intra-operative findings and care plans were documented and shared between staff members on a daily basis from the day of operation to the day of general ward transfer. Incidence of AEs was investigated in all patients who were admitted to the PCICU and was compared with incidence of AEs one year after establishment of PCS. Results: The study population consisted of 216 patients in pre-PCS group and 156 patients in post-PCS group. Incidence of readmission decreased from 6.0% (13/216) in pre-PCS group to 0.6% (1/156) in post-PCS group (${\chi}^2=7.23$, p=.010). Incidence of other major complications decreased from 4.2% (9/216) to 0.6% (${\chi}^2=6.66$, p=.012). Minor AEs such as intervention omission, order error, and protocol misunderstanding were reduced from 23.3 cases per 100 patient-days to 7.5 cases per 100 patient-days (${\chi}^2=20.31$, p<.001). Conclusion: Handover protocol is an effective strategy to reduce AEs for critically ill patients after pediatric cardiac surgery. Efforts to develop effective communication strategies should be continued and outcome research about communication strategies for patient safety should be further studied.

복강 내압 항진증이 내과계 중환자의 예후에 미치는 영향 (The Effects of Intra-Abdominal Hypertension on the Prognosis of Critically Ill Patients in the Intensive Care Unit (ICU))

  • 김세중;서정수;손명희;김수연;정기환;강은해;이승룡;이상엽;김제형;신철;심재정;인광호;유세화;강경호
    • Tuberculosis and Respiratory Diseases
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    • 제61권1호
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    • pp.46-53
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    • 2006
  • 연구배경: IAP의 증가는 혈류량을 감소시켜 여러 장기에 영향을 준다. IAH는 IAP가 12 mmHg 이상 또는 APP가 60 mmHg 이하로, ACS는 IAP가 20 mmHg 이상이면서 동시에 하나 이상의 장기 손상이 있는 경우로 각각 정의한다. 저자들은 중환자에서 IAH 및 ACS의 유병률과 이들이 환자의 예후에 미치는 영향을 고찰하고자 하였다. 방 법: 고려대학교 의료원 중환자실에 입원하는 내과계 환자를 대상으로 하여, APACHE II 및 III 점수, SAPS II 점수를 기록하였다. IAP는 삼중관 요도관을 통하여, 입원 7일째까지 매일 3회 측정하였고, 환자가 사망하거나 일반 병실로 전실 또는 요도관을 제거할 때까지 계속하였다. 환자의 예후는 28일을 기준으로 판단하였다. 결 과: 총 111명 대상 환자들의 입원 1일 IAH 및 ACS의 유병률은 각각 47.7%, 15.3%였다. 사망군과 생존군 사이에 IAH의 유병률은 유의한 차이가 없었으나, ACS는 사망군에서 더 높았다 (p=0.004). 사망군에서 IAP는 더 높았고 (p=0.012), APP는 유의하게 낮았다 (p<0.001). 결 론: 중환자에서 입원 1일에 측정한 IAP의 증가, APP의 감소 및 ACS 발생은 환자의 사망과 연관이 있을 것으로 판단된다.

소아 중환자에서 지속적 신대체요법의 치료 결과와 예후 (Outcome and Prognosis in Critically III Children Receiving Continuous Renal Replacement Therapy)

  • 박광식;손기영;황유식;김정아;정일천;신재일;박지민;안선영;유철주;이재승
    • Childhood Kidney Diseases
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    • 제11권2호
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    • pp.247-254
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    • 2007
  • 목 적 : 세계적으로 급성 신부전을 가진 소아중환자의 경우 신대체요법으로서 CRRT가 우선적으로 적용되고 있는데 국내에서 CRRT에 대한 치료 결과나 이에 미치는 예후인자에 대한 연구가 드문 설정이다. 이에 저자들은 CRRT를 시행 받은 소아 환자군을 대상으로 치료결과와 예후인자를 알아보기 위해 본 연구를 시행하였다. 방 법 : 2003년 1월부터 2006년 12월까지 세브란스 어린이병원 소아과에서 CRRT를 시행 받은 소아 중환자 32명을 대상으로 하여 환자들이 입상적 특징과 생존율, 그리고 이에 미치는 예후인자를 생존군과 사망군으로 나누어 비교하였다. 결 과 : 총 32명의 평균 나이는 7.5세로 범위는 생후 4일에서 16살까지였고 평균 몸무게는 25.8kg로 최소 3.2kg 최고 63kg였다. 기저 질환 중 조혈모세포이식과 악성종양 환자군이 가장 많았고, 이 군에서 생존율이 가장 낮았다. 전체 생존자는 11명으로 생존율은 34.4%였고 예후인자에 대한 연구에서 CRRT 시작시 PRISM III 점수($9.8{\pm}5.3$ vs. $26.7{\pm}7.6$, P<0.0001), 승압제 사용 수 ($2.1{\pm}1.2$ vs. $3.0{\pm}1.0$, P=0.038)와 수분 저류 정도 (%FO, $5.2{\pm}6.0$ vs. $15.0{\pm}8.9$, P=0.002)가 사망군보다 생존군에서 의미 있게 낮았다. 또 다중 회귀분석을 통해 높은 수분 저류만이 독립적 위험인자임을 확인하였다. 결 론 : 저자는 이 연구를 통해 소아 급성 신부전 환자에서 생존율이 환자의 중증도와 체내 수분 저류와 연관성이 높다는 것을 확인하였고, 환자의 전신상태가 보다 좋을 때 특히 수분 저류가 시작되기 전에 CRRT를 빨리 시작하는 것이 생존율을 높일 수 있다는 결론을 얻을 수 있었다.

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호기말 양압호흡이 혈류역학 및 심기능에 미치는 영향 (Hemodynamic Influences of Positive End-Expiratory Pressure Ventilation in Patients with Pulmonary Insufficiency)

  • 장병철
    • Journal of Chest Surgery
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    • 제18권1호
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    • pp.79-85
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    • 1985
  • The effect of graded increments in positive end-expiratory pressure [PEEP] on hemodynamics required to ventilate 8 critically ill patients is reported. Acute respiratory insufficiency was a cause of death in only one patient of drug inoxication among the 8 patients studied. The cardiac output was not changed significantly after the increment of PEEP to the level of 20 cm H2O. The heart rate was increased significantly from 15 cm H2O PEEP [P<0.01] as compared to 0 cm H2O PEEP; and the stroke volume was decreased significantly from 15 cm H2O PEEP [P<0.05]. The blood pressure was not affected at any level of PEEP, but the pulmonary artery pressure was elevated significantly at 10 cm H2O PEEP [P<0.01]. The right ventricular transmural filling pressure was not affected at the level of 10 cm H2O PEEP, but from 15 cm H2O PEEP it was increased significantly. With the increment of PEEP, the left ventricular stroke work index was decreased slightly; and at 20 cm H2O PEEP, it was decreased significantly. The right ventricular stroke work index was increased only at 10 cm H2O PEEP. The systemic vascular resistance was decreased significantly from 15 cm H2O PEEP [P<0.01].

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중환자실 환자의 일반 병동 전실 시 스트레스 영향요인 (Factors Influencing Relocation Stress Syndrome in Patients Following Transfer from Intensive Care Units)

  • 박진희;유문숙;손연정;배선형
    • 대한간호학회지
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    • 제40권3호
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    • pp.307-316
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    • 2010
  • Purpose: The purpose of this study was to identify the levels of relocation stress syndrome (RSS) and influencing the stress experienced by Intensive Care Unit (ICU) patients just after transfer to general wards. Methods: A cross-sectional study was conducted with 257 patients who transferred from the intensive care unit. Data were collected through self-report questionnaires from May to October, 2009. Data were analyzed using the Pearson correlation coefficient, t-test, one-way ANOVA, and stepwise multiple linear regression with SPSS/WIN 12.0. Results: The mean score for RSS was $17.80{\pm}9.16$. The factors predicting relocation stress syndrome were symptom experience, differences in scope and quality of care provided by ICU and ward nursing staffs, satisfaction with transfer process, length of stay in ICU and economic status, and these factors explained 40% of relocation stress syndrome (F=31.61, p<.001). Conclusion: By understanding the stress experienced by ICU patients, nurses are better able to provide psychological support and thus more holistic care to critically ill patients. Further research is needed to consider the impact of relocation stress syndrome on patients' health outcomes in the recovery trajectory.

의인성 쇄골하정맥 파열로 인한 응급 혈관내 스텐트 삽입 (Urgent Endovascular Stent Graft Placement for Iatrogenic Subclavian Artery Rupture)

  • 강병우;배준호;정진욱;조병주;박준기;나득영
    • Journal of Trauma and Injury
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    • 제28권2호
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    • pp.83-86
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    • 2015
  • Central venous cannulation is one of the most commonly performed procedures for critically ill patients in the emergency room. Serious complications like a rupture of subclavian artery may occur during this procedure. We report a case of successful stent graft deployment for iatrogenic ruptured subclavian artery after attempted right subclavian vein catheterization in a 31 year-old female patient with hypovolemic shock due to cervical os laceration during vaginal delivery.

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비갑상선 중증 질환에서 혈청 $fT_3$$rT_3$의 변화에 관한 연구 (A Study on Changes of Serum $fT_3\;and\;rT_3$ Concentration in Nonthyroidal Critical Illness)

  • 이종화;김주옥;유철재;문윤성;신영태;노흥규
    • 대한핵의학회지
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    • 제19권1호
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    • pp.103-111
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    • 1985
  • Recently changes in thyroid physiology during acute and chronic medical illness were demonstrated. The serum $fT_3,\;rT_3,\;T_4,\;T_3,\;fT_4$, and TSH concentration were measured by radioimmunoassay method in 49 patients with critical illness and 10 normal subjects to assess the change of thyroid function in critical illness. The results were as follows; 1) The mean serum $fT_3$ concentration was $6.68{\pm}1.05pmol/ml$ in normal subjects while in patients with critical illness the serum $fT_3$ concentration was significantly lowered to $1.55{\pm}1.15pmol/ml$(p<0.001). 2) The mean serum $rT_3$ concentration was $0.22{\pm}0.44ng/ml$ in normal subjects and $0.42{\pm}0.37ng/ml$ in patient with critical illness. There was increment in critically ill patients as compared to normal subjects but no statistically significant difference(p>0.05). 3) The mean serum $T_3$ concentration was $1.24{\pm}0.25ng/ml$ in normal subjects and $0.56{\pm}0.56ng/ml$ in patients with criticial illness and there was significant difference in each other(p<0.005). 4) The mean serum $T_4,\;fT_4$, and TSH concentrations were $7.80{\pm}1.02{\mu}g/dl,\;1.26{\pm}0.39ng/dl,\;1.87{\pm}0.45{\mu}U/ml$ in normal subjects respectively and $6.02{\pm}3.06{\mu}g/dl,\;1.46{\pm}0.80ng/dl,\;1.74{\pm}0.79{\mu}U/ml$ in patients with critical illness and there was no significant difference between critically ill patients and normal subjects. 5) The ratio of mean serum concentration of $fT_3$ and $rT_3(fT_3/rT_3)$, $30.42{\pm}5.58$ in normal subjects was significantly higher(p<0.005) than the coresponding patients with critical illness. 6) The mean serum $fT_3$ concentration in expired cases(n=12) during admission was significant difference between expired and survived cases(p<0.005). The mean serum $rT_3$ centration was $0.67{\pm}0.58ng/ml$ in expired cases and $0.34{\pm}0.22ng/ml$ in survived cases with significant difference(p<0.005). Half of the cases who showed less than $3{\mu}g/dl$ of serum $T_4$ level were expired.

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