Epoprostenol therapy for primary pulmonary hypertension.

Although a rare disease, PPH is deadly. Until recently, patients had little hope for remission of this disease. Originally viewed as a "bridge to transplantation," new research findings suggest that epoprostenol significantly improves PPH so that transplantation may not be necessary. Treatment with epoprostenol is difficult to manage, however, because it requires continuous central infusion. Nurses have a key role in ensuring that patients safely and effectively manage this therapy.

Control critically ill patients' acute pain.

Critically ill patients often can express their levels of pain--even when intubated. Follow these guidelines to measure their pain and provide pharmacologic and nonpharmacologic relief.

Effects of traumatic events, social support, and self-efficacy on adolescents' self-health assessments.

The purpose of this study was to examine the relationship between adolescents' exposure to traumatic events and their self-health assessments, and to examine the protective effects of social support and self-efficacy on this relationship. Survey results (N = 1,427) indicated that experiencing violent and nonviolent negative life events and being exposed to a disaster were inversely associated with adolescents' positive health assessments. As social support and self-efficacy decreased, adolescents' health assessments worsened. Female and Black adolescents had less favorable health assessments than their male and White counterparts. Findings suggest that traumatic events are predictive of adolescents' health assessments and that social support and self-efficacy prevent adolescents' health assessments from declining following traumatic events.

Pain, analgesic use, and morbidity in appendectomy patients.

Pain has immunosuppressive effects among the critically and chronically ill, and opioids may immunomodulate pain's deleterious effects. However, little is known about the relations between acute pain, acute illness, and morbidity among previously healthy surgical patients. This study retrospectively examined these relations in appendectomy patients (N = 61). Eleven patients (18%) had morbidity, with atelectasis (11.5%) the most frequent complication. There were no differences between those patients with and without morbidity and pain intensity, method of opioid administration, and total opioid dose. Patients who received nonopioid analgesics received fewer opioids, less preemptive analgesia, and had less morbidity, whereas patients whose appendixes perforated received higher opioid doses and received more preemptive analgesia. Although the relations between acute pain, opioid use, and morbidity among previously healthy surgical patients are unclear, findings infer that clinical practice does not follow guidelines advocated by analgesic experts.

Early enteral feeding of patients with multiple trauma.

The case study illustrates the recovery of a patient with multiple trauma who was fed a peptide-based formula via the enteral route soon after the trauma. Although the clinical course might have been worse if D.H. had not received this treatment, his generally excellent recovery might be partly attributable to this therapy. Although stress hypermetabolism occurs in most patients with multiple trauma within 48 hours after injury, no known treatment can arrest or reverse this problem. However, the lethal catabolic and septic effects of stress hypermetabolism can be at least partly thwarted through delivery of enteral nutrients within 72 hours after trauma.

Reducing the effects of acute pain in critically ill patients.

Unrelieved pain in critically ill patients can increase mortality, morbidity, length of stay, and use of resources. This article reviews the physiologic basis of acute pain and the pathophysiologic sequelae that may ensue when critically ill patients experience acute pain. The author recommends strategies critical care nurses and advanced practice nurses can use to provide effective analgesia and potentially improve patient outcomes.