bluuebunny/crossref_metadata_2025 huggingface dataset:
Nutritional Support of Pulmonary Patients: A Multidisciplinary Approach
Authors: Holtzman Gail M. , Warner Sidney C. , Melnik George , Beer William
Published: January 2016

Pulmonary disease affects and is affected by the nutritional status of the patient. The relationships between nutrition, medications, complications, and the course of pulmonary disease itself are multifaceted and are the focus of concern for the nutritional support team. Nutritional support of patients with pulmonary disease demands the expertise of a multidisciplinary team in monitoring the nutritional status of patients, appropriately selecting feeding solutions and routines, selecting and administering medications, and planning and implementing nursing interventions. Recognition of the importance of the nutritional component of care for patients with pulmonary disease is the focus of this article
Closed Tracheal Suction Systems: Effectiveness and Nursing Implications
Authors: Noll Mary Lou , Hix Carolyn D. , Scott Gwenn
Published: January 2016

Closed tracheal suction systems (CTSS) are currently being used to minimize complications associated with endotracheal suctioning. Advantages of CTSS include improved oxygenation, decreased clinical signs of hypoxemia, maintenance of positive end-expiratory pressure, infection control, convenience, cost, and reduced patient anxiety. Some concerns related to use of CTSS include autocontamination, decreased effectiveness, difficult to use, excess negative pressure, and airway trauma. Strategies for reducing these and other concerns are shared. Recommendations for nursing practice and nursing research are discussed
Modes of Ventilatory Support and Weaning Parameters in Children
Authors: Boegner Eva
Published: January 2016

Pediatric respiratory therapy management has become increasingly complex. Mechanical ventilation has become a mainstay in neonatal and pediatric intensive care units. Thorough knowledge of the modes of ventilatory support and criteria for weaning are essential for the critical care nurse to anticipate patient needs. Ventilatory support is initiated when a patient exhibits respiratory failure. For whatever reason, the respiratory system cannot meet the metabolic demands for oxygenation and carbon dioxide (CO2) elimination. Indications for mechanical ventilation in children include marked hypoxia, hypercapnea, peripheral airway obstruction, chest wall deformities, and central nervous system abnormalities. Nurses caring for these children must possess adequate knowledge of the underlying disease process as well as normal respiratory physiology and technical features of ventilators. Nursing strategies can then be directed toward weaning children from the mechanical ventilatory support
Air Transport of the Trauma Patient
Authors: Higgins Barbara , Popil Valerie
Published: January 2016

Flight nursing is a rapidly growing field in critical care nursing. An understanding of the types of trauma patients that warrant helicopter transport is important to any well functioning trauma system. The assessments and interventions necessary in transporting trauma patients are addressed. Safety, environmental, and psychosocial issues that surround the use of air transport are discussed
Clinical Management of the Pregnant Trauma Victim
Authors: Zerbe Marge
Published: January 2016

The pregnant trauma victim presents unique challenges to medical care providers because two lives must be treated concurrently. Physiologic changes inherent in the normal pregnancy, modify the assessment and treatment routines. Care directed to the mother impacts the fetus. Management of the pregnant trauma victim requires a high index of suspicion. Accurate assessment and timely interventions will enhance the probability of healthy outcomes for both mother and infant
Families Experiencing a Traumatic Accident: Implications and Nursing Management
Authors: Schlump-Urquhart Sandra R.
Published: January 2016

Families experiencing a traumatic accident experience significant psychosocial disruption. The traumatic event is sudden and unexpected. Families have no opportunity to prepare themselves emotionally, have limited experience with such catastrophic events, and are overwhelmed by the magnitude of the patient’s injuries. Critical care nurses have an important role in the psychosocial assessment, support, and management of these families. Many critical care nurses are uncomfortable interacting with families with significant psychosocial/emotional needs due to a lack of understanding of their needs, lack of knowledge of how to manage their needs, lack of confidence in communicating with families, and generalized discomfort and awkwardness when confronted with grief and bereavement issues. This article presents important information for critical care nurses to help them understand and manage families psychosocial needs and to feel more confident interacting with these families. Information presented includes (1) impact of the traumatic event, (2) emotional responses, (3) assessment of psychosocial needs, and (4) nursing interventions for the care and management of these families. Special considerations impacting on families’ psychosocial needs, including dysfunctional families, ineffective coping mechanisms, suicide, and the patient’s death, are presented
Physiology of Wound Healing and Risk Factors that Impede the Healing Process
Authors: Norris Susan O’Brien , Provo Barbara , Stotts Nancy A.
Published: January 2016

In the critically ill patient, wound repair can be impeded by processes inherent to the illness, its treatment, and the critical care environment. This vulnerability to wound complications increases patient morbidity and mortality as well as length of stay, resource consumption, and hospital cost. The physiology of wound healing and factors that impede wound repair are discussed. Those factors commonly seen in critical illness include advanced age, diabetes mellitus, compromised immunocompetence, inadequate perfusion, and oxygenation, infection, malnutrition, obesity, and preoperative illness. Knowledge of management of the physiologic factors that affect wound healing enables the nurse to maximize tissue repair and prevent wound complications
Human Wound Assessment: Status Report and Implications for Clinicians
Authors: Cooper Diane M.
Published: January 2016

Wound care has long been carried out by professional nurses. Yet, as a result of their increasing qualifications and changes in health care practices, the nurse’s role in and responsibility for wound care has expanded. Despite this, there is a paucity of valid and reliable methods by which nurses and physicians alike can evaluate healing status. This chapter provides an overview of the instruments designed to evaluate healing in humans, focusing particular attention on those intended to measure healing noninvasively. Implications for clinical practice and suggestions for research also are offered. Additionally, this article is written to raise clinicians’ awareness to the need for concentrated efforts in devising clinically usable, valid, and reliable instruments to evaluate human tissue repair
Nutrition: A Critical Component of Wound Healing
Authors: Stotts Nancy A. , Washington Donna F.
Published: January 2016

Nutrients are essential to wound healing and patients in critical care are often at risk for lack of sufficient nutrients that may result in impaired healing. Understanding the role of the various nutrients in healing provides the basis for assessment and therapy. Use of a practical and consistent nutritional assessment technique is an important part of care for critically ill patients with wounds. The health care team must provide care based on current knowledge of the effects of nutrition on wound healing and work collaboratively in doing nutritional assessment and providing nutritional support to optimize wound healing outcomes
The Quality Assurance Process in Critical Care Education
Authors: Marcus-Tabachnick Dale , Claflin Nancy
Published: January 2016

The American Association of Critical-Care Nurses (AACN) has developed education standards for critical care nursing. These structure and process standards can be used as pan of the Joint Commission on Accreditation of Healthcare Organizations’ (JCAHO) ten-step process for monitoring and evaluating critical care education programs. This chapter discusses the application of the monitoring and evaluation process, based on education standards, for critical care education programs
Quality Monitor Implementation for Standards of Care of the Mechanically Ventilated Patient
Authors: Ashton Joanne , Black Linda
Published: January 2016

Each critical care unit has a responsibility to develop a quality assurance process to evaluate nursing practice. Staff members at Shawnee Mission Medical Center (SMMC) developed a protocol, based on the Marker Model,1 to establish standards of care related to care of the patient requiring mechanical ventilation. The quality assurance process used to monitor implementation of the standards is described
Pacing for Tachydysrhythmias
Authors: Roman-Smith Priscilla
Published: January 2016

Advances in cardiac electrophysiology have clarified some of the mechanisms of tachydysrhythmias and have characterized tachycardias that are amenable to pace termination. Tachydysrhythmias most likely to be terminated by pacing techniques tend to be slow, re-entrant tachycardias. Although single extrastimulation can be effective, its yield is relatively low. Delivery of multiple extrastimuli or burst pacing are more effective than single extrastimulation at the expense of a higher risk of tachycardia acceleration or transformation of the rhythm to fibrillation. The use of pacing for the termination of tachydysrhythmias has primarily been limited to the acute care setting, although permanently implantable antitachycardia pacemakers are being used in increasing numbers. While these devices have been approved by the Food and Drug Administration (FDA) for the treatment of supraventricular tachydysrhythmias, their use to treat ventricular tachydysrhythmias has produced mixed results and remains investigational. In some cases of sustained ventricular tachycardia, automatic cardioverter/defibrillators have been implanted along with antitachycardia pacemakers to provide high-energy shock back-up in case of tachycardia acceleration by the pacemaker. Soon, devices will be available which will combine, in a single unit, antitachycardia pacing and high-energy cardioversion/defibrillation
Rate-Responsive Cardiac Pacemakers
Authors: Morton Patricia Gonce
Published: January 2016

Pacemaker technology continues to advance in the direction of restoring a normal hemodynamic response under varying physiologic conditions. Rate-responsive pacemakers meet this challenge by adjusting the pacing rate in response to a sensed physiologic variable other than sinus node activity. In an effort to design the ideal rate-responsive system, various physiologic cues have been tested. To translate shifts in the sensed physiologic indicator into an appropriate pacing rate, specialized sensor systems also have been developed and include mechanical, chemical, thermal, and electrical sensors. Although each sensor system offers advantages and disadvantages, continued research and clinical experience will determine the future of this exciting new form of cardiac pacing
Family Theoretical Perspectives and Implications for Nursing Practice
Authors: McShane Ruth E.
Published: January 2016

Health care professionals have focused for the most part on individuals within families as they provide care in acute care settings. The lack of a theoretical perspective to permit observing the family as a unit with interacting parts has contributed to this practice. This article presents an overview of trends and of four theoretical frameworks that have contributed to family practice and research, both for other disciplines and for nursing. Symbolic interactionism, systems, developmental, and social exchange theories are promising frameworks for considering family relationships now and into the future. The purpose, major concepts, and implications for nursing practice of each theory are presented
Overview of Family Needs after Critical Illness: From Assessment to Intervention
Authors: Leske Jane Stover
Published: January 2016

Results of numerous independent studies suggest that families of a critically ill hospitalized member have similar needs that they can readily identify as very important. Empirical analysis of results compiled from many studies across patient populations, settings, geographic locations, and over time indicates that families have primary needs for assurance, proximity, and information. These primary family needs provide a research-based framework to guide critical care nurses in implementing and evaluating family-centered nursing interventions
Decisions Made by Family Members of Patients with Severe Head Injury
Authors: Mirr Michaelene P.
Published: January 2016

An acute injury in which a family member requires critical care creates a period of intense stress for families. During such time, family members are often faced with decisions about the patient or the family. The ability of families to make decisions during this stressful period is not addressed in the literature. The purpose of this study was to determine what decisions families made in the one-month period after a patient’s admission. Families of patients with severe head injury were chosen because these families are often forced to make decisions quickly and to act as proxy decision-makers for the injured person. Nurses can make important contributions to assist family members in making decisions about the patient or the family. Nurses need to understand what decisions family members need to make and the circumstances surrounding the decision-making process to intervene appropriately
Families: A Link or a Liability?
Authors: Kupferschmid Barbara J. , Briones Tess L. , Dawson Carrie , Drongowski Cheryl
Published: January 2016

Hospitalization in a critical care setting has multiple effects on patients and their families. For patients, it can be a frightening and dehumanizing experience, while families are confronted with stressors that can disrupt normal family functioning. The nurse is the pivotal figure in the health care system who can positively affect family coping through the support offered. With family needs met, they are then strengthened and able to support their family member. This article examines the roles and relationships of families, social support systems, and nurses. Through the framework of social support, nurses provide emotional, instrumental, spiritual, and appraisal assistances to families. This can potentially positively affect the family’s adaptation to a stressful situation, and thus the family’s ability to provide support to the patient. A case study analysis is described to illustrate the interactions and interventions through a model of family support
Parent Stress Associated with Pediatric Critical Care Nursing: Linking Research and Practice
Authors: Jay Susan Schaeffer , Youngblut Joanne M.
Published: January 2016

This paper connects research findings to nursing practices that may be helpful when working with stressed parents of critically ill children. Theories and concepts foundational to understanding parental stress related to pediatric critical care are reviewed. Research findings particularly associated with parent role stress are introduced, and suggestions for using these findings to design nursing interventions are presented
Respiratory Pharmacology and the Weaning Patient: Implications for Critical Care Nursing
Authors: Ryan Beverly , Luer Jill M.
Published: January 2016

The process of weaning patients from mechanical ventilation may be facilitated by the appropriate selection and use of bronchodilators, mucolytics, steroids, and sedatives. This article discusses implications for the critical care nurse, focusing on the indications, applications, and evaluations of the drugs most commonly administered to patients prior to or during weaning from mechanical ventilation
Chronic Hypoventilation Syndrome: Treatment with Non-invasive Mechanical Ventilation
Authors: Dettenmeier Patricia A. , Jackson Nancy C.
Published: January 2016

Chronic hypoventilation syndrome can be caused by many disease states, although it is more commonly seen in neuromuscular disorders. Assessment of hypoventilation includes measurement of carbon dioxide level, respiratory muscle strength, pulmonary function testing, and any other system involved, such as cardiac dysfunction or sleep abnormalities. Often, chronic hypoventilation is initially diagnosed during an episode of acute respiratory failure. The use of noninvasive ventilation with positive pressure, negative pressure, or gravitational devices can be an effective treatment option for some patients, thus obviating the need for a tracheostomy. Noninvasive ventilatory equipment such as the nasal or oral masks, mouthpieces, bi-level positive airway pressure, chest cuirasses, ponchos, or the iron lung, and the rocking bed or pneumobelt can each ventilate a certain type of patient adequately. Each has specific indications, advantages, and disadvantages and must be individualized to the patient’s needs
Current Perspectives on the Use of Circulatory Assist Devices
Authors: Smith Richard G. , Cleavinger Marilyn
Published: January 2016

An overview of currently available circulatory assist devices (CADs) is presented with discussion of each system’s optimal use and limitations. Successful application of CAD technology for bridge to transplant or pending recovery of the natural heart requires understanding issues involving team readiness, patient selection, device limitations, patient management, and complications. Currently, many of these devices are in clinical trials with the Food and Drug Administration (FDA). The FDA and the National Institutes of Health play major roles in the ongoing development of this technology. In the near future the learning curve continues as totally implantable systems are used. The ultimate goal is to maintain patients with heart failure on implantable devices with a good quality of life at a reasonable cost
The Thoratec Ventricular Assist Device: Nursing Guidelines
Authors: Ley S. Jill
Published: January 2016

The Thoratec ventricular assist device (VAD) offers a final hope for survival in patients with severe cardiogenic shock unresponsive to conventional therapy. In select patients, these pneumatically activated prosthetic ventricles maintain organ perfusion pending recovery of the native heart or cardiac transplant. A detailed review of Thoratec VAD operation, its impact on the circulatory pathway and hemodynamic monitoring, and troubleshooting guidelines specific to these patients are presented. A nursing diagnosis framework assists with the identification and management of problems such as impaired cardiac output and gas exchange, as well as altered mobility, nutrition, and coping. Current information regarding the etiology and management of complications such as bleeding, infection, and end-organ failure are reviewed. A case study presentation offers guidelines for weaning patients from the VAD and includes a comprehensive nursing care plan for these challenging patients
Cardiac Assist Devices as a Bridge to Cardiac Transplant
Authors: Henker Richard
Published: January 2016

The number of heart transplants being performed in the United States over the last decade has increased significantly. The supply of human donor hearts has not kept up with the demand. This situation has led to the development of means to support patient’s cardiac function until a human donor heart can be obtained. Methods to support the patient include use of ventricular assist devices and the total artificial heart. Integration of caring and technology in patients receiving cardiac assist devices (CADs) provides a challenge for critical care nurses. Nursing care of the patient with a CAD involves identification and prevention of complications, familiarization with new technology, and development of a caring environment
Cognitive Systems: Nursing Assessment and Management in the Critical Care Environment
Authors: Boss Barbara J.
Published: January 2016

In-depth knowledge of cognitive systems allows the critical care nurse to incorporate that information into an expanded assessment. This in-depth nursing assessment enables the nurse to identify intact and deficient cognitive systems and quantify the deficits. Astute assessment is fundamental to planning appropriate interventions and permits more specific deficit-related interventions by the critical care nurse
Pediatric Central Neurologic Trauma: Issues for Special Patients
Authors: Altimier Leslie B.
Published: January 2016

Head trauma in the pediatric population older than 1 year occurs in approximately 100,00 children per year, resulting in 250,000 to 500,000 hospitalizations annually. Head trauma accounts for 80% of all trauma deaths. The pathophysiology and management of severe pediatric head trauma is discussed. Traumatic injury to the central nervous system, its sequelae, and approaches to maximize cerebral resuscitation and stabilization are reviewed
Spinal Cord Injury: Preventing Secondary Injury
Authors: Coen S. Diane
Published: January 2016

Spinal cord injury is devastating to the victim, as well as being costly in terms of medical expenses, lost wages, and lost independence. The initial damage to the spinal cord results from several mechanisms of injury—flexion, extension, compression, penetration, rotation, and the disease process. When the spinal cord is injured and there is necrosis of the nervous tissue, no regeneration of that tissue occurs. Unlike in the peripheral nervous system, where regeneration is possible, the spinal cord is part of the central nervous system, as is the brain. The spinal cord extends from the base of the skull to the L1 vertebrae: the cervical levels innervate the diaphragm and muscles of the arms; the thoracic levels innervate the muscles of the chest and abdomen; and the lumbar and sacral levels innervate the muscles of the legs. In addition, the sacral levels are responsible for bowel, bladder, and sexual function. The higher the level of injury, the more severe the loss of function because, not only is the level of injury affected, but also the levels below. Injury occurs by initial trauma to the surrounding ligaments, bones, and muscles, which then affect the spinal cord. There may be total loss of function with damage completely across the cord or partial loss of function with damage affecting only part of the cord. No current treatment can reverse this initial injury, which causes irreversible damage within minutes of injury. Secondary damage occurs as the injury spreads over several hours. Treatment can help prevent this secondary damage
The Challenge of Teaching the Elderly Cardiac Patient
Authors: Fournet Kathleen
Published: January 2016

Half of Americans aged 65 and older suffer from some form of cardiovascular problem. This fact necessitates attention to an adequate program of patient education during the hospital course, in order for the patient or the significant other to assume responsibility for home care after discharge. Consideration should be given to providing a complete and effective means of assessing the patient so that a teaching plan to meet specific needs can be formulated. Objectives must be set, with the patient included in this part of the process. Once teaching has been completed, there should be evaluation to determine whether the education goals were met. Only when the geriatric patient is regarded as a unique individual can the nurse-instructor hope to be successful with teaching endeavors
Thrombolytic Therapy for Acute Myocardial Infarction: The Elderly Population
Authors: House Mary Ann
Published: January 2016

Coronary artery disease is the most common cause of death in persons older than 65 years. More than half of all patients hospitalized for acute myocardial infarction (AMI) are now older than 65, with this percentage expected to increase significantly in subsequent years. The current evidence regarding the treatment of AMI indicates that early thrombolytic therapy can limit the extent of myocardial necrosis, preserve left ventricular function, decrease the incidence of congestive heart failure, and reduce mortality in patients with AMI. Most studies have adhered to empiric recommendations to exclude elderly patients, based on the assumption that in the elderly the risks of serious hemorrhagic complications after thrombolytic therapy outweigh the potential benefits of early reperfusion. This article reviews the current literature regarding use of thrombolytic agents in treating AMI in the elderly population with some guidelines for protocol formation
Pharmacology and Drug Therapy in Critically Ill Elderly Patients
Authors: Walker Mary K.
Published: January 2016

Aging is a complex, normal, and inevitable process affecting all living things. The physiologic changes of aging, by definition, are postmaturational, occurring after adult maturity is achieved. Changes with aging are primary, irreversible, and progressive. While the processes of aging are neither pathology nor disease, they present important changes in structure and function that alter drug disposition, metabolic rate, and excretion. These changes present special challenges to clinicians in critical care settings for whom pharmacotherapy is a common treatment modality. This article explores the physiologic changes associated with aging and the implications of these changes for management of critically compromised elders. Drug metabolism, distribution, utilization, and excretion in older adults are examined
Wide QRS Complex Tachycardia
Authors: Brzozowski Loraine A.
Published: January 2016

Electrocardiographic monitoring for dysrhythmias is a major responsibility of critical care nurses, and patients with wide QRS complex tachycardias present a challenge. Criteria for differentiating the impulse origin as ventricular or supraventricular are well documented: QRS duration, QRS morphology, QRS axis, and presence of atrioventricular dissociation. However, definitive diagnosis can only be made by invasive electrophysiologic studies. Knowledge of treatment protocols is important to prevent hemodynamic deterioration. Procainamide is effective for treating ventricular and supraventricular dysrhythmias and is the drug of choice unless certainty of impulse origin exists
Disorders of Antidiuretic Hormone Secretion
Authors: Batcheller Joyce
Published: January 2016

Depending upon the age and sex of a human, water constitutes 55% to 80% of the body’s weight and provides a milieu vital for survival. Water imbalance is common among the critically ill. Excessive increases or decreases in body water can be lethal. There are numerous pathologic and iatrogenic causes for water imbalance, the most troublesome being disorders of antidiuretic hormone (ADH) secretion. Antidiuretic hormone plays a pivotal role in conserving water by increasing reabsorption of water by the kidney. Without the influence of ADH (as is seen in diabetes insipidus), a person would be required to ingest between 5 and 15 L of water daily to match urinary losses. Conversely, excessive ADH secretion would reduce urine output in adults to as little as 500 mL per day, dangerously diluting blood volume and expanding intracellular volume. This is what causes the symptoms of the syndrome of inappropriate ADH (SIADH). The care of patients who are critically ill and have disorders of ADH secretion can be challenging. The challenge lies in the recognition and treatment of the disorder. A collaborative team approach helps patients achieve and maintain the delicate balance of body fluids
Sympathomimetics, Inotropics, and Vasodilators
Authors: Clements Joanne V.
Published: January 2016

Management of the critically ill patient often necessitates the use of multiple inotropic and vasoactive medications. This article offers a concise, clinical reference to guide the practicing clinician in the use of these agents. The focus is on parenteral agents used for acute rather than chronic management. Physiologic concepts basic to understanding the use of these agents are reviewed briefly. Sympathomimetic agents are discussed with inotropes since many of them have cardiotonic properties. Vasodilator therapy is addressed only as it is used in combination therapy. Nursing implications and treatment regimes are included
Thrombolytics
Authors: Ostrow C. Lynne
Published: January 2016

Thrombolytic therapy is the most recent advance in the treatment of acute myocardial infarction. Several research trials have been conducted worldwide in the last decade that have established that thrombolytic therapy has reduced mortality 50%, reduces the size of the infarction, improves left ventricular function, and reduces the incidence and severity of congestive heart failure. The three most commonly used thrombolytic agents at this time arc streptokinase, tissue plasminogen activator, and anisoylated plasminogen-streptokinase activator complex. All three agents can be administered through a peripheral intravenous. Recent research results have reported similar efficacy on 5-week mortality of all three agents. Careful assessment of prospective patients is essential since bleeding complications arc the most serious side effect of this therapy. Nursing care of a patient undergoing thrombolytic therapy includes careful assessment of the patient for contraindications in the patient’s medical history, assessment of potential allergic and bleeding complications, and evaluation of the reperfusion markers. Patients are subsequently treated with anticoagulants, aspirin, or dipyridamole. It appears that thrombolytic therapy will become increasingly available to all patients with a diagnosis of suspected acute myocardial infarction. At present, treatment with thrombolytic agents is less available in the United States compared to Europe
Angiotensin-Converting Enzyme Inhibitors
Authors: Kuhn Merrily
Published: January 2016

The angiotensin-converting enzyme (ACE) inhibitors available today include Captopril (Capoten), enalapril (Vasotec), enaloprilat (Vasotec IV), lisinopril (Prinivil, Zestril), benazepril (Lotensin), fosinopril (Monopril), and ramipril (Atace). These drugs are used in the treatment of hypertension and congestive heart failure. They also are used in treating renovascular hypertension not amenable to surgery and are being studied to decrease left ventricular size after infarction and to determine whether they slow the rate of internal hyperplasia. Angiotensin-converting enzyme inhibitors have negative inotropic and chronotropic effects. This chapter discusses the ACE inhibitors and their actions, uses, adverse effects, contraindications, and nursing implications
Antidysrhythmic Agents
Authors: Stier Frances
Published: January 2016

Antidysrhythmic therapy is used to suppress supraventricular and ventricular dysrhythmias, thus relieving symptoms and reducing the risk of sudden cardiac death. The Cardiac Arrhythmia Suppression Trial (CAST) found an increased mortality rate in a group of patients treated with two antidysrhythmic agents. This result has had a profound impact on the prescribing and monitoring of antidysrhythmic therapy. Prodysrhythmia is a frequent and serious complication of antidysrhythmics and is unpredictable. Assessment of benefit versus risk of drug therapy for each patient is recommended. The nurse’s knowledge of antidysrhythmic pharmacology, including symptoms that indicate adverse reactions, and prodysrhythmia influences the patient outcome
Kidney Transplantation: A Therapy Option
Authors: Beckman Nancy J. , Schell Hildegarde M. , Calixto Pedro-Reuben , Sullivan Margaret M.
Published: January 2016

The growing number of patients with end stage renal disease (ESRD) choosing kidney transplantation as a therapy option has increased critical care nurses’ exposure to this patient population. Critical care nurses have a crucial involvement when caring for the patient in the postoperative period or when serious complications develop. A knowledge base of immunosuppressive therapy and the body’s response to it is helpful in assessing and identifying rejection, infection, and technical complications
Fluid and Electrolyte Disturbances in Hepatic Failure
Authors: Kelso Lynn A.
Published: January 2016

Nurses are seeing more hepatic failure patients in intensive care units. Fluid and electrolyte disturbances, which occur in these patients, can be life-threatening and must be recognized quickly and treated
Acute Tubular Necrosis: Diagnosis, Treatment, and Nursing Implications
Authors: Douglas Sara
Published: January 2016

Acute tubular necrosis (ATN) is the most common cause of acute renal failure. Early recognition of patients who are at risk for ATN can prevent or improve the course of ATN. Acute renal failure is classified as prerenal, intrinsic, or postrenal disease. ATN is classified as a type of intrinsic renal disease. The clinical course of ATN is divided into the renal failure phase, diuretic phase, and recovery phase, with each phase having distinct symptoms and laboratory findings. Diagnosis of ATN often is complicated and confusing; understanding of laboratory findings can facilitate the critical care nurse’s ability to assess those at risk for ATN. The care and treatment of the patient with ATN is complicated, and specific treatments are discussed in detail. The critical care nurse can play a vital role in identifying the patient at risk, preventing the development of ATN in those at risk, and providing appropriate care for those who develop ATN
Case Management with the Nurse Manager in the Role of Case Manager in an Interventional Cardiology Unit
Authors: McElroy Mary Jo , Campbell Susan
Published: January 2016

Varying external and internal factors are motivating changes in how physicians and nurses deliver patient care within health-care institutions. A care delivery system that has received increasing attention in the literature is case management. This chapter describes how a community hospital implemented case management for patients undergoing percutaneous coronary angioplasty and cardiac catheterization while developing the new role of clinical manager to serve in the role of case manager. The process for planning and implementing such a role change is discussed, and initial evaluative data are presented
ST Segment Monitoring for Myocardial Ischemia
Authors: Tisdale Lisa A. , Drew Barbara J.
Published: January 2016

Many patients in the critical care unit (CCU) are at risk for myocardial ischemia and acute coronary artery reocclusion. The use of continuous ST segment monitoring detects transient and sustained ischemia, despite the absence of symptoms, more completely than rate and rhythm monitoring alone. The accuracy and sensitivity of the ST segment for detection of ischemia is dependent on the number and location of the electrocardiographic leads used in conjunction with the site of obstruction. Thus, when using ST segment monitoring for detection of ischemia, one of the most important decisions for the nurse to make is lead selection. In addition, both ischemic and nonischemic ST segment changes must be considered
Arterial Blood Pressure Measurement Technique
Authors: Gorny Deborah A.
Published: January 2016

Arterial blood pressure (BP) measurements, which include invasive direct methods and noninvasive indirect methods, provide a picture of the hemodynamic status of the patient. Invasive BP methods measure pressure pulse wave amplitude; noninvasive methods rely on blood flow or arterial wall motion as a basis for the determination of BP values. To obtain the most accurate BP value, the clinician must identify which measurement variables in a specific clinical situation are most contributory to error and, if possible, use a method of measurement for which the sources of error are not parallel. Blood pressure values obtained by different methods cannot be compared without a thorough understanding of the user-related and instrumentation-related limitations associated with each BP measurement technique
Cardiac Output Determination
Authors: Woods Susan L. , Osguthorpe Susan
Published: January 2016

Critical care nurses frequently are involved in obtaining cardiac output measurements and in using these data to assess and to plan therapy. This article reviews the physiologic determinants of cardiac output and the clinical factors that influence these determinants. Principles and techniques of common methods of cardiac output measurement are discussed. A thorough presentation of guidelines for troubleshooting problems with thermodilution cardiac output measurement is provided in a table. Nursing management issues are discussed using relevant nursing research. Future considerations in cardiac output measurement are discussed, and suggestions of an ideal cardiac output system are provided
Intracranial Pressure Monitoring
Authors: Richmond Therese S.
Published: January 2016

Intracranial pressure monitoring (ICP) is a technology that assists critical care nurses in the assessment, planning, intervention, and evaluation of care. The physiologic basis of intracranial hypertension (ICH) and ICP monitoring are reviewed. Types of monitors arc described. Advantages, disadvantages, and complications of fluid-filled versus fiberoptic systems are explored. Priorities in nursing care of the patient with an ICP monitor are examined
Surgical Myocardial Revascularization in the 1990s
Authors: Rosborough Donna
Published: January 2016

Substantial changes in the practice of cardiology ultimately produce a change in the types of patients who become candidates for surgery. This has been especially true for patients with coronary artery disease. The primary goals of coronary artery bypass graft (CABG) surgery are to relieve symptoms, prolong survival, and improve the quality of life. Because of recent improvements in pharmacologic therapy and medical interventions, the criteria used to select patients for CABG surgery has changed secondary to the clinical characteristics of the patient population
Surgical Alternatives for Patients with Heart Failure
Authors: Vargo Rita , Dimengo Josephine M.
Published: January 2016

Chronic heart failure is a progressive syndrome characterized by diffuse coronary artery disease (CAD) or left ventricular failure not amenable to acute interventions of myocardial revascularization. A spectrum of treatment options is available to such patients. Medical therapies consist largely of pharmacologic alternatives and are used in the early stages of heart failure to slow the processes of ventricular remodeling. Surgical interventions are used as adjunctive therapies in the later stages of heart failure. These procedures include coronary endarterectomy, high-risk surgical revascularization, automatic internal cardioverter-defibrillator insertion (Coronary Artery Bypass Grafting in Conjunction with Implantable Cardioverter Defibrillator Trial), cardiac transplantation, and dynamic cardiomyoplasty. This article provides an overview of each of these surgical therapies. Indications for each procedure and patient selection criteria are outlined. A description of each surgical procedure is included. Guidelines for postoperative nursing care are provided, and postoperative complications are discussed
Management of Acute Burns and Burn Shock Resuscitation
Authors: Faldmo Lynda , Kravitz Melva
Published: January 2016

Initial management of minor and moderate, uncomplicated burn injury focuses on wound management and patient comfort. Initial management of patients with major burn injury requires airway support, fluid resuscitation for burn shock, treatment for associated trauma and preexisting medical conditions, management of adynamic ileus, and initial wound treatment. Fluid resuscitation, based on assessment of the extent and depth of burn injury, requires administration of intravenous fluids using resuscitation formula guidelines for the initial 24 hours after injury. Inhalation injury complicates flame burns and increases morbidity and mortality. Electrical injury places patients at risk for cardiac arrest, metabolic acidosis, and myoglobinuria. Circumferential full-thickness burns to extremities compromise circulation and require escharotomy or fasciotomy. Circumferential torso burns compromise air exchange and cardiac return. Loss of skin function places patients at risk for hypothermia, fluid and electrolyte imbalances, and systemic sepsis. The first 24 hours after burn injury require aggressive medical management to assure survival and minimize complications.
Sternal Wound Infections
Authors: Vaska Patricia L.
Published: January 2016

Sternal wound infections are a major cause of morbidity and mortality in patients undergoing cardiac surgery. They occur in 1% to 3% of patients who undergo open-heart surgery and carry a 20% to 40% mortality rate. Sternal infections can range from minor, superficial infections to open mediastinitis with invasion of the sternum, heart, and great vessels. Staphylococcus species arc responsible for the majority of sternal infections, but environmental sources can cause infections by other organisms. The common signs and symptoms of mediastinitis are fever, leukocytosis, sternal instability, drainage, and pain. Several risk factors exist for sternal wound infection, with bilateral internal mammary artery bypass grafting in diabetic patients being the most common. Treatment entails surgical debridement with cither closed irrigation, open-wound packing, or muscle or omental flap procedures, as well as antibiotic therapy. Some simple procedures help limit the development of sternal infections in certain patients
Results of the Consensus Conference on Fostering More Humane Critical. Care: Creating a Healing Environment
Authors: Harvey Maurene A. , Ninos Nicholas P. , Adler Diane C. , Goodnough-Hanneman Sandra K. , Kaye William E. , Nikas Diana L.
Published: January 2016

The Society of Critical Care Medicine (SCCM) sponsored the Consensus Conference on Fostering More Human Care Creating a Healing Environment in October 1990 at Snowbird, Utah. The purpose of this conference was to address the challenges of providing sensitive, humane critical care in an increasingly technological and cost-conscious environment. The long-term objective was to develop this document (initially published by SCCM in 1992) as a resource for critical care professionals who are seeking methods by which to foster more humane care of their acutely ill patients.
Do Critical Care Nurses Face Burnout, PTSD, or is it Something Else?: Getting Help for the Helpers
Authors: Acker Kathleen Houston
Published: January 2016

The critical-care environment can be a stressful place to work. As a result of stress generation, critical-care nurses must use coping mechanisms not normally needed. The Adaptation Process Phenomenon describes a sequence of behavioral patterns and responses during stressful situations, perceived or not, that can result in negative behavioral responses to stress. For critical-care nurses, negative responses can impair the ability to care for patients and families. Adapation to stress must be identified and examined as a potential illness for critical-care nurses. Is the problem burnout, post traumatic stress disorder, or something else
Phrenic Nerve Pacing—An Alternative to Positive Pressure Ventilation: The Required Nursing Care
Authors: Kovach Gayle M. , Henry Susan
Published: January 2016

Phrenic nerve pacing as a method of ventilation was first recognized in 1783. For years, this technique was not used because of the lack of practical technology. Interest in phrenic nerve pacing was renewed in the 1960s with the development of a radio frequency transmission system. Applicable to a limited patient population, phrenic nerve pacing has several benefits over positive-pressure ventilation. Benefits include greater patient mobility, verbal articulation, less mechanical noise, and breathing by natural negative-pressure. This article provides information for nurses who care for patients ventilated by phrenic nerve pacing
Using Clinical Innovations for Research-Based Practice
Authors: Leske Jane S. , Whiteman Kim , Freichels Thomas A. , Pearcy Jerilyn M.
Published: January 2016

Making choices about patient-care interventions pervades critical care nursing practice. Research utilization activities provide the reasoning by which assessment parameters are established, preventative actions are identified, and interventions are evaluated in the clinical setting for positive effects on patient outcomes. For research results to be directly applicable, they must be transformed into clinical innovations specific to a patient population, clinical situation, or institutional setting. A brief summary of using research findings to design clinical innovations is provided. Examples of selected clinical innovations are included to illustrate the steps of the research utilization process. Clinical innovations are intended to improve or validate patient outcomes and are considered the key to quality patient care
Overcoming the Obstacles to Research-Based Clinical Practice
Authors: Lekander Becky Jo , Tracy Mary Fran , Lindquist Ruth
Published: January 2016

The utilization of research findings in the practice of critical care nursing is essential to obtain optimal patient outcomes. However, the speed and extent to which new research-based findings are applied to clinical practice falls short of expectations. The authors identify obstacles to the timely utilization of research. Strategies to overcome the obstacles to research-based clinical practice are presented
Research Utilization in Critical Care: An Exemplar
Authors: Titler Marita G. , Moss Linda , Greiner Jane , Alpen Michele , Jones Gerry , Olson Karen , Hauer Marilyn , Phillips Corby , Megivern Karen
Published: January 2016

The authors describe the process and outcome of implementing a research-based pain management protocol in four adult critical care units at a large, Midwestern tertiary care center. The project was initiated and directed by members of the divisional research committee. Strategies used to change practice included determining if pain management was a problem via quality assessment monitors, surveying nurses regarding their knowledge and attitude toward pain management, educating staff members about the research base for the practice change, using change champions in each unit, and developing a core group of nurses in each unit to facilitate the change. Outcomes of this research utilization project include a 41% decline in the number of patients in pain, a 44% decline in pain intensity, and improvement in nurses knowledge about pain
Sleep Promotion in the Critical Care Unit
Authors: Richards Kathy Culpepper
Published: January 2016

Promoting the quiet and relaxation necessary for sleep in a busy, noisy critical care environment is a problem critical care nurses face daily. Descriptive studies have defined and increased understanding of this problem, but few interventional studies have been accomplished. Interventions that have demonstrated significant improvements in sleep quality in the critical care environment are an audiotape of the sounds of the ocean or rain, a masking signal, and a back massage
Incidence, Pathogenesis, and Management of Sepsis
Authors: Kleinpell Ruth M. , Graves Brian T. , Ackerman Michael H.
Published: January 2016

Sepsis is a complex condition that occurs as a result of the systemic manifestation of infection. It is associated with high morbidity and mortality risks for critically ill patients. Assessment and monitoring aimed at early recognition and treatment, on the basis of evidence-based guidelines, are advocated for optimizing outcomes for patients with severe sepsis. Awareness of the risk factors, clinical signs and symptoms, pathophysiology, and updates in the management of sepsis can enhance the nursing care for patients with severe sepsis to promote best practices for sepsis care in the intensive care unit. This article reviews the incidence and pathophysiology of sepsis, highlighting updates in treatment and implications for nursing care.